Clinical Traits Characterizing an Exacerbation-Prone Phenotype in Chronic Rhinosinusitis

Objective: Acute exacerbation of chronic rhinosinusitis (AECRS) is associated with significant quality-of-life decreases. We sought to determine characteristics associated with an exacerbation-prone phenotype in chronic rhinosinusitis (CRS). Study Design: Cross-sectional. Setting: Tertiary care rhinology clinic. Subjects: Patients with CRS (N = 209). Methods: Patient-reported number of sinus infections, CRS-related antibiotics, and CRS-related oral corticosteroids taken in the last 12 months were used as metrics for AECRS frequency. Sinonasal symptom burden was assessed with the 22-item Sinonasal Outcome Test (SNOT-22). Ninety patients reporting 0 for all AECRS metrics were considered to have had no AECRS in the prior 12 months. A total of 119 patients reported >3 on at least 1 AECRS metric and were considered as having an exacerbation-prone phenotype. Characteristics associated with patients with an exacerbation-prone phenotype were identified with exploratory regression analysis. Results: An exacerbation-prone phenotype was positively associated with comorbid asthma (adjusted odds ratio [OR_adj] = 3.68, 95% CI: 1.42-9.50, P =.007) and SNOT-22 (OR_adj = 1.06, 95% CI: 1.04-1.09, P <.001). Polyps were negatively associated (OR_adj = 0.27, 95% CI: 0.11-0.68, P =.005) with an exacerbation-prone phenotype. SNOT-22 score ≥24 identified patients with an exacerbation-prone phenotype with a sensitivity of 93.3% and a specificity of 57.8%. Having either a SNOT-22 score ≥24 with a nasal subdomain score ≥12 or a SNOT-22 score ≥24 with an ear/facial discomfort subdomain score ≥3 provided >80% sensitivity and specificity for detecting patients prone to exacerbation. Conclusions: In total, these results point to a CRS exacerbation-prone phenotype characterized by high sinonasal disease burden with comorbid asthma but interestingly without polyps.