73 / 236
and ASsA) compared to nonasthmatic sinusitis (NAScA
and NASsA) (
P
<
.01). Asthmatic sinusitis versus 50/50
gender split had a
P
value of .03 in favor of more
females.
The results of the average nasal endoscopy, CT
scores, CSS, and RSDI are listed in Table III. For the
nasal endoscopy score, all of the CRS subclasses were
significantly higher than the control group (
P
<
.01). The
nasal endoscopy score for AFS, AERD, and AScA was
significantly higher than NASsA (
P
<
.01). Aspirin triad,
both AScA and ASsA, and NAScA (
P
<
.05) had signifi-
cantly more polyps on nasal endoscopy than the control
group. Cystic fibrosis (
P
5
.08) and NASsA (
P
5
.07) was
trending toward significance for the presence of puru-
lence, but did not reach statistical significance when
compared to control group.
For the CT scores, all of the CRS subclasses were
significantly higher than the control group (
P
<
.01). Aspi-
rin triad, AFS, CF, and AScA had higher CT scores than
NASsA (
P
<
.05). When CT scores were evaluated for uni-
lateral disease, allergic fungal sinusitis was significantly
higher than the control group and all the other CRS sub-
classes (
P
<
.01).
Because the two QoL questionnaires in the study
were not validated in the pediatric population, and the
majority of the CF patients were pediatric, CF was not
included in the analysis for the QoL questionnaires. For
the total CSS score, AERD was the only CRS subclass
that was statistically different than the control group
(
P
<
.05). When CSS was broken into duration and symp-
tom score, CSS symptom score was significantly higher
in aspirin triad and AScA than the control group
(
P
<
.01).
For the RSDI score, there was no difference between
the control group and any of the CRS subclasses. There
was also no statistical difference between the control
group and all of the CRS subclasses combined. Even when
RSDI was divided into its different components, there was
no statistical difference found between the control group
and any of the CRS subclasses.
When evaluating all of the CRS patients, the cor-
relation coefficient between RSDI to CSS was
r
s
5
0.52
(
P
<
.01). Correlation of CT to NE was
r
s
5
0.4 (
P
<
.01).
Correlations of CSS to CT and NE were
r
s
5
0.28 and
r
s
5
0.38 (
P
<
.05), respectively. Correlation of RSDI to
CT and NE were
r
s
5
0.32 and
r
s
5
0.34 (
P
<
.05),
respectively.
Histopathology and Immunostaining
The eosinophil ratios were significantly higher for
AFS, AERD, and AScA than both the control group and
CF (
P
<
.05) (Table IV). Aspirin triad and AScA had
higher eosinophil ratios than each nonasthmatic sinusi-
tis (
P
<
.05) among the CRS subclasses.
For PMN analysis, CF had the highest ratio of
PMN and was significantly higher than the control
group, NASsA, and AScA (
P
<
.05). There were no other
significant differences.
For the plasma analysis, cystic fibrosis had the
highest plasma cell count. Cystic fibrosis, AFS, ASsA,
TABLE III.
The Average Objective and Subjective Measurement Tools for
CRS.
CRS Subclass
NE
CT Score
CSS
RDSI
AERD
2.6
14.7
16.5
10.7
AFS
2.4
13.8
9.9
8.1
CF
2.1
14.3
AScA
2.7
14
15.9
11.2
ASsA
2
12.5
13.3
18.3
NAScA
2.2
10.2
9.1
8.7
NASsA
1.4
9.3
7.4
8.3
Control
0.2
1.5
5.3
5.7
Total
1.9
10.5
10.7
9.2
AERD
5
aspirin exacerbated respiratory disease also known as aspirin
triad; AFS
5
allergic fungal sinusitis; AScA
5
asthmatic sinusitis with allergy;
ASsA
5
asthmatic sinusitis without allergy; CF
5
cystic fibrosis; CRS
5
chronic
rhinosinusitis; CSS
5
chronic sinusitis survey; CT
5
computed tomography;
NAScA
5
nonasthmatic sinusitis with allergy; NASsA
5
nonasthmatic sinusitis
without allergy; NE
5
nasal endoscopy; RSDI
5
rhinosinusitis disability index.
TABLE IV.
The Average Ratio of Cells.
CRS Subclass
Eosinophil
PMN
Plasma
Lymphocyte
Mast
Cellularity
Goblet
AERD
0.44
0.03
0.14
0.39
92
150
45
AFS
0.35
0.03
0.3
0.31
101
141
19
CF
0.004
0.06
0.45
0.47
163
96
8
AScA
0.44
0.01
0.17
0.32
85
138
80
ASsA
0.17
0.04
0.35
0.44
63
130
43
NAScA
0.17
0.02
0.26
0.45
133
109
53
NASsA
0.08
0.01
0.32
0.49
64
39
89
Control
0.02
0.03
0.17
0.76
32
18
60
Total
0.23
0.02
0.25
0.44
92
104
55
AERD
5
aspirin exacerbated respiratory disease also known as aspirin triad; AFS
5
allergic fungal sinusitis; AScA
5
asthmatic sinusitis with allergy; ASsA-
asthmatic sinusitis without allergy; CF
5
cystic fibrosis; CRS
5
chronic rhinosinusitis; NAScA
5
nonasthmatic sinusitis with allergy; NASsA
5
nonasthmatic sinusitis
without allergy; PMN
5
polymorphonuclear leukocyte.
Laryngoscope 123: March 2013
Han:
Subclassification
of Chronic
Sinusitis
51