R081: VEMP Absence, Caloric Weakness, and Hearing Loss

Abstract

The clinical diagnosis of chronic rhinosinusitis is based on the major and minor critera described by the 1997 Task Force in Rhinology (TFR). This study attempts to discriminate among the various criteria to identify individual symptom predictors of CRS as well as to evaluate the predictive accuracy of the TFR criteria in aggregate. METHODS: A retrospective chart review of 187 patients referred to a tertiary care rhinology clinic for evaluation of suspected chronic rhinosinusitis. Data reviewed included each patient's symptoms, as recorded in a standarized survey that included all of the major and minor criteria and each patient's diagnosis (CRS or other). RESULTS: Of 187 patients who met inclusion criteria, 112 (60%) were diagnosed with CRS and 75 (40%) were diagnosed with conditions other than CRS. Chronic purulent rhinorrhea and hyposmia individually and in combination were significant predictors of CRS [odds ratio (OR) 2.2, 2.3, and 3.8, respectively]. The major criteria (facial pain, congestion, nasal obstruction, nasal discharge, and hyposmia) also predicted CRS (OR 1.9) but the minor criteria (headache, fever, halitosis, fatigue, dental pain, cough, ear pain) did not predict CRS (OR 0.3). CONCLUSION: The major criteria of the 1997 TFR predict CRS but the minor criteria do not. Refinement of the symptomatic criteria for the diagnosis of suspected CRS may improve the accuracy of a clinical diagnosis of CRS. SIGNIFICANCE: This study identifies hyposmia and purulent rhinorrhea as independent predictors of CRS and confirms the predictive value of the major criteria. However, it also suggests that symptoms considered minor factors by the AAO-HNS TFR are not predictive of CRS.