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Poto R, Pelaia C, di Salvatore A, Saleh H, Scadding GW, Varricchi G. Imaging of chronic rhinosinusitis with nasal polyps in the era of biological therapies. Curr Opin Allergy Clin Immunol 2024; 24:243-250. [PMID: 38205820 PMCID: PMC11213496 DOI: 10.1097/aci.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a chronic inflammatory disorder of the sinonasal cavities classified into two major phenotypes: CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). The diagnosis of CRS is based on clinical symptoms associated with imaging and/or nasal endoscopy findings of mucosal inflammation. RECENT FINDINGS Recently, novel biological therapies have emerged as therapeutic options for CRSwNP. Imaging is helpful in deciding whether surgery is likely to be beneficial and in guiding surgery. It can also help demonstrate a clinical response to medical therapy. However, specific guidelines concerning the role of imaging in CRwNP are lacking. SUMMARY This article provides a comprehensive and critical multidisciplinary review of the role of conventional radiology, computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis and characterization of CRSwNP. Since the complete characterization of nasal polyps on CT or MR images is very challenging, we provide a critical review of the best imaging methods and essential reporting elements used to assess nasal polyps.
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Affiliation(s)
- Remo Poto
- Department of Translational Medical Sciences
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II
- World Allergy Organization (WAO) Center of Excellence, Naples
| | - Corrado Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | | | - Hesham Saleh
- Charing Cross Hospital, Imperial College Healthcare NHS Foundation Trust
| | - Guy W. Scadding
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College, London, UK
| | - Gilda Varricchi
- Department of Translational Medical Sciences
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II
- World Allergy Organization (WAO) Center of Excellence, Naples
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy
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Alsalem S, Almontashri A, Alsalem M, Altamimi F, Alyami N, Hajjaf S, Ahmed F. Value of MRI signal intensity in evaluation of allergic fungal rhinosinusitis compared with CT Hounsfield units: Retrospective study. Medicine (Baltimore) 2024; 103:e38951. [PMID: 38996133 PMCID: PMC11245196 DOI: 10.1097/md.0000000000038951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
"Allergic fungal sinusitis (AFS)" is typically diagnosed using radiologic images like computed tomography (CT) scans and magnetic resonance imaging (MRI), with the "Hounsfield unit (HU)" in CT scans and T2-weighted images (T2WI) in MRI serving as reliable objective parameters. However, diagnosing AFS might be difficult because of possible signal changes and densities caused by variations in the secretion concentration in the sinus. Few studies have compared the diagnostic performance of MRI and CT scans. This study aimed to investigate the value of MRI signal intensity in evaluating AFS compared with CT HUs. This retrospective study included 111 patients with pathologically confirmed AFS who underwent CT imaging followed by MRI evaluation at King Saud Medical City, Riyadh, Saudi Arabia, from January 2012 to December 2022. Radiographic densities of sinus opacities on CT scan, including the mean HU values, and MRI findings, including signal voids on T1-weighted images and T2WI, were gathered and analyzed. To determine the efficacy of these radiographic characteristics in predicting the disease and the best cutoff value, we employed receiver operator characteristic curves. The mean age was 31.9 ± 15.6 years, and most patients were 74 females (66.7%). The main symptom was nasal obstruction in 73 patients (65.8%). In comparison, between HU and signal void on T2WI, there was moderate predictive performance [area under the curve: 0.856, P = .001]. An ideal HU cutoff value of 69.50 HU was obtained with a sensitivity of 100% and a specificity of 44.7%. However, the receiver operator characteristic for T1-weighted images could not be plotted, as no signal was avoided to predict AFS and it was not statistically significant (area under the curve: 0.566; P = .287). The study found a CT HU of 69.5 can predict MRI T2WI signal values with a void signal, aiding in diagnostic workup and evaluation for AFS.
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Affiliation(s)
- Seham Alsalem
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Department of Radiology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ali Almontashri
- Department of Hematology, Maternity and Children Hospital, Najran, Saudi Arabia
| | - Mohammed Alsalem
- Department of Radiology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fahad Altamimi
- Department of Otolaryngology, King Saud Medical City, Alfaisal University, Riyadh, Saudi Arabia
| | - Nasher Alyami
- Department of Laboratory Medicine, Hematology Section, King Khaled University Hospital, Ministry of Health, Najran, Saudi Arabia
| | - Shaker Hajjaf
- Department of Radiology, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University, Ibb, Yemen
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Miller JE, Taylor-Cousar JL, Humphries SM, Khatiwada A, Chen H, Wilson A, Vladar EK, Lynch DA, Li DA, Beswick DM. Chronic rhinosinusitis and olfaction after highly effective modulator therapy: The role of individual sinus inflammation. Int Forum Allergy Rhinol 2024; 14:986-989. [PMID: 38146638 DOI: 10.1002/alr.23299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 12/27/2023]
Abstract
KEY POINTS Individual sinus opacification (ISO) is measurable via a convolutional neural network approach. ISO decreased through 2 years after highly effective modulator therapy was initiated. In adults with cystic fibrosis, ISO did not correlate with quality of life or olfaction.
