Diagnostic Accuracy of Symptoms, Endoscopy, and Imaging Signs of Chronic Rhinosinusitis Without Nasal Polyps Compared to Allergic Rhinitis

Koskinen, Anni; Numminen, Jura; Markkola, Annamari; Karjalainen, Jussi; Karstila, T.; Seppälä, Mika; Julkunen, Anna; Lemmetyinen, Riikka; Pekkanen, Juha; Rautiainen, Markus; Dastidar, Prasun; Hytönen, Maija; Toppila‐Salmi, Sanna

doi:10.1177/1945892418762891

Cited by 19 publications

(8 citation statements)

References 30 publications

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“…Koskinen et al demonstrated no significant difference in LMS between CRS patients with and without allergic rhinitis as exhibited in this study as well. 33 An epidemiologic study done in the United Kingdom by Philpott et al showed that aspirin sensitivity is strongly associated with CRSwNP 34 ; however, other studies have not considered the association between aspirin sensitivity and LMS which was shown not to be significant in the current study.…”

Section: Discussioncontrasting

confidence: 60%

Radiographic disease severity in chronic rhinosinusitis patients and health care utilization

Mehta

Hur

Price

et al. 2021

Laryngoscope Investig Oto

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Objectives: Chronic rhinosinusitis (CRS) affects approximately 12% of the population and leads to increased health care utilization and indirect costs exceeding $20 billion annually in the United States. The Lund-Mackay score (LMS) measures radiographic disease severity for CRS but poorly correlates with symptom scores. The association between LMS and health care utilization in CRS patients has not yet been investigated. The study aimed to assess the association between health care utilization and CRS radiographic severity using LMS.Methods: CRS patients enrolled in a clinical registry were evaluated. Nasal endoscopy findings and LMS were recorded for patients with sinus CT imaging. Patient symptom scores, demographic characteristics, and health care utilization measures were collected. The relationship between these factors and LMS was examined.Results: A total of 556 patients met inclusion criteria. Mean age was 45.3 years, 53.4% were male, and 41.7% had nasal polyps. There was no difference in sex, smoking history, 22-item Sino-nasal Outcome Test scores, or past medical history factors between patients with high (≥8, n = 410) and low (<8, n = 146) LMS. Among high LMS patients, 73.7% underwent endoscopic sinus surgery (ESS) compared to 55.5% with low LMS (P < .01), and a greater percentage of patients had nasal polyps (49.3% vs 20.5%, P < .01). On multivariable logistic regression, high LMS patients used fewer antibiotic courses (OR: 0.68 [0.51-0.91]), but were more likely to be managed with ESS (OR: 2.28 [1.41-3.73]), and have nasal polyps ]) compared to low LMS patients. There was no significant difference in the number of steroid courses, over the counter pill use, provider visits, work/school days missed, or symptom duration between the two LMS groups.Conclusion: CRS patients with severe radiographic disease are more likely to have nasal polyps, undergo ESS, and take fewer antibiotic courses. However, there is no

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Section: Discussioncontrasting

confidence: 60%

Radiographic disease severity in chronic rhinosinusitis patients and health care utilization

Mehta

Hur

Price

et al. 2021

Laryngoscope Investig Oto

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“…Our findings are different from other studies showing no correlation of endoscopic findings with other factors; Koskinen at al looked at differentiating CRSsNP and allergic rhinitis patients and found endoscopy not useful. 19 Feng et al examined different chronic nasal conditions in 150 asthmatic patients and did not find a difference in the Lund-Kennedy endoscopic score; however, they did find the nasal symptoms score in correlation with endoscopy score. 20 The usefulness of nasal endoscopy in these studies was low; however, different pathologies were evaluated there while the group in the current study was more homogenous and that may allow a better evaluation of nasal endoscopy as a tool.…”

Section: Discussionmentioning

confidence: 98%

Is Nasal Endoscopy of Diagnostic Value in Chronic Rhinosinusitis Without Nasal Polyps?

