Symptom analysis of chronic rhinosinusitis reveals association with history of aspirin sensitivity and surgical outcomes

Published Online: July 29, 2015

Diagnosis of chronic sinusitis is based, in part, on presence of symptoms of sinus inflammation lasting greater than 12 weeks. A standardized questionnaire (such as Sino-nasal outcome test-22, SNOT-22) can be used to define the disease and to evaluate response to therapy. SNOT-22 is a well-rounded tool that asks for severity of sinus-related symptoms, such as nasal discharge and anosmia as well as non-sinus-related (general) symptoms such as fatigue, sleep issues, and productivity. Differences in symptom perception do exist among sinusitis patients, but differences in symptoms among subgroups of sinusitis patients are increasingly being recognized.

In the study published in The Journal of Allergy and Clinical Immunology: In Practice, Divekar et. al explored the question, “could an unbiased analysis of a structure questionnaire (such as SNOT-22) distinguish patient groupings based on symptoms patterns?” And if so, how would these symptom-based groups differ amongst each other? To this end, patients with chronic sinusitis who elected to have sinus surgery and had graded their symptoms based on SNOT-22 survey prior to surgery were enrolled. CT scan scores, laboratory values, history of aspirin sensitivity, allergies, asthma, and polyps were recorded. The patients recorded their symptoms before surgery and in two follow-up visits post-surgery.

Using an unsupervised (unbiased) approach, the analysis of symptoms showed that severity and the pattern of specific symptoms divide the patients into five subgroups. The first group had high symptom burden with equal emphasis on sinus and non-sinus symptoms; a second group had high burden which was sinonasal predominant; a third group had moderate burden which was sinonasal predominant; a fourth group had moderate burden but non-sinonasal predominant; and finally, the last group had mild sino-nasal predominant symptoms. In comparing the group characteristics, the first group showed worsening of symptoms at follow up visits, and the last group had no differences in symptoms before or after surgery. The last two groups were remarkable for lack of patients with history of aspirin sensitivity. In addition, patients with history of aspirin sensitivity were characterized by increased symptom scores for need to blow nose, runny nose, thick nasal discharge, ear pain/pressure, and reduction in sense of smell and taste.

Chronic sinusitis patients with aspirin sensitivity are unique in that they often have severe sinus disease, repeated surgeries and recurrence of polyps. Patients without a history of specific airway reaction to aspirin, may still have aspirin reactive airway disease and may benefit from aspirin desensitization. Biochemical markers to predict aspirin sensitivity are still in development; therefore, exploration of easily obtainable information such as symptoms may have a role. The observations of the current study suggest that specific symptom patterns could increase the index of suspicion for the presence of aspirin sensitivity. Furthermore, the results also identify a group of chronic sinusitis patients burdened by non-sinus related symptoms in whom symptoms return after surgery.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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