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Open Access
CC BY 4.0 · Facial Plast Surg
DOI: 10.1055/a-2656-6413
Original Research

Can a Rule-Based Expert System Diagnose Nasal Obstruction from Nasoendoscopy Videos?

Authors

  • Annakan Navaratnam   ‡

    1   Department of ENT, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom

  • Nonpawith Phoommanee    ‡

    2   Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom

  • Vikas Acharya

    1   Department of ENT, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom

  • Alfonso Luca Pendolino 

    1   Department of ENT, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
    3   UCL Ear Institute, University College London, London, United Kingdom
    4   Department of ENT, Imperial College Healthcare NHS Trust, London, United Kingdom

  • Terence S. Leung

    2   Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom

  • Peter J. Andrews

    1   Department of ENT, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
    3   UCL Ear Institute, University College London, London, United Kingdom
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Abstract

Introduction

Nasal obstruction has multiple causes requiring specialist endoscopy for diagnosis. A rule-based expert system (RB-ES), which applies five “if–then” rules based on nasal features, may help replicate ENT decision-making in settings with limited access.

Objectives & Hypotheses

This study evaluated RB-ES in diagnosing allergic rhinitis, chronic rhinosinusitis with (CRSwNP) and without (CRSsNP) nasal polyps, and deviated nasal septum. Primary outcomes were sensitivity and specificity; the secondary outcome was agreement with ENT specialists.

Study Design

Prospective cohort study.

Methods

Seventy-one participants (65 patients, 6 controls) underwent pre- and postdecongestion endoscopy. Four ENT specialists provided diagnoses. RB-ES performance was compared against confirmed clinical diagnoses.

Results

RB-ES showed no detectable significant sensitivity differences from ENT specialists (all p > 0.05). Sensitivity was highest for CRSwNP; specificity remained high overall.

Conclusion

RB-ES matched specialist performance in CRSwNP diagnosis. Dataset expansion and artificial intelligence integration are recommended for further validation.

Level of Evidence

II.

Keywords

nasal obstruction - nasal endoscopy - rule-based expert systems

Declaration of GenAI Use

A generative AI tool (ChatGPT, OpenAI) was used exclusively for grammar and language refinement in this manuscript. No content generation, data analysis, or substantive intellectual contributions were made by the AI. The authors take full responsibility for the accuracy and integrity of the final text.


‡ Both are joint first authors and contributed equally to this article.




Publikationsverlauf

Accepted Manuscript online:
16. Juli 2025

Artikel online veröffentlicht:
28. Juli 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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