110 / 236
The fate of CRS sufferers after MMT
FIGURE 3.
Posttreatment mean nasal symptom scores within patient groups.
TABLE 3.
Endoscopic findings within post-MMT groups
Post-MMT groups
Symptomatic CRS
Resolved CRS
Asymptomatic CRS
Alternate diagnosis
Total
Post-MMT endoscopic examination
No evidence of sinus inflammation
13
9
5
9
36
Evidence of sinus inflammation
29
2
15
1
47
Total
42
11
20
10
83
CRS
=
chronic rhinosinusitis; MMT
=
maximal medical therapy.
underwent surgery. Three were managed with further pred-
nisone courses and one with more intensive topical therapy
(Fig. 4).
Symptom relapse was not related to gender (
χ
2
0.016,
p
=
0.90), age (
t
test,
p
=
0.28) atopic status (
χ
2
0.28,
p
=
0.60), history of asthma (
χ
2
0.30,
p
=
0.58) or presence
of polyps (
χ
2
0.064,
p
=
0.80). It was also not related to
pre-MMT SNOT 22 (
p
=
0.89) or NSS (
p
=
0.71), or post-
MMT SNOT-22 (
p
=
0.37) or NSS (
p
=
0.07). Pre-MMT
and post-MMT CT scores were not related (
p
=
0.42 and
0.31, respectively) and neither was history of previous ESS
(
p
=
1.0).
Predictive value of endoscopy
Post-MMT endoscopy was considered positive for inflam-
mation in 47 of 86 patients (57%) and was significantly
correlated with post MMT radiologic inflammation (
p
=
0.001) (Table 3). When compared with CT scanning, en-
doscopy had a positive predictive value (PPV) of 94% and
a negative predictive value (NPV) of 50%, with sensitiv-
ity 71% and specificity 86%. Among symptomatic patients
(n
=
52) PPV was 97% and NPV 41% (sensitivity 69%,
specificity 90%, Table 3). Among symptomatic patients
with facial pain scores 3 (n
=
12) the NPV was 100%
(5/5).
International Forum of Allergy & Rhinology, Vol. 4, No. 7, July 2014
88