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Identifying clinical symptoms for improving the symptomatic diagnosis of chronic rhinosinusitis
Author(s) -
Hsueh Wayne D.,
Conley David B.,
Kim Haena,
ShintaniSmith Stephanie,
Chandra Rakesh K.,
Kern Robert C.,
Tan Bruce K.
Publication year - 2013
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21106
Subject(s) - medicine , hyposmia , otorhinolaryngology , retrospective cohort study , chronic rhinosinusitis , cohort , headaches , gold standard (test) , sinusitis , physical therapy , pediatrics , surgery , disease , covid-19 , infectious disease (medical specialty)
Background Current symptom criteria for identifying patients with chronic rhinosinusitis (CRS) has poor specificity. The objective of this study was to test the hypothesis that symptoms drawn from the Task Force on Rhinosinusitis (RSTF) criteria and the International Headache Society (IHS) criteria for primary headaches can differentiate CRS patients from those with CRS‐symptoms but no evidence for inflammation (non‐CRS). Methods A retrospective cohort study from a total of 140 charts of patients who received a diagnostic computed tomography (CT) scan for CRS symptoms in a tertiary care clinic. The study was conducted in 2 phases: (1) using a retrospective review of otolaryngologist‐documented symptoms (ODS) in the medical record; and (2) using patient‐reported symptoms (PRS) on a prospectively collected customized review of systems form from a separate cohort. A radiographic gold standard differentiated CRS from non‐CRS patients. Results Subjects in the CRS and non‐CRS group were matched for age and race and almost universally met symptomatic criteria as defined by the RSTF in both study phases. In both study phases, facial pain, but not facial pressure, was negatively predictive for CRS ( p < 0.05). Similarly, hyposmia was positively predictive, whereas facial pain of a pulsating quality and photophobia were negatively predictive ( p < 0.05), although analysis of PRS was significant only when symptom frequency was considered. Nonetheless, significant overlap exists between the prevalence and frequency of symptoms in both groups. Conclusion The symptom‐based diagnosis of CRS is challenging but symptoms of hyposmia is positively predictive while facial pain, a throbbing quality, headaches and photophobia are negatively predictive and show promise for improving the specificity of CRS diagnosis. Further validation studies are needed.