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Affiliation(s)
- Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | | | | | - Aastha Khatiwada
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | - Haidee Chen
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Alexandra Wilson
- Department of Clinical Research Services, National Jewish Health, Denver, Colorado, USA
| | - Eszter K Vladar
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, USA
| | - Douglas A Li
- Division of Pediatric Pulmonology, University of California, Los Angeles, California, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
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Li F, Wang S, Cha X, Li T, Xie Y, Wang W, Ren W, Liao J, Liu H. Blood Eosinophil Percentage and Improved Sinus CT Score as Diagnostic Tools for ECRS. OTO Open 2024; 8:e106. [PMID: 38223492 PMCID: PMC10784852 DOI: 10.1002/oto2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Differentiating 2 types of chronic rhinosinusitis with nasal polyps (CRSwNP) is important for the treatment. The current diagnostic methods using single indicators, including peripheral blood eosinophils and traditional sinus computed tomography (CT) scores, are not accurate. In this study, we aimed to investigate the diagnostic value of combining peripheral blood eosinophils and improved sinus CT scores for eosinophic chronic rhinosinusitis (ECRS). Study Design Retrospective cohort. Setting Tertiary medical center. Methods We conducted a study involving 81 patients with CRSwNP. Peripheral blood samples were collected from the non-ECRS and ECRS groups. Improved three-dimensional volume image analysis and Lund-Mackay scoring system were performed to quantify the thickening of sinus mucosa. Multivariate binary logistic regression analysis was carried out to detect the predictive value of the scoring indicators. For significant indexes, receiver operating characteristic (ROC) curve analysis was applied. Results The ECRS group had higher levels of blood eosinophil percentage and count, ethmoid sinus score, total sinus score, the ratio of ethmoid sinus score and maxillary sinus score, and the difference between ethmoid and maxillary score, compared to the non-ECRS group (P < 0.05). Binary logistic regression analysis demonstrated that both blood eosinophil percentage and the improved E - M score (subtraction of ethmoid and maxillary sinus scores) were significant predictors of ECRS diagnosis (P < .01). ROC curve analysis indicated that the combination of improved E - M score and blood eosinophil percentage had a higher diagnostic value compared to either factor alone (area under the curve = 0.874). Conclusion Our study suggested the combination of improved total ethmoid sinus-maxillary score and blood eosinophil percentage is more accurate in predicting the diagnosis of ECRS.
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Affiliation(s)
- Fengzhen Li
- Department of Otolaryngology–Head and Neck Surgery, Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Shenglei Wang
- Department of Otolaryngology–Head and Neck Surgery, Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Xudong Cha
- Department of Otolaryngology–Head and Neck Surgery, Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Tengfei Li
- Department of Otolaryngology–Head and Neck Surgery, Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Yingqi Xie
- Department of Otolaryngology–Head and Neck Surgery, Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Wenwen Wang
- Department of Neurology, Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Wenwen Ren
- Department of Otolaryngology–Head and Neck Surgery, Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Jianchun Liao
- Department of Otolaryngology–Head and Neck Surgery, Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Huanhai Liu
- Department of Otolaryngology–Head and Neck Surgery, Changzheng HospitalNaval Medical UniversityShanghaiChina
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Beswick DM, Humphries SM, Miller JE, Balkissoon CD, Khatiwada A, Vladar EK, Ramakrishnan VR, Lynch DA, Taylor‐Cousar JL. Objective and patient-based measures of chronic rhinosinusitis in people with cystic fibrosis treated with highly effective modulator therapy. Int Forum Allergy Rhinol 2022; 12:1435-1438. [PMID: 35595546 PMCID: PMC9790219 DOI: 10.1002/alr.23016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel M. Beswick
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of CaliforniaLos AngelesCA
| | | | - Jessa E. Miller
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of CaliforniaLos AngelesCA
| | | | | | - Eszter K. Vladar
- Department of MedicineDivision of Pulmonary Sciences and Critical Care MedicineAuroraCO,Department of Cell and Developmental BiologyUniversity of Colorado School of MedicineAuroraCO
| | | | | | - Jennifer L. Taylor‐Cousar
- Department of MedicineNational Jewish HealthDenverCO,Department of PediatricsNational Jewish HealthDenverCO
