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

• Published in: Allergy (Copenhagen) Vol. 75; no. 4; pp. 911 - 920
• Main Authors: Hirsch, Annemarie G., Nordberg, Cara, Bandeen‐Roche, Karen, Tan, Bruce K., Schleimer, Robert P., Kern, Robert C., Sundaresan, Agnes, Pinto, Jayant M., Kennedy, Thomas L., Greene, Joseph Scott, Kuiper, Jordan R., Schwartz, Brian S.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.04.2020
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; chronic rhinosinusitis; CT scan; Epidemiology; Female; Headache; Humans; Inflammation; Male; Middle Aged; Migraine; Paranasal Sinuses - diagnostic imaging; Pennsylvania; Rhinitis; Rhinitis - diagnostic imaging; Rhinitis - epidemiology; Rhinosinusitis; sex; sinus; Sinuses; Sinusitis; Sinusitis - diagnostic imaging; Sinusitis - epidemiology; Surgery; Young Adult; Pennsylvania; chronic rhinosinusitis; epidemiology; sinus; CT scan; sex
• ISSN: 0105-4538; 1398-9995; 1398-9995
• DOI: 10.1111/all.14106

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. This was a cross‐sectional study of nasal and sinus symptoms and sinus opacification in a population‐based sample in central Pennsylvania. Chronic rhinosinusitis (CRS), defined as the co‐occurrence of symptoms and radiologic inflammation, was found in 1.6% of women and 7.5% of men in central Pennsylvania. A greater proportion of men (vs. women) had opacification in the frontal, anterior ethmoid and sphenoid sinuses.