Background Traditional methods of staging chronic rhinosinusitis (CRS) through imaging do not differentiate between degrees of partial mucosal sinus inflammation, thus limiting their utility as imaging biomarkers. We hypothesized that software-aided, quantitative measurement of sinus inflammation would generate a metric of disease burden that would correlate with clinical parameters in patients with suspected sinus disease. Methods Adults with rhinologic complaints undergoing CT imaging were recruited at an urban, academic, tertiary care center (n=45 with Lund-Mackay [LM] scores ≥ 4). 3D volumetric image analysis was performed using a semi-automated method to obtain a “Chicago-modified Lund-Mackay” (Chicago MLM) score, which provides a continuous scale to quantify extent of opacification. Linear regression was used to test the association of the Chicago MLM score with concurrent symptoms (total nasal symptom scores [TNSS]) and disease-specific quality of life (Sinonasal Outcome Test-22 [SNOT22]). Results Chicago MLM scores were significantly associated with both symptoms (p=0.037) and disease-specific quality of life (p=0.007). Inflammation in the ethmoid and sphenoid sinuses appeared to influence these associations. These findings were even more robust when analysis was limited to patients with more severe disease (LM>6). Conclusions The quantitative measurement of sinus inflammation by computer-aided 3D analysis correlates modestly with both symptoms and disease-specific quality of life. Posterior sinuses appear to have the greatest impact on these findings, potentially providing an anatomic target for clinicians to base therapy. The Chicago MLM score is a promising imaging biomarker for clinical and research use.

Low-carbohydrate diets have been advocated as an effective method for promoting weight loss in overweight and obese individuals and preventing and treating type 2 diabetes. This article reviews the differences between various lowcarbohydrate eating plans and discusses the benefits and drawbacks of such a diet based on available evidence. It also offers practical pointers for clinicians.

It is widely known that patients with chronic rhinosinusitis (CRS) commonly suffer from sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population. This study aims to identify these risk factors. METHODS: We performed a cohort study of 1004 patients with confirmed diagnostic criteria for CRS. Patient charts were reviewed to identify those with sleep study confirmed OSA. Patient charts were further reviewed for demographic information (age, ethnicity, race, sex, BMI) and medical history including: duration of CRS, presence of nasal polyps, number of endoscopic sinus surgeries, asthma, asthma hospitalizations, asthma ED visits, AERD, allergic rhinitis, eczema, food allergy, GERD, GERD treatment, anosmia and Lund-Mackay score (LMS). RESULTS: 970 patients were included. Logistic or linear regression analyses were performed to correct for BMI. Blacks were at higher risk for OSA (20.7% vs. 10.5% in Latinos and 8% in whites). Higher age was associated with higher risk for OSA. Male gender was a risk factor for OSA (14.2% in Male vs 9.4% Female). OSA was more common in CRSsNP patients. In CRSsNP cases, OSA was associated with GERD and duration of CRS. 25% of male CRSsNP patients above 40 had OSA; this prevalence increased to 40% in male black CRSsNP patients above 40yrs. CONCLUSIONS: Patients with CRS should be screened for OSA. Especially male, black CRSsNP cases who are older than 40 years old.

No abstract