Nasal endoscopy assessment
Patient’s nose was decongested with co-phenylcaine forte spray 2 sprays each nostril for 15 minutes prior to nasal endoscopic assessment. The endoscopy was done using Hopkins II straight telescope 0 degree with a diameter of 4mm and a length of 18 cm. The nasal endoscopy was advanced till the nasopharynx to visualize the features of PND including secretions at posterior nasal cavity, redness at the roof of nasopharynx and presence of hemorrhagic spots at nasopharynx. The larynx was viewed using a 70-degree scope with a diameter of 4mm and a length of 18 cm. The granular posterior pharyngeal wall was assessed, and features of reflux were scored based on the RFS tool (9). All nasal endoscopies were recorded, and the videos were anonymized. Two experienced rhinologists reviewed and graded the images guided by the reference images (Figure 1-4). The assessors were blinded to the PND status of the patient and their presenting symptoms. These two independent assessors reviewed a group of patients for interobserver reliability. For intra-observer reliability, the main assessor also rescored the same group 8 weeks later.