Clinical and symptom criteria for the accurate diagnosis of chronic rhinosinusitis.

摘要: Objectives/Hypothesis: The objectives of this prospective, double-blind diagnostic cohort study were to explore the relationship between patients' reported symptoms chronic rhinosinusitis (CRS) and radiographic findings in CRS define clinically based criteria for determine a classification scheme that would allow accurate diagnosis patients with CRS. Methods: A prospective series adult undergoing evaluation potential was studied. Patients' tabulated Rhinosinusitis Symptom Inventory (RSI), which records associated on Likert scale (5 = maximally severe). Medication resource utilization also tabulated. Scores nasal, facial, oropharyngeal, systemic, total symptom domains computed (100 maximum severity). Concurrent paranasal sinus tomography obtained each patient scored according Lund-McKay system reviewer blinding. Patients classified as normal or representing true previously published under two analyses. In analysis 1, Lund scores ≤1 considered nondiseased ≥2 CRS. 2, ≤3 represented ≥4 For analysis, univariate statistics differences among without Subsequently, using regression trees conducted heuristics CRS. Results: Seven hundred three enrolled (mean age, 43.1 years). most commonly order decreasing severity presence nasal obstruction, congestion, discharge, fatigue, headache, facial pressure, dysosmia, all mean ≥2.0. treated approximately 3 months topical steroids, oral antihistamines, antibiotics. missed substantial workdays (mean, 3.8/year) incurred significant physician visits 3.5/year) result domain exhibited greatest (51.8) followed closely by (47.3). According 144 (20.5%) 559 (79.5%) Only polyps (P 2 effectively predicted Fatigue ≤2, discharge ≤4, obstruction further Symptoms despite ≥5.5-week trial steroids Other major minor symptoms, RSI domains, factors failed influence classification. Conclusions: is difficult because (other than dysosmia) do not distinguish radiographically diseased patients. absence valid. It possible classify but requires complicated heuristics. Corroborating evidence should be required establish before long periods therapy surgical intervention.