Cohen‐Kerem¹,

Marshak²,

Uri³

et al. 2019

Ear Nose Throat J

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Endoscopic examination of the nasal cavity is an integral part of the assessment of patients with chronic rhinosinusitis. However, the benefit gained by performing endoscopy with respect to the patient’s medical condition has not been completely assessed. We conducted a prospective cohort in an academic medical center. Thirty-nine patients diagnosed with chronic rhinosinusitis, without polyps, whose ailment was managed conservatively with no surgical intervention. All patients underwent nasal endoscopy, a computed tomography (CT) scan rated for Lund-MacKay score, and completed a sino nasal outcome test (SNOT)-20 questionnaire. This same evaluation was repeated 6 weeks following medical treatment. The CT scan and SNOT-20 questionnaire were independent parameters to evaluate the endoscopy score in each nasal passage. Thirty-nine (28 females) patients completed the follow-up period. A total of 156 endoscopic evaluations were performed, in which 74 nasal cavities were found to have significant pathology and 82 were either normal or displayed mild pathology. The correlation with the Lund-MacKay score was poor with a positive predictive value of 68.9% (31.1% false positive and 28% false negative). However, while looking at the SNOT-20 score, corrected for repeated measures, a higher endoscopy score was associated with a higher SNOT-20 score (odds ratio = 3.53, 95% confidence interval = 1.54-8.09, P = .003). Patients with higher endoscopy scores had a greater probability for exhibiting severe symptoms. However, we could not demonstrate a strong correlation between nasal endoscopy findings and CT scan scores. Therefore, with respect to patients with chronic rhinosinusitis without polyps, nasal endoscopy could be utilized as a beneficial objective tool.

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“…Точна захворюваність на гострий бактеріальний риносинусит (ГБРС) невідома. Цей показник було встановлено на рівні 0,5-2 % від усіх вірусних інфекцій носа та навколоносових пазух [4,5]. В цілому тяжко встановити відмінність між бактеріальним й небактеріальним риносинуситом.…”

Section: клініко-мікробіологічні паралелі відкладеного призначення антибіотиків у пацієнтів з гострим риносинуситомunclassified

“…Інформативних додаткових методів діагностики не існує, тому діагноз виставляється клінічно. Традиційна рентгенографія ще з 2012 року взагалі більше не показана при ГРС, а додаткові методи, включаючи КТ, не рекомендовані, якщо тільки патологічний стан не персистує, незважаючи на лікування, або немає підозри на ускладнення [5,6]. Цілком очевидно, що в реальній клінічній практиці частота ГБРС значно переоцінюється, особливо при одночасному надмірному використанні діагностичних засобів, а також прийнятті рішення про призначення антибіотиків.…”

Clinical and microbiological parallels of delayed prescribing of antibiotics in patients with acute rhinosinusitis

Hariri

Koshel

Попович

2020

OTORHINOLARYNGOLOGY

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Topicality: The rate of acute bacterial rhinosinusitisis 0,5-2% of all cases of acute rhinosinusitis, however, up to 60 % of patients receive the course of antibiotics since the first day of disease. It is well known that earlier use of antibiotics has almost no effect on the development of bacterial ARS and its complications. The purpose of study was to examine the bacterial spectrum of post-viral RS and evaluate clinical and bac-teriological efficiency of polyvalent bacteriophage in technique of delayed prescribing of antibiotics in comparison with the patients receiving standard APVRS therapy. Material and methods: 155 adult patients with acute post-viral RS participated in the trial who were given either standard therapy or polyvalent bacteriophage in addition to the standard therapy. In conjunction with the treatment, the microbiological composition of nasal microflora was examined and its comparison with clinical dynamics was undertaken. Evaluation criteria: decrease in intensity of disease symptoms evaluated in accordance with MSS scale system during each visit in comparison with the 1st visit, antibiotic prescribing frequency, dynamics of microbiological changes. Outcomes and discussion: The use of polyvalent bacteriophagein addition to the standard therapy of acute post-viral rhinosinusitis as a part of technique of delayed prescribing of antibioticsensures clinically significant decrease in the intensity of rhinorrhea symptoms, nasal congestion and post-nasal drip on the third day of supervision (p<0.05). It reduces the prescription of antibacterial medicines by 20%without negative impact on overall treatment results. Decrease in the number of prescription of antibacterial therapy correlates with the fair reduction in bacterial loadwith Staphylococcus aureus and typical representative of ABRS – S. pneumoniae, Haemophilus influenza and M. catarrhalis. Therefore, the intervention group in comparison with the control group has had “therapeutic advantage” during the first days of treatment which allowed to assess the course of disease as a “positive” and avoid in appropriate use of antibiotics. There have been documented no patients with adverse effects during the course of treatment. Conclusion: polyvalent bacteriophage is a safe and effective medication for additional treatment of acute post-viral rhinosinusitis intended to reduce the use of antibiotics. The inclusion of the medication into the treatment regimen could be recommended to the patients as a part of technique of delayed prescribing of antibiotics.

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Diagnostic Accuracy of Symptoms, Endoscopy, and Imaging Signs of Chronic Rhinosinusitis Without Nasal Polyps Compared to Allergic Rhinitis

Cited by 19 publications

References 30 publications

Radiographic disease severity in chronic rhinosinusitis patients and health care utilization

Radiographic disease severity in chronic rhinosinusitis patients and health care utilization

Is Nasal Endoscopy of Diagnostic Value in Chronic Rhinosinusitis Without Nasal Polyps?

Clinical and microbiological parallels of delayed prescribing of antibiotics in patients with acute rhinosinusitis

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