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Massey CJ, Ramos L, Beswick DM, Ramakrishnan VR, Humphries SM. Clinical Validation and Extension of an Automated, Deep Learning-Based Algorithm for Quantitative Sinus CT Analysis. AJNR Am J Neuroradiol 2022; 43:1318-1324. [PMID: 36538385 PMCID: PMC9451634 DOI: 10.3174/ajnr.a7616] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/18/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Sinus CT is critically important for the diagnosis of chronic rhinosinusitis. While CT is sensitive for detecting mucosal disease, automated methods for objective quantification of sinus opacification are lacking. We describe new measurements and further clinical validation of automated CT analysis using a convolutional neural network in a chronic rhinosinusitis population. This technology produces volumetric segmentations that permit calculation of percentage sinus opacification, mean Hounsfield units of opacities, and percentage of osteitis. MATERIALS AND METHODS Demographic and clinical data were collected retrospectively from adult patients with chronic rhinosinusitis, including serum eosinophil count, Lund-Kennedy endoscopic scores, and the SinoNasal Outcomes Test-22. CT scans were scored using the Lund-Mackay score and the Global Osteitis Scoring Scale. CT images were automatically segmented and analyzed for percentage opacification, mean Hounsfield unit of opacities, and percentage osteitis. These readouts were correlated with visual scoring systems and with disease parameters using the Spearman ρ. RESULTS Eighty-eight subjects were included. The algorithm successfully segmented 100% of scans and calculated features in a diverse population with CT images obtained on different scanners. A strong correlation existed between percentage opacification and the Lund-Mackay score (ρ = 0.85, P < .001). Both percentage opacification and the Lund-Mackay score exhibited moderate correlations with the Lund-Kennedy score (ρ = 0.58, P < .001, and ρ = 0.58, P < .001, respectively). The percentage osteitis correlated moderately with the Global Osteitis Scoring Scale (ρ = 0.48, P < .001). CONCLUSIONS Our quantitative processing of sinus CT images provides objective measures that correspond well to established visual scoring methods. While automation is a clear benefit here, validation may be needed in a prospective, multi-institutional setting.
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Affiliation(s)
- C J Massey
- From the Department of Otolaryngology-Head and Neck Surgery (C.J.M., L.R., V.R.R.), University of Colorado School of Medicine, Aurora, Colorado
| | - L Ramos
- From the Department of Otolaryngology-Head and Neck Surgery (C.J.M., L.R., V.R.R.), University of Colorado School of Medicine, Aurora, Colorado
| | - D M Beswick
- Department of Otolaryngology-Head and Neck Surgery (D.M.B.), University of California-Los Angeles School of Medicine, Los Angeles, California
| | - V R Ramakrishnan
- From the Department of Otolaryngology-Head and Neck Surgery (C.J.M., L.R., V.R.R.), University of Colorado School of Medicine, Aurora, Colorado
| | - S M Humphries
- Quantitative Imaging Laboratory (S.M.H.), Department of Radiology, National Jewish Health, Denver, Colorado
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Hopkins C, Lee SE, Klimek L, Soler ZM. Clinical Assessment of Chronic Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1406-1416. [PMID: 35183784 DOI: 10.1016/j.jaip.2022.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 12/15/2022]
Abstract
Chronic rhinosinusitis (CRS) is a common disease that affects >10% of the adult population in Europe and the United States. It has been delineated phenotypically into CRS without nasal polyps and CRS with nasal polyps. Both have a high disease burden and an overlapping spectrum of symptoms such as nasal obstruction, olfactory dysfunction, facial pain, pressure, and nasal discharge. Primary assessment includes evaluation of patient symptoms and impact on quality of life, nasal endoscopic examination, and imaging. Significant progress has been made in the understanding of CRS pathophysiology. There is a move toward describing CRS in terms of the predominant endotype or inflammatory pattern pathomechanism rather than the traditional classification of patients with and without nasal polyps. An increased elucidation of the disease endotypes, as characterized by their inflammatory pathways and mediators, is leading to a tailored more personalized treatment approach to the different disease subtypes.
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Affiliation(s)
| | - Stella E Lee
- Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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Imaging in chronic rhinosinusitis: A systematic review of MRI and CT diagnostic accuracy and reliability in severity staging. J Neuroradiol 2021; 48:277-281. [PMID: 33539844 DOI: 10.1016/j.neurad.2021.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Computerized tomography (CT) severity scores are frequently used as an objective staging tool in chronic rhinosinusitis (CRS). Magnetic resonance imaging (MRI) has also been proposed as a valid option in CRS imaging. PURPOSE The aim of this systematic review was to briefly present the recent developments on sinus imaging utilized in clinical practice with regard to diagnostic accuracy of imaging and severity staging in CRS according to evidence-based medicine (EBM) principles. MATERIAL AND METHODS This review paper has been assembled following PRISMA guidelines. A PubMed and Scopus (EMBASE) search using CRS, "severity staging", "diagnostic accuracy "and "imaging "resulted with 80 results. Of these, only 12 (59%) contained original data, constituting the synthesis of best-quality available evidence. RESULTS CT is the most commonly used imaging technique for the severity staging of CRS, but a question of higher cumulative radiation dose should be taken into consideration when repeating CT examinations in evaluating treatment efficacy. MRI may be a complementary diagnostic and staging tool, especially when repeated examinations are required, or when paediatric CRS patients are evaluated. The severity staging system may be improved to better correlate with subjective scores. CONCLUSIONS MRI may be utilized as a staging tool with comparable diagnostic accuracy, using the same staging systems as with CT examinations.
