Association of olfactory dysfunction in chronic rhinosinusitis with economic productivity and medication usage.

BACKGROUND: Chronic rhinosinusitis (CRS) has significant impacts upon productivity, economic metrics, and medication usage; however, factors that are associated with these economic outcomes are unknown. METHODS: We evaluated olfactory dysfunction in 221 patients with CRS using the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) and the 40-item Smell Identification Test (SIT) and assessed whether an association existed between these olfactory metrics and healthcare utilization, productivity, and medication usage over the preceding 90 days. RESULTS: After adjusting for CRS-associated comorbidities, objective measures of disease, demographics, and CRS-specific quality of life (QOL), patients with lower QOD-NS scores (worse patient-reported olfaction) had more missed days of normal productivity and employment, worse productivity levels, more hours of missed employment due to physician visits, more time caring for sinuses, greater distance traveled to medical appointment, more days of oral steroid use, and higher odds of being on disability insurance. Clinical olfaction, as measured by SIT, was associated with greater distance traveled to medical appointment and higher odds of being on disability insurance, but did not correlate with other productivity measures. CONCLUSION: Impaired olfactory-specific QOL is associated with significantly worse economic and productivity metrics and increased medication usage even after adjusting for CRS-specific comorbidities, objective measures of disease, demographics, and severity of CRS-specific QOL. Future studies are warranted to determine if targeting the impaired olfactory-specific QOL noted in patients with CRS results in improved productivity and economic outcomes.

Cost effectiveness of magnetic resonance imaging in the workup of the dysosmia patient.

BACKGROUND: Intracranial causes of dysosmia are uncommon. Nonetheless, a missed intracranial disorder or neoplasm is worrisome. Magnetic resonance imaging (MRI) may be used in diagnosis; however, the cost effectiveness of this practice is unclear. We hypothesize that MRI scans for idiopathic dysosmia will demonstrate sufficient significant findings to be a cost-effective screening tool. METHODS: Tertiary-care otolaryngology clinic records were queried for smell and taste disturbance. The patients underwent anosmia-protocol MRI of the brain for idiopathic dysosmia in 122 cases. Each MRI report was reviewed for dysosmia findings, intracranial neoplasms, and incidental findings. RESULTS: MRI was normal in 44.3%, there were dysosmia-related findings in 25.4%, and incidental findings in 40.2%. The most common related diagnosis was occult frontoethmoid sinusitis (18.8%). The most common incidental diagnosis was small vessel disease (21.1%). Intracranial neoplasms were observed in 6 patients (4.9%). Nine patients had intracranial causes of dysosmia including olfactory meningiomas, infarct, trauma, and atrophy. MRI cost per dysosmia etiology diagnosis was $9445. Costs increased to $32,355 and $48,880 per intracranial cause or neoplasm, respectively. Cost to diagnose 1 causal intracranial neoplasm was $146,400. From 1997 to 2003, median medical malpractice settlements ranged from $625,616 for misdiagnosis to $682,500 for delay in treatment to $1,750,000 for brain injury. The median jury award was $975,000 for misdiagnosis, $1,550,000 for delayed treatment, and $6,000,000 for brain injury. CONCLUSION: MRI in idiopathic dysosmia yielded information regarding the diagnosis in one-quarter of cases. The implications of missing an intracranial neoplasm alone justify the cost of screening MRI for idiopathic dysosmia.

Aspirin-exacerbated respiratory disease: burden of disease.

Aspirin-exacerbated respiratory disease (AERD) is characterized by adult onset of asthma, chronic rhinosinusitis (CRS), nasal polyposis, and aspirin sensitivity. In this syndrome, each disease component has deleterious effects on the patient's health and quality of life. Latest figures from the Centers for Disease Control indicate 8.2% of the U.S. population has asthma and among adult asthmatic patients, up to 9% have AERD. Approximately 13% of the population suffers from CRS and 15% of patients with CRS with nasal polyposis have AERD. A review of the impact that each component of AERD has on patients will delineate the considerable burden of AERD, especially when considering the cumulative effects of the tetrad.

Effects of injury severity and cognitive exaggeration on olfactory deficits in head injury compensation claims.

The purpose of this study was to examine the relationship between exaggeration and scores on a test of olfactory discrimination in patients being assessed in connection with a claim for financial benefits. Participants were 448 patients referred to a private practice in Edmonton, Alberta, Canada for psychological or neuropsychological assessment, related to evaluation of impairment and disability resulting from a work-related or non-work related accident. All patients were involved in some form of compensation claim at the time of their evaluation. All patients completed two tests designed to detect exaggerated cognitive deficits, the Computerized Assessment of Response Bias (CARB) and the Word Memory Test (WMT) as part of their evaluation. The diagnostic groups included 322 head injury cases, varying from very minor to very severe. Normative data for the smell test were derived from 126 patients with orthopedic injuries who passed both the CARB and the WMT. Patients with more severe traumatic brain injuries were 10-12 times more likely to have olfactory deficits than persons with trivial to mild head injuries. In a subgroup of patients who failed either the CARB or the WMT, there was no relationship between injury severity and total scores on the smell test. Therefore, the dose-response relationship between brain injury severity and olfactory deficits is severely attenuated when patients who are probably exaggerating their cognitive deficits are included in the analyses. Those patients with trivial to mild head injuries who demonstrated adequate effort on both the CARB and the WMT were no more likely to show olfactory deficits than the non-head-injured orthopedic control subjects. Therefore, anosmia following mild traumatic brain injury should not be concluded from self-reports or from tests of smell unless tests of effort have been passed. Effort should also be controlled in group studies of olfaction.