Do Anxiety and Depression Confound Symptom Reporting and Diagnostic Accuracy in Chronic Rhinosinusitis?

Abstract

We sought to determine the impact of psychiatric comorbidity on symptom reporting and diagnostic accuracy in chronic rhinosinusitis (CRS). A prospective cohort of patients presenting for evaluation of CRS was studied with the Rhinosinusitis Symptom Inventory and the Hospital Anxiety and Depression Scale. Data concerning symptom scores, symptom domains, and psychiatric comorbidity were analyzed with respect to paranasal sinus computed tomography (CT) Lund score. The degree of correlation between sinonasal symptoms and CT scan stage adjusting for anxiety and depression was determined. The relationships between symptoms, psychiatric comorbidity, and the presence of radiographic CRS were determined with multivariate logistic regression. There were 230 patients (mean age, 43.4 years) enrolled. High levels of anxiety and depression were noted in 23.5% and 13.0%, respectively. According to CT criteria, 61.3% to 71.3% of patients had true CRS. Even adjusting for anxiety and depression, only the nasal symptom domain severity had a statistically significant correlation with Lund score (r = 0.240; p = .001); facial, oropharyngeal, systemic, and total symptoms did not correlate with CT score. Similarly, multivariate analysis revealed that even with adjustment for anxiety and depression, sinus symptom domains failed to predict radiographic positivity. Individually, only dysosmia, dental pain, and fatigue were predictive for CRS (odds ratios, 1.29 [p = .032], 1.69 [p = .001], and 0.70 [p = .023], respectively). Although anxiety and depression are prevalent in patients with CRS, they do not influence the correlation between nasal symptoms and CT findings. Markers of psychiatric comorbidity do not correlate with CRS symptoms. The presence of anxiety or depression does not cloud symptom reporting in CRS and should not bias clinical decision-making.