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Who knows what is wrong with your nose?

Published online: December 19, 2018

Diseases of the nose and/or sinuses often present with (a combination of) the same few complaints: a blocked or runny nose, loss of smell and / or a feeling of fullness in the face or head. This is true for someone with allergies as well as for someone with chronic inflammation of the nose and sinuses, which is termed ‘chronic rhinosinusitis’ or ‘CRS’. This is why determining the number of people with CRS (the prevalence) using questionnaires is somewhat tricky and the outcome is prone to overestimation. Currently, the prevalence of CRS is thought to be around 12%.

In a recently published article in in The Journal of Allergy & Clinical Immunology (JACI), Fokkens and co-workers report on their attempt to attain a more precise prevalence for CRS in the Netherlands by using information from imaging studies (computed tomography (CT) or magnetic resonance imaging (MRI) scans) in addition to information from surveys. Over 800 subjects who underwent imaging of the head for reasons other than a nasal/sinus problem were asked to fill in a questionnaire regarding their nasal complaints, if any.

Based on the questionnaires alone, the prevalence of CRS was found to be 12.8%. After they added data from the imaging studies, this number was reduced to 3.0 - 6.4%, depending on the cut-off values for the imaging abnormalities. Interestingly, many subjects had abnormalities on the scans but reported no complaints.

The authors concluded that the clinically based prevalence of CRS in the Netherlands is between 3.0 and 6.4%. Furthermore, they stated that the poor alignment of having complaints (or not) with having abnormalities on scans (or not) is a good incentive to reconsider the way CRS can be diagnosed accurately and reliably. In other words: it is not easy to know what exactly is wrong with a nose.

The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.