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Zhou AS, Prince AA, Maxfield AZ, Corrales CE, Shin JJ. Sinonasal Outcome Scores and Imaging: A Concurrent Assessment of Factors Influencing Their Association. Otolaryngol Head Neck Surg 2020; 165:215-222. [PMID: 33170758 DOI: 10.1177/0194599820972672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The overall discriminatory ability of validated instrument scores for computed tomography (CT) findings of chronic rhinosinusitis has limitations and may be modified by multiple factors. To support optimal methods for assessment, we studied which factors could influence this relationship, including the concurrent impact of multiple discrete CT scoring mechanisms, colocalized imaging findings, and nasal comorbid conditions. STUDY DESIGN Observational outcomes study. SETTING Academic medical center. METHODS Patients with sinonasal complaints who completed the 22-item Sinonasal Outcome Test (SNOT-22) and underwent CT were included. Multivariate ordinal regression was utilized to assess associations. CT data were quantified with the Lund-Mackay system, Zinreich system, and a direct measure of maximal mucosal thickness. The impact of incidental findings (mucous retention cysts, periapical dental disease) and nasal comorbid conditions was also assessed. RESULTS A total of 233 patients were included. SNOT-22 nasal scores were significantly associated with CT results when those with incidental findings were excluded, regardless of the radiologic scoring mechanism utilized: Lund-Mackay regression coefficient, 0.321 (P = .046); Zinreich, 0.340 (P = .033); and maximum mucosal thickness, 0.316 (P = .040). This relationship subsided when incidental findings were present. SNOT-22 overall scores, sleep scores, and psychological domain scores had no significant association with imaging results, regardless of radiologic scoring system utilized. Nasal comorbid conditions had inconsistent associations. CONCLUSIONS SNOT-22 nasal domain scores were associated with all 3 radiologic scoring systems when incidental findings were absent but not when they were present. Delineating the presence or absence of these colocalized findings affected the relationship between SNOT-22 scores and radiological results, beyond other concurrent factors.
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Affiliation(s)
- Allen S Zhou
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony A Prince
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Z Maxfield
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - C Eduardo Corrales
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Lu H, Liu Z, Hu L, Feng X, Hu L, Gu Y, Li H, Li H, Wang D. Are objective 'findings' the same as subjective 'severity'? A study of the relationship between computed tomography findings and subjective severity in preoperative CRSwNP patients. Exp Ther Med 2020; 20:2985-2992. [PMID: 32855664 PMCID: PMC7444383 DOI: 10.3892/etm.2020.9032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/22/2020] [Indexed: 01/20/2023] Open
Abstract
In pre-surgical patients with chronic rhinosinusitis with nasal polyps (CRSwNPs), positive findings on computed tomography (CT) scans and an exacerbation of symptoms are two possible factors that indicate surgery. However, the relationship between these factors remains unclear. Confirmed CRSwNP patients ready for sinus surgery were consecutively enrolled. The Sino-Nasal Outcome Test 22 (SNOT-22) and visual analog scale (VAS) scoring were completed by these patients, and scores were subjected to factor analysis using a principal component analysis (PCA) to evaluate subjective symptom components related to CRS. Patient CT scores, measured by the Lund-Mackay score (LMS), together with their demographics, medical treatment, and atopy status, were collected and analyzed. A total of 288 patients who met the criteria for CRSwNP and underwent CT scanning prior to surgery in the Eye, Ear, Nose, and Throat Hospital of Fudan University were enrolled. Five components were identified from the PCA of the SNOT-22 results and VAS scores related to subjective symptoms. More severe ‘nasal’ symptoms (P=0.03; 95% CI, 0.092-1.824), loss of smell and taste (P<0.001; 95% CI, 0.961-1.767) and lower facial pain (P=0.001; 95% CI 1.811 to -0.475), derived from the SNOT-22, were significantly associated with total CT score. For the VAS PCA components, less severe ‘ocular’ symptoms (P=0.004; 95% CI -1.852 to -0.352), a reduced ‘pain’ component (P<0.001; 95% CI -2.133 to -0.715), a higher ‘nasal’ symptom component (P<0.001; 95% CI 0.752-2.257) and, again, loss of smell and taste (P<0.001; 95% CI 0.437-0.811) showed an association with total CT score. ‘Allergy-associated symptoms’ in both the SNOT-22 and VAS scores and ‘loss of smell or taste’ and ‘hyposmia’ were significantly more severe in patients with ethmoid sinus/maxillary sinus (E/M) ratios of >2.59 compared with patients with E/M ratios <2.59. Loss of smell and taste alone was correlated with the LMS in patients with highly positive CT scores. The present study demonstrated associations between several subjective symptoms and objective severity in preoperative CRSwNP patients. Nasal symptoms, including olfaction loss, were correlated positively with CT scores, while ocular- and pain-related symptoms showed an opposite pattern. However, this relationship was not confirmed in patients with highly positive CT scores. A subset analysis confirmed, in terms of symptoms, the value of the E/M ratio for indicating eosinophilic chronic rhinosinusitis.
