Are objective ‘findings’ the same as subjective ‘severity’? A study of the relationship between computed tomography findings and subjective severity in preoperative CRSwNP patients

Abstract

In pre-surgical patients with chronic rhinosinusitis with nasal polyps (CRSwNPs), positive findings on computed tomography (CT) scans and an exacerbation of symptoms are two possible factors that indicate surgery. However, the relationship between these factors remains unclear. Confirmed CRSwNP patients ready for sinus surgery were consecutively enrolled. The Sino-Nasal Outcome Test 22 (SNOT-22) and visual analog scale (VAS) scoring were completed by these patients, and scores were subjected to factor analysis using a principal component analysis (PCA) to evaluate subjective symptom components related to CRS. Patient CT scores, measured by the Lund-Mackay score (LMS), together with their demographics, medical treatment, and atopy status, were collected and analyzed. A total of 288 patients who met the criteria for CRSwNP and underwent CT scanning prior to surgery in the Eye, Ear, Nose, and Throat Hospital of Fudan University were enrolled. Five components were identified from the PCA of the SNOT-22 results and VAS scores related to subjective symptoms. More severe 'nasal' symptoms (P= 0.03; 95% CI, 0.092-1.824), loss of smell and taste (P<0.001; 95% CI, 0.961-1.767) and lower facial pain (P=0.001; 95% CI 1.811 to-0.475), derived from the SNOT-22, were significantly associated with total CT score. For the VAS PCA components, less severe 'ocular' symptoms (P= 0.004; 95% CI-1.852 to-0.352), a reduced 'pain' component (P<0.001; 95% CI-2.133 to-0.715), a higher 'nasal' symptom component (P<0.001; 95% CI 0.752-2.257) and, again, loss of smell and taste (P<0.001; 95% CI 0.437-0.811) showed an association with total CT score. 'Allergy-associated symptoms' in both the SNOT-22 and VAS scores and 'loss of smell or taste' and 'hyposmia' were significantly more severe in patients with ethmoid sinus/maxillary sinus (E/M) ratios of >2.59 compared with patients with E/M ratios <2.59. Loss of smell and taste alone was correlated with the LMS in patients with highly positive CT scores. The present study demonstrated associations between several subjective symptoms and objective severity in preoperative CRSwNP patients. Nasal symptoms, including olfaction loss, were correlated positively with CT scores, while ocular-and pain-related symptoms showed an opposite pattern. However, this relationship was not confirmed in patients with highly positive CT scores. A subset analysis confirmed, in terms of symptoms, the value of the E/M ratio for indicating eosinophilic chronic rhinosinusitis.

Preoperative Sinonasal Computed Tomography Score in Chronic Rhinosinusitis with Nasal Polyps

“…Possible associations between the aforementioned CRSwNPs types and any single sinonasal sub-site involved (maxillary, ethmoid, frontal, or sphenoid) and OMC at CT scan were also evaluated. It was preferred to analyze the role of the CT staging system in relation to clinical and prognostic objective aspects of CRSwNPs instead of considering subjective symptomatological aspects as recently done by other authors [ 15 , 16 ]. The possibility of using preoperative partial CT scores as an additional instrument to stratify CRSwNP sub-types is nowadays worthy of investigation.…”

Imaging of chronic rhinosinusitis with nasal polyps in the era of biological therapies

“…On the other hand, some studies reported a significant correlation between CT and symptom scores. Hanyu et al [ 37 ▪ ] demonstrated a positive correlation between nasal symptoms and loss of smell, as well as an inverse correlation between pain and ocular symptoms, with objective radiological findings in patients with presurgical CRSwNP.…”