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. 2009 Nov;136(5):1324-1332.
doi: 10.1378/chest.08-1983. Epub 2009 Jul 6.

Criteria to screen for chronic sinonasal disease

Anne E Dixon  1 , Elizabeth A Sugar  2 , S James Zinreich  2 , Raymond G Slavin  3 , Jonathan Corren  4 , Robert M Naclerio  5 , Masaru Ishii  2 , Rubin I Cohen  6 , Ellen D Brown  2 , Robert A Wise  2 , Charles G Irvin  7 ; American Lung Association-Asthma Clinical Research Centers
Affiliations

Criteria to screen for chronic sinonasal disease

Anne E Dixon et al. Chest. 2009 Nov.

Abstract

Background: Sinusitis and rhinitis are associated with uncontrolled asthma. There are no simple, validated tools to screen for these diseases. The objective of this study was to assess instruments to assist in the diagnosis of chronic sinonasal disease.

Methods: Participants without acute sinonasal symptoms underwent an extensive evaluation. The results were submitted to an expert panel that used the Delphi method to achieve consensus. Using the consensus diagnosis of the panel, we determined the sensitivity and specificity of test procedures to diagnose chronic sinonasal disease. We determined the reproducibility of the most sensitive and specific instrument in a separate cohort.

Results: Fifty-nine participants were evaluated, and the expert panel reached consensus for all (42 participants with chronic sinonasal disease, 17 participants without chronic sinonasal disease). A six-item questionnaire based on the frequency of nasal symptoms was the most sensitive tool used to diagnose sinonasal disease (minimum specificity, 0.90). Reproducibility testing in a separate cohort of 63 participants (41 chronic sinonasal disease with asthma, 22 chronic sinonasal disease without asthma) showed a concordance correlation coefficient of 0.91 (95% CI, 0.85 to 0.94) when this questionnaire was limited to five items (ie, excluding a question on smell). This five-item questionnaire had a sensitivity of 0.90 (95% CI, 0.77 to 0.97), a specificity of 0.94 (95% CI, 0.71 to 1.00), and an area under the receiver operating characteristic curve of 0.97 (95% CI, 0.93 to 1.0). Sinus CT scans and nasal endoscopy lacked sensitivity for use in the diagnosis of chronic sinonasal disease.

Conclusions: We have developed a sensitive, specific, and reproducible instrument to screen for chronic sinonasal disease. Validation studies of this five-item questionnaire are needed, including in patients with asthma.

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Figures

Figure 1
Figure 1
Overview of study protocol.
Figure 2
Figure 2
ROC, including the AUC, with a bootstrap estimate of the 95% CI. Value shown for RQLQ is without activities, n = 56. Fifty-eight participants had sinus CT scores, and 1 participant without asthma was missing a sphenoid reading. The total sinus CT score is generated by calculating the sum of the area scores. See Table 3 for other abbreviations.
Figure 3
Figure 3
The SNQ.
See this image and copyright information in PMC

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