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Affiliation(s)
- Hanyu Lu
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
| | - Zhuofu Liu
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
| | - Li Hu
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
| | - Xian Feng
- Department of Clinical Laboratory, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
| | - Li Hu
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
| | - Yurong Gu
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
| | - Houyong Li
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
| | - Huabin Li
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
| | - Dehui Wang
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
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Speth MM, Phillips KM, Hoehle LP, Caradonna DS, Gray ST, Sedaghat AR. Longitudinal improvement in nasal obstruction symptoms of chronic rhinosinusitis directly associates with improvement in mood. Eur Arch Otorhinolaryngol 2019; 276:2827-2833. [PMID: 31325032 DOI: 10.1007/s00405-019-05569-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/13/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The effects of nasal obstruction in patients with chronic rhinosinusitis (CRS) are associated with depressed mood. We sought to validate this finding by determining whether improvement in nasal obstruction would translate to improvement in depressed mood. METHODS This was a prospective observational study of 150 patients undergoing medical management for CRS. Data were collected at two timepoints: enrollment and a subsequent follow-up visit 3-12 months later. Impact of nasal obstruction was measured using the Nasal Obstruction Symptom Evaluation (NOSE) instrument and depressed mood was measured using the 2-item Patient Health Questionnaire (PHQ-2). Sinonasal symptoms associated with CRS were also measured using the 22-item Sinonasal Outcome Test (SNOT-22). Clinical and demographic characteristics were collected. The relationship between changes in PHQ-2 and NOSE scores was determined with correlation and linear regression. RESULTS Change in PHQ-2 score was significantly correlated with change in NOSE score (ρ = 0.30, p < 0.001). After controlling for covariates, change in PHQ-2 score was associated with change in NOSE score (adjusted linear regression coefficient [β] = 0.014, 95% CI 0.006-0.022, p = 0.001). We confirmed these relationships, finding that change in PHQ-2 was associated (adjusted β = 0.037, 95% CI 0.013-0.061, p = 0.003) with change in the nasal subdomain score of the SNOT-22. Improvement in NOSE score by greater than 22 points was predictive of improvement in PHQ-2 score with sensitivity 54.5% and 83.8% specificity (p < 0.001). CONCLUSION These results provide evidence that improvements in nasal manifestations/symptoms of CRS translate to significant improvements in mood.
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Affiliation(s)
- Marlene M Speth
- Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Switzerland
| | - Katie M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Lloyd P Hoehle
- Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, SC, USA
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Medical Sciences Building Room 6410, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA.
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Lim S, Ramirez MV, Garneau JC, Ford MK, McKeough K, Ginat DT, Baroody FM, Armato SG, Pinto JM. Three-dimensional image analysis for staging chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:1052-1057. [PMID: 28941169 DOI: 10.1002/alr.22014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/13/2017] [Accepted: 08/22/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Traditional methods of staging chronic rhinosinusitis (CRS) through imaging do not differentiate between degrees of partial mucosal sinus inflammation, thus limiting their utility as imaging biomarkers. We hypothesized that software-aided, quantitative measurement of sinus inflammation would generate a metric of disease burden that would correlate with clinical parameters in patients with suspected sinus disease. METHODS Adults with rhinologic complaints undergoing computed tomography imaging were recruited at an urban, academic, tertiary care center (n = 45 with Lund-Mackay [LM] scores ≥4). Three-dimensional (3D) volumetric image analysis was performed using a semiautomated method to obtain a "Chicago-modified Lund-Mackay" (Chicago MLM) score, which provides a continuous scale to quantify extent of opacification. Linear regression was used to test the association of the Chicago MLM score with concurrent symptoms (Total Nasal Symptom Score [TNSS]) and disease-specific quality of life, based on the Sinonasal Outcome Test-22 (SNOT-22). RESULTS Chicago MLM scores were significantly associated with both symptoms (p = 0.037) and disease-specific quality of life (p = 0.007). Inflammation in the ethmoid and sphenoid sinuses appeared to influence these associations. These findings were even more robust when analysis was limited to patients with more severe disease (LM >6). CONCLUSION The quantitative measurement of sinus inflammation by computer-aided 3D analysis correlates modestly with both symptoms and disease-specific quality of life. Posterior sinuses appear to have the greatest impact on these findings, potentially providing an anatomic target for clinicians to base therapy. The Chicago MLM score is a promising imaging biomarker for clinical and research use.
