Associations between the Quality of Life and Nasal Polyp Size in Patients Suffering from Chronic Rhinosinusitis without Nasal Polyps, with Nasal Polyps or Aspirin-Exacerbated Respiratory Disease

Abstract

Chronic rhinosinusitis (CRS) is a common disease that substantially impairs the quality of life (QoL). Here, we aimed to assess patients' QoL in different subtypes of CRS and correlated this with nasal polyp size to improve the clinical understanding of the burden of disease. In this retrospective single-center study, 107 patients with the following diagnoses were analyzed: CRS without nasal polyps (CRSsNP), CRS with nasal polyps (CRSwNP), or aspirin-exacerbated respiratory disease (AERD). Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV) scores and their correlation with endoscopic Total Polyp Scores (TPS) were evaluated. The mean SNOT-20 GAV scores were highest in patients with AERD (AERD = 43.4, CRSwNP = 36.3, CRSsNP = 30.9). A statistically significant correlation of total SNOT-20 GAV score with TPS was observed in CRSwNP patients (r = 0.3398, p = 0.0195), but not in AERD patients (r = 0.2341, p = 0.1407). When analyzing single SNOT-20 parameters, a strong correlation with TPS was observed for blockage/congestion of the nose, particularly in AERD patients (r = 0.65, p < 0.0001). The impact of nasal polyp size on the QoL differs amongst the subgroups of CRS. Nasal symptoms have the greatest impact on QoL in patients suffering from AERD. CRSwNP and AERD patients should be separately analyzed in clinical investigations and interpretations due to significant differences in QoL.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Lin et al 1350 found that patients with moderate‐to‐severe asthma displayed worse sinus disease than those with mild asthma, with significantly higher mean CT‐scores. Subsequently, the association of both asthma and CRSwNP have also been related to an impaired QoL and loss of productivity 1351–1353 . Alobid et al 1354 showed that the QoL in patients with CRSwNP was worse with concomitant asthma mainly on physical functioning, body pain, and vitality.…”

Differences in men and women suffering from CRSwNP and AERD in quality of life

“…Bars represent mean values with standard deviation (SD). Significance is displayed in figures *p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001, ****p ≤ 0.0001, ns not significant symptoms [9]. The fact that they only observed significant differences between those two groups with regard to the single item "difficulty to smell or taste" but not in the other two above-mentioned items may be due to the fact that no stratification according to gender was performed.…”

“…A wide range of factors including genetics, epigenetics, hormones, immune function, and behaviour might be influenced by patients’ sex and gender identity [ 2 ]. CRS is a highly prevalent disease and especially phenotypes with nasal polyps and AERD can significantly impair patients’ QoL [ 9 ]. Although the impact of sex in CRSwNP and AERD is not yet fully elucidated, studies evaluating e.g.…”

“…CRSwNP affects between 2.7 and 4.4% of the population and approximately 10% of these patients with nasal polyps suffer from aspirin-exacerbated respiratory disease (AERD) syndrome, which is characterized by the clinical triad of nasal polyps, bronchial asthma, and hypersensitivity to non-steroidal antiinflammatory drugs (NSAIDs) [6][7][8]. CRSwNP and AERD generate not only nasal symptoms but also impair quality of sleep, mood, cognition, and productivity [9].…”

Development and validation of Nasal Polyposis Quality of Life Questionnaire (NPQ)

“…Recently it has been shown that nasal polyposis might have a variable impact on HRQoL 27 and that patients with CRSwNP present a different HRQoL pro le compared to those with CRSsNP 28 .…”