Prevalence of chronic rhinosinusitis in the general population based on sinus radiology and symptomatology.

BACKGROUND: The prevalence of chronic rhinosinusitis (CRS) measured in epidemiologic studies is 5% to 12%. This might be an overestimation because of overlap with other diseases, such as allergic rhinitis. OBJECTIVE: We aimed to calculate the prevalence of CRS using a combination of epidemiologically based CRS according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) together with sinonasal opacification on imaging. METHODS: Subjects who underwent a computed tomographic or magnetic resonance imaging scan of the head for any nonrhinologic indication were asked to fill in the Global Allergy and Asthma European Network survey containing EPOS symptom criteria. The scans were evaluated according to the Lund-Mackay (LM) scoring system. Epidemiologically based CRS is based on nasal symptoms according to EPOS; clinically based CRS also encompasses endoscopy and/or CT scanning. RESULTS: Eight hundred thirty-four subjects were included. One hundred seven (12.8%) had epidemiologically based CRS according to EPOS. Of these subjects, 50% had an LM score of 0, 26% had an LM score of 1 to 3, and 23% had an LM score of 4 or greater. Twenty-five (3.0%) subjects had clinically based CRS (based on LM score ≥4), and 53 (6.4%) subjects had clinically based CRS (based on LM score >0). Allergic rhinitis was reported by 167 (20%) subjects. In subjects who did not report upper airway symptoms, 57% had an LM score of 0, 30% had an LM score of 1 to 3, and 12% had an LM score of 4 or greater. CONCLUSION: We found a prevalence of 3.0% to 6.4% of clinically based CRS (depending on an LM cutoff point; ie, LM ≥ 4 or LM > 0, respectively) in a relatively randomly selected group of subjects.

Symptoms in chronic rhinosinusitis with and without nasal polyps.

OBJECTIVES/HYPOTHESIS: In this study we analyzed differences in symptoms scored between chronic rhinosinusitis patients with (CRSwNP) and without nasal polyps (CRSsNP). According to the European Position Paper on Rhinosinusitis and Nasal Polyps, CRSwNP and CRSsNP diagnoses are defined by clinical criteria supported with endoscopy. We wanted to know if it is possible to make an accurate distinction between patients with and without nasal polyps based on clinical impression. STUDY DESIGN: Retrospective case-control study. METHODS: We collected Rhinosinusitis Outcome Measure 31 (RSOM-31) questionnaires from chronic rhinosinusitis patients with and without nasal polyps and compared mean total RSOM-31 scores, mean domain scores, mean symptoms scores, and percentages of patients reporting symptoms per diagnosis based on endoscopy and computed tomography scan. RESULTS: RSOM-31 questionnaires were collected from 234 patients. Although the total RSOM-31 score was similar and symptomatology considerably overlapping, patients with CRSwNP scored significantly higher and more often on nasal symptoms such as "rhinorrhea" and "decreased sense of taste or smell." Patients with CRSsNP significantly scored more often and higher on "facial pain" and "ear pain." CONCLUSIONS: Although there were significant differences in scores on several symptoms, there was considerable overlap of many symptoms, and it remains difficult to distinguish between CRSwNP and CRSsNP based on clinical impression alone.

Disease-specific quality-of-life questionnaires in rhinitis and rhinosinusitis: review and evaluation.

Quality of life (QoL) measurements are the best approximation of the burden of disease for the patient. Patient-reported outcome measurements (PROMs) estimate health-related quality of life (HRQoL). PROMs can be generic or disease-specific. Generic PROMs allow comparisons between different diseases but can be relatively insensitive for measuring changes within a disease. Recommended QoL questionnaires in allergic rhinitis and rhinoconjunctivitis are the RQLQ (or adapted versions), in chronic rhinosinusitis, the SNOT-22 or RSOM-31, and in acute rhinosinusitis, the modified SNOT-16. PROMs can be used both for daily clinical work and for research. In daily practice, a quick evaluation of the questionnaire directly indicates how the patient is doing. It makes sure that symptoms important for the patient are not overlooked and, during the consultation, the physician can elaborate on specific aspects of the symptomatology. It is important, especially in research, to realize that disease-specific questionnaires are only validated for specific diseases and are not automatically valid for other diseases.