108 / 236
The fate of CRS sufferers after MMT
FIGURE 1.
Allocation of patient groups after MMT. MMT
=
maximal medical therapy.
TABLE 1.
Characteristics of post-MMT groups
Post MMT group n Age (years) Gender (%F) CRSwNP Pre-NSS Pre-SNOT-22 Post-NSS Post-SNOT-22 Pre-CT
Post-CT
Symptom
relapse
Symptomatic CRS 43 45
±
12
26% 33% 2.5
±
0.9 1.9
±
0.9 1.9
±
1.0 1.4
±
0.8 11.6
±
5.2 10.5
±
4.5 n/a
Resolved CRS
12 42
±
11
58% 17% 2.0
±
1.0 1.7
±
0.9 0.6
±
0.3 0.5
±
0.3 8.2
±
3.9 2.75
±
2.0
0
Asymptomatic CRS 21 52
±
11
43% 52% 2.7
±
1.1 2.2
±
1.1 1.1
±
0.9 0.8
±
0.7 12.1
±
6.3 11.1
±
3.5
9
Alternate diagnosis 10 42
±
20
60% 0% 2.2
±
1.1 1.9
±
0.8 1.9
±
1.3 1.7
±
1.0 5.2
±
2.9 0.7
±
1.6
0
p
a
0.07
0.07
0.02
0.42
0.54
<
0.01
<
0.01
<
0.01
<
0.01
<
0.01
a
Bold values are significant.
CRS
=
chronic rhinosinusitis; CT
=
computed tomography; MMT
=
maximal medical therapy; NSS
=
nasal symptom scores; pre/post CT
=
Lund-Mackay CT scores
before/after MMT; n/a
=
not applicable; SNOT-22
=
22-item SinoNasal Outcome Test.
time of MMT was 46 days (IQR 24) and did not differ
between the patient groups outlined in the next paragraph
(
p
=
0.94). Although the post-MMT CT scan was always
performed at the post-MMT visit, there was variation in
the interval between the 2 scans being compared (median
63 days, IQR 78).
At the post-MMT visit, patients were categorized into
4 groups: 43 (50%) were symptomatic with persistent ra-
diologic disease (“symptomatic CRS”); 12 (14%) were
asymptomatic with no radiologic disease (“resolved CRS”);
21 (24%) were asymptomatic with persistent radiologic
disease (“asymptomatic CRS”); and 10 (12%) were symp-
tomatic with no radiologic disease (“alternate diagnosis”)
(Fig. 1).
Pretreatment factors affecting response to MMT
Age was highest in the “asymptomatic CRS” group
(52
±
11 years,
p
=
0.07) (Table 1). The proportion of pa-
tients with nasal polyposis was highest in the “symptomatic
CRS” (33%) and “asymptomatic CRS” groups (52%), and
lowest among those with alternate diagnoses (0%,
p
=
0.018). Table 2 shows percentages of patients within each
group, when separated for CRS phenotype (with vs without
polyps).
There were 2 patients with ASAD. One ended up with
“symptomatic CRS” and 1 with “asymptomatic CRS.” Pre-
viously operated patients (n
=
9) were fairly evenly split
TABLE 2.
Post-MMT groups and CRS phenotype
Post-MMT groups
CRS phenotype
Symptomatic
CRS
Resolved
CRS
Asymptomatic
CRS
Alternate
diagnosis
With polyps (n
=
27)
52% 7% 41% 0%
Without polyps (n
=
59)
49% 17% 17% 17%
CRS
=
chronic rhinosinusitis; MMT
=
maximal medical therapy.
between the “symptomatic CRS” (4) and “asymptomatic
CRS” groups (5), with none of these patients having reso-
lution of CT changes after MMT (
χ
2
7.26,
p
=
0.06).
Pre-MMT NSS and SNOT-22 were similar across the
4 groups. This included pre-MMT facial pain scores
(
p
=
0.64). Pre-MMT and post-MMT LM scores for the
entire study group were 10.9
±
5.3 and 8.3
±
5.5 (change
2.6
±
3.8,
p
<
0.001). The interval between pretreatment
and posttreatment scans did not differ significantly between
groups (
p
=
0.82). The “alternate diagnosis” group had
the lowest LM scores initially (
p
=
0.001, Fig. 2) and
was more likely to score facial pain highly after treatment
(
p
=
0.028). This group had other reasons for their per-
sistent symptoms, such as migraine, rhinitis, mucus recir-
culation, postviral hyposmia, and postviral cough, despite
having evidence of CRS on radiology at initial assessment.
International Forum of Allergy & Rhinology, Vol. 4, No. 7, July 2014
86