Relationship between Mucosal Inflammation, Computed Tomography, and Symptomatology in Chronic Rhinosinusitis without Polyposis

Abstract

This study was an attempt to determine whether sinus mucosal inflammation is related to computed tomographic findings and patients' reported symptoms in chronic rhinosinusitis (CRS) without polyposis. I retrospectively reviewed the clinical symptom scores according to the Rhinosinusitis Symptom Inventory (RSI), the radiographic findings, and the histopathologic findings in the paranasal sinus mucosa for a consecutive series of adult patients who underwent endoscopic sinus surgery for CRS. Linear regression analysis was conducted for the relationship between tissue pathology inflammatory severity score graded on a 5-point Likert scale and the RSI symptom domains. A similar analysis was conducted for the relationship between the pathology inflammatory score and the total Lund score. The study cohort consisted of 115 adult patients (mean age, 40.2 years). The mean Lund score for the cohort was 8.8 (95% confidence interval, 7.9 to 9.7), and the mean pathology severity score was 2.1 (median, 2.0). The mean total symptom score for the overall cohort was 41.3; the mean total symptom scores for pathology severity grades 0, 1, 2, 3, and 4 were 25.0, 43.8, 41.8, 42.4, and 32.8, respectively. No significant association could be identified between pathology severity and any of the 5 RSI symptom domains (nasal, facial, oropharyngeal, systemic, and total symptoms; all p > .436, linear regression). A statistically significant relationship between total Lund score and pathology severity was identified (p < .001). Poor correlation exists between the histopathologic severity of sinonasal inflammation and self-reported symptom scores in CRS. Histopathologic inflammatory grade alone fails to stratify CRS cases according to disease symptom severity. Histopathologic inflammation and computed tomographic findings correlate strongly.