Assessing the clinical applicability of prior head imaging in patients with chronic rhinosinusitis

Background

Patients often have received some modality of head imaging prior to being evaluated for chronic sinonasal complaints, and the clinical significance of these scans on current sinonasal symptomatology is unknown.

Methods

We performed a retrospective, cohort study of 578 patients with chronic sinonasal indications for maxillofacial computed tomography scans (CTs) in 2016. Patients were included if previous head cross‐sectional imaging had been performed. Lund‐McKay (LM) scores were calculated on the prior CT scan for each patient and compared to LM scores of the most recent scan. Scans with LM scores ≤3 were deemed normal, scores >3 were deemed positive, and Δ >3 was deemed a significant change.

Results

Of 578 patients, 153 (26.5%) patients had previous imaging. Overall, a strong correlation was noted between scans (r = 0.791, p < 0.001). Significant correlations remained with the subset of positive prior scans (r = 0.743, p < 0.001). The 3 most common prior imaging modalities were maxillofacial CT, head CT, and brain magnetic resonance imaging (MRI). Correlations between these modalities and subsequent maxillofacial CTs range from strong to moderately strong. Women were significantly more likely to have negative prior imaging (p = 0.048). Patients with negative prior imaging (80/153) were significantly more likely to remain unchanged (71/80) compared to patients with positive prior scans (56/73) (p = 0.023).

Conclusion

Prior head imaging highly correlates to future maxillofacial CT in patients with chronic sinonasal complaints, and patients with prior negative scans are likely to remain negative on future imaging. If prior head scans exist, practitioners may want to avoid ordering additional scans in the absence of changing symptoms.     

Asthma onset pattern and patient outcomes in a chronic rhinosinusitis population

Background

Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early‐onset and late‐onset asthma in a CRS population using patient‐reported and clinical characteristics.

Methods

At enrollment into a clinical registry, CRS patients completed the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Asthma Control Test (ACT), mini‐Asthma Quality of Life Questionnaire (miniAQLQ), the 29‐item Patient‐Reported Outcomes Measurement Information System (PROMIS‐29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early‐onset (<18 years) and late‐onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi‐square, and Kruskal‐Wallis tests were used to compare patient responses.

Results

A total of 199 non‐asthmatic (56.1%), 71 early‐onset asthmatic (20.0%), and 85 late‐onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late‐onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT‐22, ACT, and miniAQLQ were not different between asthma groups, but late‐onset asthmatics had significantly lower physical function than non‐asthmatics (p = 0.008). Compared to non‐asthmatics, late‐onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund‐Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late‐onset asthmatics compared to early‐onset asthmatics showed increased nasal polyposis (p = 0.011) and oral steroid courses for CRS (p = 0.003).

Conclusion

While CRS‐specific and asthma‐specific patient‐reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late‐onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late‐onset asthma may predict more severe disease in CRS.