Abstract
Objectives: Chronic Rhinosinusitis without Nasal Polyps (CRSsNP) and with Nasal Polyps (CRSwNP) affect 10% and 1-4% of the general population respectively. Early detection and treatment of CRSwNP might prevent recalcitrant disease forms. The aim of this prospective controlled study was to evaluate association between endoscopic, radiologic, and self-reported CRSwNP, and a family history in defining CRSwNP. Methods: This study involved 73 CRS patients aged 18 years or over undergoing CRS-surgical consultation at the Tampere University Hospital. Data of sinus Computed Tomography (CT) scans and nasal endoscopy was obtained from patient records. Sixty controls ±allergic rhinitis underwent clinical examination. All subjects filled a questionnaire. Associations were analyzed by Chi square and adjusted regression models. The predictive performance of various parameters was assessed using the Area Under the Receiver Operating Characteristic curve (AUROC). Results: A total of 33% of CRSwNP patients reported not having Nasal Polyps (NPs), while 18% of CRSsNP patients reported having NPs (p < 0.001). Radiologic Nasal Polyp (NP) score differentiated CRSwNP from CRSsNP with an AUROC of 0.95 (95% CI 0.91-1.00). The AUROC value for Lund-Mackay (LM) score was 0.84 (0.75-0.94). Positive family history of NP did not differ significantly between CRS and control groups. Family history of allergy or asthma was given with certainty, whereas CRS patients had uncertainty of reporting NPs in family compared to controls (adjusted OR=6.02, 95% CI 1.98-18.30, p = 0.002). Conclusion: Our findings suggest that in situations where nasal endoscopy cannot be performed, early detection of CRSwNP could result from information obtained from sinus CT scans and patients, in comparison to family history which has lower predictive value. However validation studies with larger sample sizes are still needed.
Highlights
Chronic Rhinosinusitis (CRS) is an inflammatory disorder of the nose and paranasal sinuses lasting for at least 12 weeks and affects 10.9% of the European population [1, 2]
History of allergy or asthma was given with certainty, whereas CRS patients had uncertainty of reporting Nasal Polyps (NP) in family compared to controls
Our findings suggest that in situations where nasal endoscopy cannot be performed, early detection of CRSwNP could result from information obtained from sinus Computed Tomography (CT) scans and patients, in comparison to family history which has lower predictive value
Summary
Chronic Rhinosinusitis (CRS) is an inflammatory disorder of the nose and paranasal sinuses lasting for at least 12 weeks and affects 10.9% of the European population [1, 2]. 1-4% of the general population report having Nasal Polyps and in patients with respiratory phenotypes such as asthma and Allergic Rhinitis (AR) [3 - 6]. Asthma 1-18% in the general population their risk is strongly associated to a family history of asthma or allergy [7 - 9]. Early awareness and treatment of CRSwNP might prevent recalcitrant disease forms and asthma [10, 11]. The aim of this prospective controlled study was to evaluate association between endoscopic, radiologic, self-reported CRSwNP, and family history in detecting CRSwNP. The hypothesis was that radiologic, self-reported and heredity of NPs would all have high predictability of CRSwNP phenotype
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