EPIDEMIOLOGY OF CHRONIC RHINOSINUSITIS IN THE GENERAL POPULATION USING OBJECTIVE EVIDENCE OF DISEASE

Abstract

Introduction Chronic rhinosinusitis (CRS) is a highly prevalent (8-12%) and morbid inflammatory disease of the sinuses. General population CRS prevalence has been identified by European Position Paper on Rhinosinusitis (EPOS) symptom criteria rather than by clinical criteria which requires both subjective and objective evidence (Lund-Mackay (LM) score ≥4). Methods This is a descriptive study of the prevalence of CRS and LM score in the general population, stratified by sex. Using questionnaire-based symptom criteria as identified by EPOS and latent class analysis on 7847 subjects, stratified random sampling was done to invite 3269 subjects for sinus CT scan, which could be reflected back to 200,769 in the source population. EPOS symptoms were collected along with CT, which were independently reviewed by two otolaryngologists to provide LM score. Prevalence estimates were obtained by weighted frequency analysis. Results There were 646 who had CT scan, with 67% female, 96% white, 50% with EPOS symptoms and 30% with asthma. After applying sampling weights, the prevalence of EPOS symptoms was 16%, LM ≥3 12% and LM ≥4 11%, and clinical criteria for CRS 3%. There were sex differences in these, EPOS symptoms, female 15%, male 20%; LM ≥4, female 10%, male 15%, and clinical criteria for CRS female 2%, male 8%. Conclusions Our general population clinical CRS prevalence estimates are closer to previous estimates by EPOS symptoms for males but not females. This signifies disconnect between symptoms and objective evidence for females, and the need for re-evaluation of the current diagnostic criteria for females. Chronic rhinosinusitis (CRS) is a highly prevalent (8-12%) and morbid inflammatory disease of the sinuses. General population CRS prevalence has been identified by European Position Paper on Rhinosinusitis (EPOS) symptom criteria rather than by clinical criteria which requires both subjective and objective evidence (Lund-Mackay (LM) score ≥4). This is a descriptive study of the prevalence of CRS and LM score in the general population, stratified by sex. Using questionnaire-based symptom criteria as identified by EPOS and latent class analysis on 7847 subjects, stratified random sampling was done to invite 3269 subjects for sinus CT scan, which could be reflected back to 200,769 in the source population. EPOS symptoms were collected along with CT, which were independently reviewed by two otolaryngologists to provide LM score. Prevalence estimates were obtained by weighted frequency analysis. There were 646 who had CT scan, with 67% female, 96% white, 50% with EPOS symptoms and 30% with asthma. After applying sampling weights, the prevalence of EPOS symptoms was 16%, LM ≥3 12% and LM ≥4 11%, and clinical criteria for CRS 3%. There were sex differences in these, EPOS symptoms, female 15%, male 20%; LM ≥4, female 10%, male 15%, and clinical criteria for CRS female 2%, male 8%. Our general population clinical CRS prevalence estimates are closer to previous estimates by EPOS symptoms for males but not females. This signifies disconnect between symptoms and objective evidence for females, and the need for re-evaluation of the current diagnostic criteria for females.