Radiographic disease severity in chronic rhinosinusitis patients and health care utilization

Abstract

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

Association Between Smoking and Chronic Rhinosinusitis: A Systematic Review and Meta‐Analysis

“…Baseline study characteristics of the included studies are summarized in Tables I and II. Briefly, of the 45 included studies, 23 were cross‐sectional studies, 3,6–8,17–35 19 were cohort studies, 10,36–53 two were case–control studies, 54,55 and 1 was a prospective clinical trial 56 . The proportion of males in the included studies ranged from 38% to 84%, while mean age ranged from 33.5 to 58.8 years.…”

“…Three studies investigated the CT score in both smokers and non‐smokers with CRS 42,48,53 . While one of the studies demonstrated that the mean LMS was higher in non‐smokers, 48 another found that a higher percentage of non‐smokers had a high LMS compared to smokers (67.3% vs. 32.7%), 53 suggesting that non‐smokers with CRS have more severe sinus opacification. However, in both studies, the p‐value did not reach statistical significance.…”

“…Data for these outcomes could not be pooled as they either utilized different analysis methods or were from single‐arm studies. The lack of significant association with LMS and endoscopy scores in spite of poorer initial QOL in smokers may reflect the poor correlation between objective assessments and symptom burden in CRS 45,48,66 . Nonetheless, rigorous testing for CRS is still key in diagnosing and evaluating treatment options for patients, while the variety of QOL assessment tools aid in evaluating burden on daily living such as loss in productivity, physical and psychosocial impact.…”

“…Six studies investigated the CT score in smokers and non-smokers with CRS, of which two were cross-sectional studies 17,34 and four were cohort studies. 39,42,48,53 All studies used the Lund-Mackay score (LMS) for radiological evaluation of CRS, in which a higher score indicates a greater degree of opacification in the imaged sinuses.…”

A pilot prospective longitudinal study comparing dupilumab to surgery in CRSwNP

“…All patients met the criteria of severe CRS as defined by symptom scores, polyp size, smell impairment, and LMK-CT score. 20,25,26 Changes in outcomes within and between groups We first measured outcome measures from each time-point to baseline within each respective group. We then directly compared outcome effects between dupilumab and FESS by calculating the mean difference in scores between baseline and longitudinal time points.…”