Clinical, Endoscopic and Radiological Correlates of Disease Severity and Sinonasal Quality of Life in Adults with Chronic Rhinosinusitis: A Hospital-Based Observational Study

Abstract

Background: Chronic rhinosinusitis (CRS) is clinically heterogeneous, and symptom burden, endoscopic inflammation, radiological disease extent and patient-reported quality of life do not necessarily vary in parallel. An integrated assessment may therefore provide a more informative representation of disease burden. Objective: To evaluate the relationships among clinical, endoscopic and radiological disease severity and sinonasal quality of life in adults with CRS. Methods: This hospital-based observational study included 200 adults with CRS. Clinical history and symptom severity were recorded using a study assessment form. Participants underwent nasal endoscopic assessment, completed the 22-item Sinonasal Outcome Test (SNOT-22), and underwent CT of the paranasal sinuses. Clinical, endoscopic and radiological disease severity were classified as mild, moderate or severe. Associations were tested using Spearman's rank correlation. Comparison of SNOT-22 scores between severity groups used the KruskalWallis test and Holm-adjusted pairwise Mann-Whitney U tests. Results: Clinical severity was mild in 79 (39.5%), moderate in 67 (33.5%) and severe in 54 (27.0%) participants. Endoscopic severity was mild in 61 (30.5%), moderate in 104 (52.0%) and severe in 35 (17.5%), whereas radiological severity was mild in 17 (8.5%), moderate in 61 (30.5%) and severe in 122 (61.0%). Mean SNOT-22 scores increased across clinical, endoscopic and radiological severity categories. The greatest degree of association with SNOT-22 was with endoscopic severity (rho=0.730, p.<0.001), followed by the CT/LundMackay-type score (rho=0.616, p<0.001) and radiological severity (rho=0.578, p<0.001). The relation between clinical severity and SNOT-22 was least [clinical severity: rho=0.249, p<0.001]. Endoscopic and radiological severity were more strongly correlated with each other (rho=0.567, p<0.001) than either was with clinical severity. Conclusion: Clinical symptoms, nasal endoscopy, CT and SNOT-22 represent complementary dimensions of CRS. The endoscopic severity of disease had the greatest correlation with the patients reported burden of sinonasal disease, and radiological findings also had sizable correlations. Multidimensional assessment may provide a more complete characterization of disease severity than reliance on a single measure.