Annual trends in Google searches provides insights related to rhinosinusitis exacerbations

Abstract

Purpose Temporal trends of disease-specific internet searches may provide novel insights into seasonal dynamics of disease burden and, by extension, disease pathophysiology. The aim of this study was to define the temporal trends in rhinosinusitis-specific internet searches. Methods This was a cross sectional analysis of search volume for predefined search terms. Google trends was used to explore the volume of searches for five specific search terms related to rhinosinusitis: nose, mucus, sinus, sinusitis, chronic sinusitis, which were entered into Google web search between 2004 and 2019. Results were analyzed within search “context” which included temporally associated related searches. Relative search volume (RSV) was analyzed for English and non-English speaking countries from the Northern and Southern hemispheres. Analysis of seasonality was performed using the cosinor model. Results The five specific search terms were most related to rhinosinusitis-related search contexts, indicating that they were appropriately reflective of internet queries by patients for rhinosinusitis. The RSV for rhinosinusitis-related terms and more general search terms increased with each passing year indicating constant interest in rhinosinusitis. Cosinor time series analysis revealed inquiry peaks in winter months for all five specific rhinosinusitis-related search terms independent from the hemisphere. Conclusion Over a 15-year period, Google searches with rhinosinusitis-specific search terms consistently peaked during the winter around the world. These findings indirectly support the model of viral infection or exposure as the predominant cause of acute rhinosinusitis and acute exacerbations of chronic rhinosinusitis.

Acute exacerbations of chronic rhinosinusitis: The current state of knowledge

“…This study was performed in patients who were not experiencing AEs, however, suggesting that chronic inflammation in CRS may in itself predispose to infection with respiratory viruses 30 . The role of viral infections in AECRS pathophysiology is supported by the finding of worldwide temporal trends, which show a two‐fold increase in AECRS during the winter months; a time of increased respiratory viral infections 25,26 . Viruses implicated in the development of AECRS are respiratory syncytial virus, influenza virus, coronavirus, parainfluenza virus, rhinovirus, and enterovirus 1,2,30 .…”

“…21,25 This has been validated using the frequency of internet search trends in the Northern and Southern Hemispheres, as well as in English and non-English speaking countries. 26 Although aeroallergen hypersensitivity has been shown to be a disease modifier in CRS, 1,19 studies into temporal trends have not supported an increase in AECRS during "peak allergy seasons," or transitions between seasons. 26 In a similar vein to study of the asthma exacerbation-prone phenotype, work has been done to study CRS patients who have frequent AECRS or an exacerbation-prone phenotype.…”

“…26 Although aeroallergen hypersensitivity has been shown to be a disease modifier in CRS, 1,19 studies into temporal trends have not supported an increase in AECRS during "peak allergy seasons," or transitions between seasons. 26 In a similar vein to study of the asthma exacerbation-prone phenotype, work has been done to study CRS patients who have frequent AECRS or an exacerbation-prone phenotype. 27 We have previously proposed that AECRS-prone be defined as having at least 4 AECRS episodes in a 12 months period 18 based on previous guidelines indicating that at least 1 rescue medication in 3 months was an indication of uncontrolled CRS.…”

“… 26 Although aeroallergen hypersensitivity has been shown to be a disease modifier in CRS, 1 , 19 studies into temporal trends have not supported an increase in AECRS during “peak allergy seasons,” or transitions between seasons. 26 …”

“… 30 The role of viral infections in AECRS pathophysiology is supported by the finding of worldwide temporal trends, which show a two‐fold increase in AECRS during the winter months; a time of increased respiratory viral infections. 25 , 26 Viruses implicated in the development of AECRS are respiratory syncytial virus, influenza virus, coronavirus, parainfluenza virus, rhinovirus, and enterovirus. 1 , 2 , 30 The development of AECRS is a complex process, however, and thus there is disagreement regarding how significant the contribution of viruses is in the pathophysiology of AECRS.…”