Elimination of pain improves specificity of clinical diagnostic criteria for adult chronic rhinosinusitis

Abstract

4. Laryngoscope, 127:1011-1016, 2017.

The Sinonasal Outcome Test–22 or European Position Paper: Which Is More Indicative of Imaging Results?

“…Some studies have demonstrated poor association with chronic rhinosinusitis, as related symptoms may be nonspecific. 3 - 6 For example, authors have suggested that facial pain, dental pain, ear pain, and headache could be removed from diagnostic criteria without significant changes in diagnostic sensitivity. 5 In contrast, other authors have concluded that questionnaire results can have functional sensitivity and specificity.…”

“… 3 - 6 For example, authors have suggested that facial pain, dental pain, ear pain, and headache could be removed from diagnostic criteria without significant changes in diagnostic sensitivity. 5 In contrast, other authors have concluded that questionnaire results can have functional sensitivity and specificity. 45 Prior studies have also demonstrated that even within a single validated instrument, results may be mixed, with SNOT-22 nasal domain scores performing better than overall scores, 7 - 10 , 21 - 26 , 42 also suggesting that specific approaches to symptoms and symptom clusters can alter discriminatory capacity.…”

“…Prior studies of patient-reported symptoms and diagnostic impressions related to chronic rhinosinusitis have had mixed results, with some data suggesting useful specificity and sensitivity, while others suggest poor discrimination across reports. 3 - 10 …”

Longitudinal Evaluation of Chronic Rhinosinusitis Symptoms in a Population-Based Sample

“…Migraine is associated with rhinorrhea and nasal congestion due to sinonasal neurogenic stimulation in 50–60% of people, leading to misdiagnosis of CRS in the absence of objective evidence of sinus disease. 37, 38 However, migraine is also co-morbid with CRS 39 and can also influence timing of surgical management. 40 We suspect that co-morbidity and misdiagnosis may each be occurring.…”

Orofacial pain

“…Data from cohort studies show that orofacial pain is a poor predictor of chronic rhinosinusitis, and patients are more likely to be misdiagnosed if pain is used as a criterion to screen patients for rhinosinusitis 6789. A prospective observational study involving 108 patients with confirmed chronic rhinosinusitis found that less than a third of patients had orofacial pain 7.…”