Co-morbid anxiety and depression impacts on the correlation between symptom and radiological severity in patients with chronic rhinosinusitis.

Abstract

Previous studies have reported that there is little correlation between sino-nasal outcome test (SNOT-22) score in chronic rhinosinusitis (CRS) and objective radiological scoring, although conclusions vary. We aimed to investigate whether comorbid anxiety and depression, which are highly prevalent in patients with CRS may cause symptom amplification and account for the lack of correlation in previous studies. 100 patients with CRS were evaluated using the General Anxiety Disorder-7 (GAD-7), Patient Health Question- naire-9 (PHQ-9) and SNOT-22 questionnaires as well as the Lund Mackay Score (LMS). Overall correlation analysis did not show a significant relationship between SNOT-22 and LMS scores. Subgroup analysis of patients who do not suffer with anxiety and depression showed a significant correlation between SNOT-22 and LMS scores. The nasal domain of the SNOT-22 showed strongest correlation to LMS in this patient group. We also observed a significant difference in both median SNOT-22 and LMS between patients who suffered both anxiety and depression and patients without either co- morbidity. When CRS patients who do not have anxiety and depression are analysed in isolation, or when these conditions are controlled in a multivariable regression, there is a significant correlation between radiological findings and symptom score. This correlation is absent in patients with co-morbid anxiety and depression. Anxiety and depression should be considered in patients in whom there is a mismatch in symptom and radiological disease severity as it is associated with symptom amplification.