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. 2020 Apr;75(4):911-920.
doi: 10.1111/all.14106. Epub 2019 Dec 2.

Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population-based sample

Annemarie G Hirsch  1   2 , Cara Nordberg  3 , Karen Bandeen-Roche  4 , Bruce K Tan  5   6 , Robert P Schleimer  5   6 , Robert C Kern  5   6 , Agnes Sundaresan  1 , Jayant M Pinto  7 , Thomas L Kennedy  8 , Joseph Scott Greene  8 , Jordan R Kuiper  2 , Brian S Schwartz  1   2
Affiliations

Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population-based sample

Annemarie G Hirsch et al. Allergy. 2020 Apr.

Abstract

Background: Chronic rhinosinusitis (CRS) epidemiology has been largely studied using symptom-based case definitions, without assessment of objective sinus findings.

Objective: To describe radiologic sinus opacification and the prevalence of CRS, defined by the co-occurrence of symptoms and sinus opacification, in a general population-based sample.

Methods: We collected questionnaires and sinus CT scans from 646 participants selected from a source population of 200 769 primary care patients. Symptom status (CRSS ) was based on guideline criteria, and objective radiologic inflammation (CRSO ) was based on the Lund-Mackay (L-M) score using multiple L-M thresholds for positivity. Participants with symptoms and radiologic inflammation were classified as CRSS+O . We performed negative binomial regression to assess factors associated with L-M score and logistic regression to evaluate factors associated with CRSS+O . Using weighted analysis, we calculated estimates for the source population.

Results: The proportion of women with L-M scores ≥ 3, 4, or 6 (CRSO ) was 11.1%, 9.9%, and 5.7%, respectively, and 16.1%, 14.6%, and 8.7% among men. The respective proportion with CRSS+O was 1.7%, 1.6%, and 0.45% among women and 8.8%, 7.5%, and 3.6% among men. Men had higher odds of CRSS+O compared to women. A greater proportion of men (vs women) had any opacification in the frontal, anterior ethmoid, and sphenoid sinuses.

Conclusion: In a general population-based sample in Pennsylvania, sinus opacification was more common among men than in women and opacification occurred in different locations by sex. Male sex, migraine headache, and prior sinus surgery were associated with higher odds of CRSS+O .

Keywords: CT scan; chronic rhinosinusitis; epidemiology; sex; sinus.

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Conflict of interest statement

Conflict of interest statement:

Dr. Hirsch reports grants from NIAID, during the conduct of the study; Dr. Bandeen-Roche reports grants from Geisinger, during the conduct of the study; grants from National Institutes of Health, grants from Centers for Disease Control, outside the submitted work; Dr. Tan reports grants from NIH, personal fees from Optinose, personal fees from Sanofi, outside the submitted work; Dr. Schleimer reports grants from NIH, during the conduct of the study; personal fees from Intersect ENT, personal fees from GlaxoSmithKline, other from Allakos, other from Aurasense, personal fees from Merck, other from BioMarck, personal fees from Sanofi, personal fees from AstraZeneca/Medimmune, personal fees from Genentech, other from Exicure Inc, personal fees from Otsuka Inc, other from Aqualung Therapeutics Corp, personal fees from Actobio Therapeutics, personal fees from Lyra Therapeutics, personal fees from Astellas Pharma Inc, outside the submitted work; In addition, Dr. Schleimer has a patent Siglec-8 and Siglec-8 ligand related patents licensed to Allakos Inc.; Dr. Kern reports personal fees from Sanofi, personal fees from Novartis, personal fees from Lyra Pharmaceutical, personal fees from Neurent, outside the submitted work; Dr. Sundaresan reports grants from NIH, during the conduct of the study; Dr. Pinto reports personal fees from Optinose, personal fees from Genentech, personal fees from ALK, personal fees from Stallergenes, grants from NIH, outside the submitted work; Dr. Kennedy has nothing to disclose; Dr. Greene has nothing to disclose; Dr. Kuiper has nothing to disclose; Dr. Schwartz reports grants from NIAID, during the conduct of the study.

Figures

Figure I.
Figure I.
Associations (odds ratios) of sex, migraine headache, and prior sinus surgery with CRSS+O (CRS symptoms with Lund-Mackay ≥ 3) in the source population (646 sinus CT participants weighted for sampling and participation using truncated weights) and among participants with no evidence of prior sinus surgery on sinus CT (n = 526). Adjusted for age (centered), sex, anxiety sensitivity index, and patient-reported asthma diagnosis.
See this image and copyright information in PMC

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