ABSTRACT
Allergic rhinitis [AR] is a global health problem and its impact on health related quality of life for patients is substantial, and the economic impact often underestimated. The prevalence of allergic rhinitis in Oman is unknown. This study aimed to estimate the prevalence of AR and associated co-morbidities among adults in Oman. Its secondary objective was to identify knowledge gaps in the literature with the aim of directing future research. A prospective, cross-sectional study of patients who presented to the outpatient otolaryngology clinic at Sultan Qaboos University Hospital with nasal symptoms between June 2010 and June 2011 was conducted. A total of 887 patients were seen with nasal complaints. Among them 127 patients were diagnosed with non-infective rhinitis, the mean age of presentation was 27 years. AR was noted in 48% of patients, and non-allergic rhinitis in 52%. The prevalence of AR was 7%, with females being more affected than males, and age ranging from 18 to 51 years. Prevalence of perennial AR was 84% compared to seasonal AR which was 16%. The most common perennial antigens were house dust mites [80%] followed by cockroaches [67%]. All patients diagnosed with seasonal AR were found to be sensitive to Russian thistle. The prevalence of chronic rhinosinusitis in patients with AR was 34%. The prevalence of AR in the adult population presenting with nasal symptoms was found to be 7%, with associated chronic rhinosinusitis present in a third of these patients. However, there appears to be substantial knowledge gaps regarding the association of other comorbidities, like otitis media, bronchitis and bronchial asthma, the long-term outcomes of medical management, and indication of surgical intervention in patients with AR. Future research in AR among Omani patients should aim to address these issues
ABSTRACT
To define the role of endoscopic evaluation of middle meatus in adult patients clinically diagnosed to have chronic rhinosinusitis and its ability to predict intra-sinus mucosal involvement as compared to CT scan. This prospective analytical study was conducted on consecutive patients with diagnosis of chronic rhino-sinusitis who were symptomatic and fulfilled the American Academy of Otolaryngology - Head and Neck Surgery Task Force criteria. The patients were enrolled prospectively and were subjected to rigid diagnostic nasal endoscopy and classified as defined by the revised Sinus Allergy Health Partnership Task Force criteria. The patients then underwent non contrast CT sinuses on the same day. Results were analyzed as a diagnostic test evaluation using CT as a gold standard. Among the 75 study patients with symptom based chronic rhino-sinusitis, nasal endoscopy was abnormal in 65 patients [87%]. Of these patients, 60/65 [92%] showed positive findings on CT scan. Ten patients had normal endoscopy, of these 6/10 [60%] had abnormal CT scan. Sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% [95% CI: 81-97] and 44% [95% CI: 14-79], respectively. The likelihood ratio for positive nasal endoscopy to diagnose chronic rhino-sinusitis was 1.6 and the likelihood ratio to rule out chronic rhino-sinusitis when endoscopy was negative was 0.2. Nasal endoscopy is a valid and objective diagnostic tool in the work up of patients with symptomatic chronic rhinosinusitis. When clinical suspicion is low [<50%] and endoscopy is negative, the probability of rhino-sinusitis is very low [<17%] and there is no need to perform a CT scan to reconfirm this finding routinely. Endoscopy alone is able to diagnose chronic rhinosinusitis in >90% of patients when clinical suspicion is high [88%] as defined in this study by AAO-HNS Task Force criteria. Negative endoscopy, however, does not totally exclude the sinus disease in patients fulfilling task force criteria. CT scan may be needed on follow-up if there is clinical suspicion in 10% of these patients who are negative on endoscopy if symptoms persists. It is thus possible to reduce the number of CT scans if patients are carefully selected based on clinical criteria and endoscopy is done initially as part of their evaluation.