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Villarreal R, Wrobel BB, Macias-Valle LF, Davis GE, Prihoda TJ, Luong AU, McMains KC, Weitzel EK, Yao WC, Brunworth J, Clark DW, Nair S, Valdés CJ, Halderman A, Jang DW, Sivasubramaniam R, Zhang Z, Chen PG. International assessment of inter- and intrarater reliability of the International Frontal Sinus Anatomy Classification system. Int Forum Allergy Rhinol 2018; 9:39-45. [PMID: 30216705 DOI: 10.1002/alr.22200] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/05/2018] [Accepted: 07/31/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated "reference standard" classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS). METHODS Forty-two computed tomography (CT) scans, each with a marked frontal cell, were reviewed by 15 international fellowship-trained rhinologists. Each marked cell was classified into 1 of 7 categories described in the IFAC, on 2 occasions separated by 2 weeks. Inter- and intrarater reliability were evaluated using Light's kappa (κ), the interclass correlation coefficient (ICC), and simple proportion of agreement. RESULTS Interrater reliability showed pairwise κ values ranging from 0.7248 to 1.0, with a mean of 0.9162 (SD, 0.0537). The ICC was 0.98. Intrarater reliability showed κ values ranging from 0.8613 to 1.0, with a mean of 0.9407 (SD, 0.0376). The within-rater ICC was 0.98. CONCLUSION Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC.
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Affiliation(s)
- Ricardo Villarreal
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Bozena B Wrobel
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Luis F Macias-Valle
- Department of Otolaryngology Head and Neck Surgery, Hospital Español de México, Mexico City, México
| | - Greg E Davis
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Thomas J Prihoda
- Department of Pathology, University of Texas Health San Antonio, Graduate School of Biomedical Sciences, San Antonio, TX
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | | | - Erik K Weitzel
- United States Army Institute of Surgical Research Fort Sam Houston, TX
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Joe Brunworth
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, MO
| | - David W Clark
- Department of Otolaryngology, Texas A&M University College of Medicine/Baylor Scott & White Health, Temple TX
| | - Salil Nair
- Department of Otolaryngology, Auckland Hospitals and University of Auckland, Auckland, New Zealand
| | - Constanza J Valdés
- Department of Otolaryngology- Head and Neck Surgery, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Ashleigh Halderman
- Department of Otolaryngology Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - David W Jang
- Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC
| | | | - Zhipeng Zhang
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX
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Abstract
The sinonasal tract plays important roles in respiration, olfaction, and defense against external pathogens. Like many organ systems, the nose and sinuses undergo several changes with advancing age that can play a role in the development of disease. This article discusses the physiology of the aging sinonasal tract and reviews the common diseases affecting older patients, such as rhinitis and rhinosinusitis.
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Affiliation(s)
- Constanza J Valdés
- Department of Otolaryngology-Head and Neck Surgery, Hospital del Salvador, Universidad de Chile, Av. Salvador 364, Providencia, Santiago 7500922, Chile; Department of Otolaryngology-Head and Neck Surgery, Clínica Las Condes, Av. Estoril 450, Las Condes, Santiago 7591047, Chile
| | - Marc A Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, 1001 Decarie Boulevard, Room D05.5718, Montreal, Québec H4A 3J1, Canada.
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