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Affiliation(s)
- Sooyoung Lim
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | | | - Megan K Ford
- Department of Radiology, University of Chicago, Chicago, IL
| | - Katherine McKeough
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Daniel T Ginat
- Department of Radiology, University of Chicago, Chicago, IL
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | | | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL.,Center on Demography and Economics of Aging, University of Chicago, Chicago, IL
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13
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Gray S, Hoehle L, Phillips K, Caradonna D, Sedaghat A. Patient-reported control of chronic rhinosinusitis symptoms is positively associated with general health-related quality of life. Clin Otolaryngol 2017; 42:1161-1166. [DOI: 10.1111/coa.12841] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 02/04/2023]
Affiliation(s)
- S.T. Gray
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston MA USA
| | - L.P. Hoehle
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston MA USA
| | - K.M. Phillips
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston MA USA
| | - D.S. Caradonna
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Division of Otolaryngology; Beth Israel Deaconess Medical Center; Boston MA USA
| | - A.R. Sedaghat
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston MA USA
- Division of Otolaryngology; Beth Israel Deaconess Medical Center; Boston MA USA
- Department of Otolaryngology and Communications Enhancement; Boston Children's Hospital; Boston MA USA
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14
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Association of severity of chronic rhinosinusitis with degree of comorbid asthma control. Ann Allergy Asthma Immunol 2016; 117:651-654. [DOI: 10.1016/j.anai.2016.09.439] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/12/2016] [Accepted: 09/23/2016] [Indexed: 12/13/2022]
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15
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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16
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Abuzeid WM, Mace JC, Costa ML, Rudmik L, Soler ZM, Kim GS, Smith TL, Hwang PH. Outcomes of chronic frontal sinusitis treated with ethmoidectomy: a prospective study. Int Forum Allergy Rhinol 2016; 6:597-604. [PMID: 26879467 DOI: 10.1002/alr.21726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/24/2015] [Accepted: 12/22/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND In medically refractory chronic frontal sinusitis, ethmoidectomy without instrumentation of the frontal ostium may resolve frontal disease. Our aim was to determine the efficacy of ethmoidectomy alone for the treatment of chronic frontal sinusitis. METHODS Adults with chronic rhinosinusitis prospectively enrolled in a multicenter study who demonstrated frontal sinusitis on computed tomography were divided into 2 groups: (1) endoscopic sinus surgery (ESS) incorporating ethmoidectomy, but excluding frontal sinusotomy; and (2) ESS incorporating frontal sinusotomy. The primary outcome was improvement in 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Secondary outcomes included endoscopic scores and use of corticosteroids and antibiotics. RESULTS A total of 196 cases undergoing frontal sinusotomy and 30 cases treated with ethmoidectomy without frontal sinusotomy were analyzed and were comparable demographically. The prevalence of nasal polyps, previous ESS, asthma, and aspirin intolerance was more common in the frontal sinusotomy group (p < 0.050). Preoperative endoscopy and computed tomography scores were higher in the frontal sinusotomy group (p ≤ 0.001). Postoperatively, both groups showed comparable SNOT-22 scores with worse endoscopy scores in the frontal sinusotomy group (p = 0.038). Postoperative improvement in SNOT-22 total and subdomain scores was comparable between groups. Nasal endoscopy scores improved to a greater degree in the frontal sinusotomy group (p = 0.023). Duration of postoperative topical steroid use was higher in the frontal sinusotomy group (p = 0.007). Revision surgery was needed in 2.6% of frontal sinusotomy patients and 0% of patients without frontal sinusotomy. CONCLUSION The treatment of chronic frontal sinusitis through ethmoidectomy is a potential alternative to frontal sinusotomy achieving similar quality of life (QOL) improvements in patients manifesting less severe sinus disease.
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Affiliation(s)
- Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, OR
| | - Milena L Costa
- Department of Otolaryngology, Medical School of the University of Sao Paulo, Sao Paulo, Brazil
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Grace S Kim
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, OR
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA
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17
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Sedaghat AR, Gray ST, Caradonna SD, Caradonna DS. Clustering of chronic rhinosinusitis symptomatology reveals novel associations with objective clinical and demographic characteristics. Am J Rhinol Allergy 2016; 29:100-5. [PMID: 25785749 DOI: 10.2500/ajra.2015.29.4140] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is associated with varied head and neck symptomatology and quality-of-life impairments that are not necessarily correlated with each other or with objective measures of disease. OBJECTIVE To determine how clustering patterns of CRS symptoms associate with objective clinical findings. METHODS Symptom scores from 193 Sinonasal Outcomes Test-22 (SNOT-22) questionnaires, from 177 consecutive CRS patients, were analyzed by principal component analysis (PCA) to uncover fewer and physiologically understandable latent components. Univariate and multivariate regressions were made with patients' demographic characteristics, nasal polyposis, comorbid