TY - JOUR
T1 - Ethmoid-to-maxillary opacification ratio
T2 - a predictor of postoperative olfaction and outcomes in nasal polyposis?
AU - Beswick, Daniel M.
AU - Smith, Timothy L.
AU - Mace, Jess C.
AU - Alt, Jeremiah A.
AU - Farrell, Nyssa F.
AU - Ramakrishnan, Vijay R.
AU - Schlosser, Rodney J.
AU - Soler, Zachary M.
N1 - Funding Information:
sources of the study: National Institute on Deafness and Other Communication Disorders of the National Institutes of Health (3R01 DC005805 [co‒principal investigators: T.L.S. and Z.M.S.] to T.L.S., J.C.M., J.A.A., V.R.R., R.J.S., and Z.M.S.). The funding organization played no role in the design or conduct of this study, or the preparation, review, approval, or decision to submit this manuscript for publication.
Publisher Copyright:
© 2020 ARS-AAOA, LLC
PY - 2021/1
Y1 - 2021/1
N2 - Background: Inflammatory profiles for patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) vary between North American and Asian populations. An elevated ethmoid-to-maxillary (E/M) opacification ratio on preoperative imaging is associated with certain postoperative outcomes in Asian populations and populations that are non‒type 2 dominant. In this study we explore this factor in North American/type 2‒based populations. Methods: Adult patients (n = 165) from a North American population with CRSwNP who underwent endoscopic sinus surgery (ESS) were prospectively enrolled into an observational, multi-institutional study. The 22-item Sino-Nasal Outcome Test (SNOT-22), Brief Smell Identification Test (BSIT), and Lund-Kennedy (LK) endoscopic scores were obtained pre- and postoperatively. Patients were stratified according to increasing E/M ratios based on Lund-Mackay (LM) scores. Results: On average, significant within-subject postoperative improvement was found in all patients for SNOT-22 total and domain scores, and also BSIT results (p ≤ 0.019). Preoperatively, elevated E/M ratio correlated with worse BSIT scores (r = −0.343, p < 0.001). Postoperatively, elevated E/M ratio correlated with BSIT improvement (r = 0.284, p = 0.002), but did not correlate with SNOT-22 improvement or polyp recurrence. An elevated E/M ratio was associated with greater likelihood of reporting a minimal clinically important difference in BSIT scores (χ2 = 9.96, p = 0.041). Conclusion: Elevated E/M ratios were found to associated with worse baseline olfaction and an increased likelihood of achieving a clinically meaningful postoperative improvement in olfaction in this North American population with CRSwNP. Elevated E/M ratios did not predict postoperative changes in SNOT-22 measures or polyp recurrence. This suggests that prognostic factors may vary according to geography and generalized inflammatory profiles (type 2 vs non‒type 2) in patients with CRS.
AB - Background: Inflammatory profiles for patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) vary between North American and Asian populations. An elevated ethmoid-to-maxillary (E/M) opacification ratio on preoperative imaging is associated with certain postoperative outcomes in Asian populations and populations that are non‒type 2 dominant. In this study we explore this factor in North American/type 2‒based populations. Methods: Adult patients (n = 165) from a North American population with CRSwNP who underwent endoscopic sinus surgery (ESS) were prospectively enrolled into an observational, multi-institutional study. The 22-item Sino-Nasal Outcome Test (SNOT-22), Brief Smell Identification Test (BSIT), and Lund-Kennedy (LK) endoscopic scores were obtained pre- and postoperatively. Patients were stratified according to increasing E/M ratios based on Lund-Mackay (LM) scores. Results: On average, significant within-subject postoperative improvement was found in all patients for SNOT-22 total and domain scores, and also BSIT results (p ≤ 0.019). Preoperatively, elevated E/M ratio correlated with worse BSIT scores (r = −0.343, p < 0.001). Postoperatively, elevated E/M ratio correlated with BSIT improvement (r = 0.284, p = 0.002), but did not correlate with SNOT-22 improvement or polyp recurrence. An elevated E/M ratio was associated with greater likelihood of reporting a minimal clinically important difference in BSIT scores (χ2 = 9.96, p = 0.041). Conclusion: Elevated E/M ratios were found to associated with worse baseline olfaction and an increased likelihood of achieving a clinically meaningful postoperative improvement in olfaction in this North American population with CRSwNP. Elevated E/M ratios did not predict postoperative changes in SNOT-22 measures or polyp recurrence. This suggests that prognostic factors may vary according to geography and generalized inflammatory profiles (type 2 vs non‒type 2) in patients with CRS.
KW - chronic disease
KW - outcome assessment (health care)
KW - quality of life
KW - sinusitis
UR - http://www.scopus.com/inward/record.url?scp=85087175452&partnerID=8YFLogxK
U2 - 10.1002/alr.22625
DO - 10.1002/alr.22625
M3 - Article
C2 - 32558260
AN - SCOPUS:85087175452
SN - 2042-6976
VL - 11
SP - 48
EP - 57
JO - International Forum of Allergy and Rhinology
JF - International Forum of Allergy and Rhinology
IS - 1
ER -