Clinical Examination and Diagnosis of Nasal Bone Fracture; Is There Really a Need for X-ray Nasal Bone?

Objective: To evaluate the role of clinical examination in diagnosing nasal bone fracture. Methodology: This Prospective Observational study was carried out in the departments of Otolaryngology-Head and Neck Surgery and Radiology at the Pakistan Institute of Medical Sciences, Islamabad, from Jan 2022 to Dec 2023. About 1000 patients of nose trauma patients coming to ENT emergency were evaluated clinically by thorough nose examination by ENT surgeon and radiologically by X-ray nasal bone both lateral and anteroposterior view. Based on examination if nasal bone fracture was suspected patient was referred to radiology department for X-ray nasal bone which was reported by radiologist if the bone is fractured or not. The clinical findings were correlated with X-ray reports to find out if there really is a need for X-ray nasal bone for diagnosing nasal bone fracture. The diagnostic accuracy of clinical examination was calculated. Results: When clinical and radiological findings were compared regarding the diagnosis of nasal bone fracture a statistically significant association was found between the two (p=<0.001) showing patients with clinical suspicion of fracture actually had fracture on X-ray. The diagnostic accuracy of clinical examination was very high with Positive Predictive Value, Negative Predictive Value, Sensitivity, Specificity, False Negative Rate and False Positive Rate being 96.1%, 93%, 88.5%, 97.7%, 11.5% and 2.3% respectively. Conclusion: We concluded that almost all patients with suspected nasal bone fracture actually had fractures on X-ray. Fractured nasal bone can correctly be diagnosed clinically by ENT surgeon and there is no real need for X-ray nasal bone just for diagnosing nasal bone fracture.