allergic rhinitis, asthma, gastro-esophageal reflux disease (GERD) or depression, and Lund-Mackay scoring of sinus computed tomography (CT) results. RESULTS Four principal components (PCs), heavily weighted on sleep symptoms, nasal symptoms, otologic symptoms, and emotional function symptoms, respectively, are found to primarily describe the variability in patients' SNOT-22 scores. SNOT-22 subset scores reflecting sleep, nasal, otologic, and emotional function symptoms were constructed from corresponding PCs. Only female gender associated with the total SNOT-22 score (p = 0.004), whereas only Lund-Mackay score associated with the nasal subset score (p = 0.015). Allergic rhinitis only associated with the otologic subset score (p = 0.005), whereas only asthma associated with the emotional function subset score (p = 0.027). None of the measured covariates were associated with the sleep subset score. CONCLUSION Variability in SNOT-22 scores from CRS patients may be explained by the independent presence of sleep, nasal, otologic, and emotional function symptoms, with which we find novel clinical and demographic associations. These findings may represent clinical evidence for distinct pathophysiologic processes that differentially cause specific CRS symptomatology.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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18
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Killeen DE, Sedaghat AR, Cunnane ME, Gray ST. Objective radiographic density measurements of sinus opacities are not strong predictors of noninvasive fungal disease. Am J Rhinol Allergy 2015; 28:483-6. [PMID: 25514484 DOI: 10.2500/ajra.2014.28.4104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND High-density paranasal sinus opacities are often deemed consistent with fungal elements. No studies of objective quantitative radiographic density measures have been performed to support this assertion. METHODS A consecutive series of 120 patients with chronic rhinosinusitis who underwent maxillary antrostomy with microbiological evaluation of contents within 60 days of sinus computed tomography scanning was investigated. Radiographic density characteristics of opacities in cultured maxillary sinuses (minimum, maximum, average, and standard deviation of Hounsfield units [HUstd]) were recorded. Receiver operator characteristic (ROC) curves were used to analyze the accuracy of radiographic characteristics in predicting fungal opacities. RESULTS Of 133 maxillary sinus opacities, 22 were ultimately consistent with noninvasive fungal disease: 11 allergic fungal rhinosinusitis and 11 fungal balls. Fungal balls had higher-density components and were more heterogeneous and allergic fungal mucin was generally more radiodense. These findings were reflected by statistically significant ROC curves for maximum HU (p = 0.019) and HUstd (p = 0.023) for fungal balls and for average HU (p = 0.002) for allergic fungal mucin. A maximum HU cutoff of 334.0 detected fungal balls with 90.9% sensitivity and 72.7% specificity. An average HU cutoff of 42.9 HU detected allergic fungal mucin with 100% sensitivity and 46.3% specificity, although specificity improved to 73.2% with inclusion of nasal polyposis as a second requirement. CONCLUSION Higher average HU more accurately predicts allergic fungal mucin whereas heterogeneity/high-density components more accurately predict fungal balls. No objective radiographic density measure, in isolation, is both sensitive and specific in predicting noninvasive fungal sinusitis.
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Affiliation(s)
- Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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19
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Soler ZM, Pallanch JF, Sansoni ER, Jones CS, Lawrence LA, Schlosser RJ, Mace JC, Smith TL. Volumetric computed tomography analysis of the olfactory cleft in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2015; 5:846-54. [PMID: 26010298 DOI: 10.1002/alr.21552] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/03/2015] [Accepted: 04/17/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Commonly used computed tomography (CT) staging systems for chronic rhinosinusitis (CRS) focus on the sinuses and do not quantify disease in the olfactory cleft. The goal of the current study was to determine whether precise measurements of olfactory cleft opacification better correlate with olfaction in patients with CRS. METHODS Olfaction was assessed using the 40-item Smell Identification Test (SIT-40) before and after sinus surgery in adult patients. Olfactory cleft opacification was quantified precisely using three-dimensional (3D), computerized volumetric analysis, as well as via semiquantitative Likert scale estimations at predetermined anatomic sites. Sinus opacification was also quantified using the Lund-Mackay staging system. RESULTS The overall cohort (n = 199) included 89 (44.7%) patients with CRS with nasal polyposis (CRSwNP) and 110 (55.3%) with CRS without nasal polyposis (CRSsNP). The olfactory cleft opacified volume correlated with objective olfaction as determined by the SIT-40 (Spearman's rank correlation coefficient [Rs ] = -0.461; p < 0.001). The correlation was significantly stronger in the CRSwNP subgroup (Rs = -0.573; p < 0.001), whereas no appreciable correlation was found in the CRSsNP group (Rs = -0.141; p = 0.141). Correlations between sinus-specific Lund-Mackay CT scoring and SIT-40 scores were weaker in the CRSwNP (Rs = -0.377; p < 0.001) subgroup but stronger in the CRSsNP (Rs = -0.225; p = 0.018) group when compared to olfactory cleft correlations. Greater intraclass correlations (ICCs) were found between quantitative volumetric measures of olfactory cleft opacification (ICC = 0.844; p < 0.001) as compared with semiquantitative Likert grading (ICC = 0.627; p < 0.001). CONCLUSION Quantitative measures of olfactory cleft opacification correlate with objective olfaction, with the strongest correlations seen in patients with nasal polyps.
