Association of olfactory dysfunction in chronic rhinosinusitis with economic productivity and medication usage

Abstract

Background Chronic rhinosinusitis (CRS) has significant impacts upon productivity, economic metrics and medication usage; however, factors that are associated with these economic outcomes are unknown. Methods We evaluated olfactory dysfunction in 221 patients with CRS using the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) and the 40 item Smell Identification Test (SIT) and assessed whether an association between these olfactory metrics and healthcare utilization, productivity and medication usage over the preceding 90 days existed. Results After adjusting for CRS-associated comorbidities, objective measures of disease, demographics and CRS-specific quality of life (QOL), patients with lower QOD-NS scores (worse patient-reported olfaction) had more missed days of normal productivity and employment, worse productivity levels, more hours of missed employment due to physician visits, more time caring for sinuses, greater distance traveled to medical appointment, more days of oral steroid use and higher odds of being on disability insurance. Clinical olfaction, as measured by SIT, was associated with greater distance traveled to medical appointment and higher odds of being on disability insurance, but did not correlate with other productivity measures. Conclusions Impaired olfactory-specific QOL is associated with significantly worse economic and productivity metrics and increased medication usage even after adjusting for CRS-specific comorbidities, objective measures of disease, demographics and severity of CRS-specific QOL. Future studies are warranted to determine if targeting the impaired olfactory-specific QOL noted in patients with CRS results in improved productivity and economic outcomes.

Establishing the minimal clinically important difference for the Questionnaire of Olfactory Disorders

“…One could consider objective olfactory data like psychophysical testing. However, objective smell loss is likely not a good anchor for olfactory‐specific QOL, since we have previously shown that in CRS there are several factors that affect QOD‐NS scores in subjects, of which objective olfactory testing is but 1 of them . Furthermore, the collection of psychophysical olfactory testing is time consuming and labor intensive.…”

“…Olfactory dysfunction (OD) is a known sequela of chronic rhinosinusitis (CRS) . OD affects 40% to 80% of patients with CRS depending on the method of measurement and population studied, while significantly decreasing olfactory‐specific quality of life (QOL) . Olfactory‐specific QOL can be measured using the Questionnaire of Olfactory Disorders Negative Statements (QOD‐NS) survey, which is a previously validated instrument used to analyze multiple aspects of how changes in olfaction impact an individual's daily life …”

“…While posttreatment improvement in objective olfaction is of importance, the impact of OD on QOL is equally relevant. We have previously shown that QOD‐NS scores improve after ESS, and that changes in QOD‐NS have a stronger association with economic productivity than changes in psychophysical olfactory parameters . However, while it is understood that improvements in the QOD‐NS reflect better olfactory‐specific QOL, the interpretation of the magnitude of change after treatment remains uncertain.…”

Understanding the relationship between olfactory‐specific quality of life, objective olfactory loss, and patient factors in chronic rhinosinusitis

“…There remain, however, important unanswered questions on the exact nature of the relationship between OD and olfactory‐specific QOL . For example, OD in CRS has been associated with decreased economic productivity, but worse olfactory QOL is more closely associated with economic metrics than psychophysical measures of smell identification . Identification of odorants is not the only method for detecting OD.…”

Impaired eating‐related quality of life in chronic rhinosinusitis

“…Patients with CRS are afflicted with functional changes in both smell and taste, resulting in significant impacts on QOL . Although changes in smell are a cardinal symptom of CRS and documented in up to 83% of patients afflicted with this disease, the role of taste dysfunction in CRS is not as well described .…”