Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population‐based sample

Abstract

Allergy. 2020;75:911-920.wileyonlinelibrary.com/journal/all | 911 Abstract Background: Chronic rhinosinusitis (CRS) epidemiology has been largely studied using symptom-based case definitions, without assessment of objective sinus findings.Objective: To describe radiologic sinus opacification and the prevalence of CRS, defined by the co-occurrence of symptoms and sinus opacification, in a general population-based sample. Methods:We collected questionnaires and sinus CT scans from 646 participants selected from a source population of 200 769 primary care patients. Symptom status (CRS S ) was based on guideline criteria, and objective radiologic inflammation (CRS O ) was based on the Lund-Mackay (L-M) score using multiple L-M thresholds for positivity. Participants with symptoms and radiologic inflammation were classified as CRS S+O . We performed negative binomial regression to assess factors associated with L-M score and logistic regression to evaluate factors associated with CRS S+O .Using weighted analysis, we calculated estimates for the source population. Results:The proportion of women with L-M scores ≥ 3, 4, or 6 (CRS O ) was 11.1%, 9.9%, and 5.7%, respectively, and 16.1%, 14.6%, and 8.7% among men. The respective proportion with CRS S+O was 1.7%, 1.6%, and 0.45% among women and 8.8%, 7.5%, and 3.6% among men. Men had higher odds of CRS S+O compared to women. A greater proportion of men (vs women) had any opacification in the frontal, anterior ethmoid, and sphenoid sinuses. Conclusion:In a general population-based sample in Pennsylvania, sinus opacification was more common among men than in women and opacification occurred in different locations by sex. Male sex, migraine headache, and prior sinus surgery were associated with higher odds of CRS S+O . K E Y W O R D S chronic rhinosinusitis, CT scan, epidemiology, sex, sinus S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Hirsch AG, Nordberg C, Bandeen-Roche K, et al. Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population-based sample.Allergy. 2020;75:911-920. https ://doi.

A new approach to categorization of radiologic inflammation in chronic rhinosinusitis

“…Subjects who were pregnant were excluded and subjects reporting a cold or upper respiratory infection in the past 30 days were asked to postpone their CT visit. Of the 3269 subjects invited to participate, 646 completed a sinus CT, but this 19.8% participation rate did not appear to induce selection bias as the sample was comparable to the larger study cohort [10]. The sample size was determined primarily by budgetary limits as key parameters needed for sample size calculations were not available before this study.…”

“…This study was approved by Geisinger's Radiation Safety Committee and Institutional Review Board (IRB), which has an IRB Authorization Agreement with the Johns Hopkins Bloomberg School of Public Health. Health Insurance Portability and Accountability Act authorization was approved and written informed consent was received from all participants [10].…”

“…Neither approach includes nasal cavity opacification as part of the total score, despite the fact that nasal polyposis, usually detected through endoscopic examination of the nasal cavity, causes nasal cavity opacification, and characterizes one phenotype of CRS (CRS with nasal polyps [CRSwNP]) [1]. While nasal polyps generally develop in the anterior and posterior ethmoids, not all individuals with opacification in the ethmoids go on to develop nasal polyps [9,10]. As such, inclusion of nasal cavity opacification in scoring approaches may provide important information on disease severity and prognostication.…”

“…Further, symptom scoring approaches like CRS S consider NSS to be largely interchangeable; however, a recent study of NSS has shown the four symptom groups used in CRS S (nasal blockage/congestion/obstruction; anterior/posterior nasal discharge; smell loss; and facial pain/pressure), identify separate constructs, not one, which would be expected if they all represent the same underlying process or pathogenesis [14]. Additionally, few studies have assessed sinus opacification in a general population [6,10,15] and only one among a sample without indications requiring a CT scan of the head [10]. As such, there have not been rigorous approaches to measurement across the broad spectrum of disease.…”

Airway Epithelial Dynamics in Allergy and Related Chronic Inflammatory Airway Diseases

“…Chronic rhinosinusitis (CRS) is a chronic symptomatic inflammation of the sinonasal tract, with a prevalence of 3-10% (Fokkens et al, 2012;Dietz de Loos et al, 2019;Hirsch et al, 2019). CRS presents with (CRSwNP) or without (CRSsNP) nasal polyps (NP), and is defined by typical subjective symptoms (facial pain, post-nasal drip, obstruction, discharge) lasting for at least 12 weeks, objectively confirmed by either positive endoscopic findings (oedema, mucus secretions, polyps) or positive radiologic findings (mucosal inflammation on sinus CT scans).…”