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Affiliation(s)
- Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - John F Pallanch
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
| | - Eugene Ritter Sansoni
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health and Science University, Portland, OR
| | - Cameron S Jones
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Lauren A Lawrence
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health and Science University, Portland, OR
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health and Science University, Portland, OR
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20
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Garneau J, Ramirez M, Armato SG, Sensakovic WF, Ford MK, Poon CS, Ginat DT, Starkey A, Baroody FM, Pinto JM. Computer-assisted staging of chronic rhinosinusitis correlates with symptoms. Int Forum Allergy Rhinol 2015; 5:637-642. [PMID: 25854318 DOI: 10.1002/alr.21499] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/28/2014] [Accepted: 01/01/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Lund-Mackay (LM) staging system for chronic rhinosinusitis (CRS) does not correlate with clinical parameters, likely due to its coarse scale. We developed a "Modified Lund Mackay" (MLM) system, which uses a three-dimensional (3D), computerized method to quantify the volume of mucosal inflammation in the sinuses, and sought to determine whether the MLM would correlate with symptoms and disease-specific quality of life. METHODS We obtained Total Nasal Symptom Score (TNSS) and 22-item Sino-Nasal Outcome Test (SNOT-22) data from 55 adult subjects immediately prior to sinus imaging. The volume of each sinus occupied by mucosal inflammation was measured using MATLAB algorithms created using customized, image analysis software after manual outlining of each sinus. Linear regression was used to model the relationship between the MLM and the SNOT-22 and TNSS. Correlation between the LM and MLM was tested using Spearman's rank correlation coefficient. RESULTS Adjusting for age, gender, and smoking, a higher symptom burden was associated with increased sinonasal inflammation as captured by the MLM (β = 0.453, p < 0.013). As expected due to the differences in scales, the LM and MLM scores were significantly different (p < 0.011). No association between MLM and SNOT-22 scores was found. CONCLUSION The MLM is one of the first imaging-based scoring systems that correlates with sinonasal symptoms. Further development of this custom software, including full automation and validation in larger samples, may yield a biomarker with great utility for both treatment of patients and outcomes assessment in clinical trials.
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Affiliation(s)
| | | | | | | | - Megan K Ford
- Department of Radiology, The University of Chicago
| | - Colin S Poon
- Department of Radiology, The University of Chicago
| | | | - Adam Starkey
- Department of Radiology, The University of Chicago
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago
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21
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de Camargo RA, Nicodemo AC, Sumi DV, Gebrim EMMS, Tuon FF, de Camargo LM, Imamura R, Amato VS. Facial structure alterations and abnormalities of the paranasal sinuses on multidetector computed tomography scans of patients with treated mucosal leishmaniasis. PLoS Negl Trop Dis 2014; 8:e3001. [PMID: 25080261 PMCID: PMC4117457 DOI: 10.1371/journal.pntd.0003001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/31/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/OBJECTIVES Mucosal leishmaniasis (ML) is a progressive disease that affects cartilage and bone structures of the nose and other upper respiratory tract structures. Complications associated with ML have been described, but there is a lack of studies that evaluate the structural changes of the nose and paranasal sinuses in ML using radiological methods. In this study, we aimed to assess the opacification of the paranasal sinuses in patients with treated ML and any anatomical changes in the face associated with ML using multidetector computed tomography scans (MDCT) of the sinuses. We compared the findings with a control group. METHODOLOGY/PRINCIPAL FINDINGS We evaluated 54 patients with treated ML who underwent CT scans of the sinuses and compared them with a control group of 40 patients who underwent orbital CT scans. The degree of sinus disease was assessed according to the Lund-Mackay criteria. Forty of the 54 patients with a history of ML (74.1%) had a tomographic score compatible with chronic sinusitis (Lund-Mackay ≥4). CT scans in the leishmaniasis and control groups demonstrated significant differences in terms of facial structure alterations. Patients from the ML group showed more severe levels of partial opacification and pansinus mucosal thickening (42.6%) and a greater severity of total opacification. Patients from the ML group with a Lund-Mackay score ≥4 presented longer durations of disease before treatment and more severe presentations of the disease at diagnosis. CONCLUSION/SIGNIFICANCE CT scans of the sinuses of patients with ML presented several structural alterations, revealing a prominent destructive feature of the disease. The higher prevalence in this study of chronic rhinosinusitis observed in CT scans of patients with treated ML than in those of the control group suggests that ML can be considered a risk factor for chronic rhinosinusitis in this population (p<0.05).
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Affiliation(s)
- Raphael Abegão de Camargo
- Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Antonio C. Nicodemo
- Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Daniel Vaccaro Sumi
- Institute of Radiology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | | | - Felipe Francisco Tuon
- Division of Infectious Diseases, Federal University of Paraná, Curitiba, Paraná, Brazil
- Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, Paraná, Brazil
| | | | - Rui Imamura
- Department of Otorhinolaryngology and Ophthalmology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Valdir Sabbaga Amato
- Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
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22
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Kennedy DW. Case number trends in sinus and septal surgery. Int Forum Allergy Rhinol 2013; 2:355-6. [PMID: 23065938 DOI: 10.1002/alr.21108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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