The impact of osteitis on disease severity measures and quality of life outcomes in chronic rhinosinusitis

Abstract

BACKGROUND The significance of osteitis in the management of recalcitrant chronic rhinosinusitis (CRS) has yet to be clearly understood and clinical outcomes data for these patients is lacking. Osteitis has been characterized by inflammatory infiltrate, osteoneogenesis, and bony sclerosis with remodeling. In this study we sought to determine if osteitis negatively impacts quality-of-life (QOL) or clinical outcomes following endoscopic sinus surgery (ESS). METHODS 190 adult patients with CRS were prospectively enrolled. Osteitis was characterized by quantifiable bony thickening on sinus computed tomography (CT). Baseline measures and post-operative outcomes were evaluated using endoscopy exam, olfactory testing, and two validated disease-specific QOL surveys: the Chronic Sinusitis Survey and Rhinosinusitis Disability Index (RSDI). Bivariate and multivariate analyses were performed to evaluate differences between patients with and without osteitis. RESULTS Patients with osteitis (n=79) had higher prevalence of nasal polyposis and prior ESS (both p<0.001) and significantly worse baseline CT, endoscopy, and olfactory scores (all p<0.001) than patients without osteitis. There was no difference in baseline QOL scores between patients with and without osteitis. Following ESS, there were significant improvements in all QOL measures in both groups, however patients without osteitis were more likely to exhibit clinically meaningful improvement on physical RSDI subscale scores, independent of other clinical factors (79.0% vs 62.3%; OR: 3.85, p=0.011). CONCLUSIONS Osteitis is associated with worse baseline measures of disease severity and inflammation. Our data suggest that while patients with osteitis improve after ESS, the presence of osteitis is associated with a reduced chance of improvement in some outcome measures.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Saylam et al 400 showed markedly worse subjective scores for patients with osteitis (as determined by higher SPECT scan) compared to a non-osteitis cohort. Bhandarkar et al 78 found no difference on Rhinosinusitis Outcome Measure (RSOM), RSDI, or CSS in patients with and without osteitis. Nonetheless, fewer patients with osteitis achieved improvement from ESS after controlling for baseline diseasespecific factors.…”

“…CT scans do provide important information on anatomy, location of disease, extent of disease, and presence of osteoneogenesis. Some have tried to identify predictive data from CT scans, and have noted that presence of osteoneogenesis on CT is associated with diminished QoL gains after surgery, 78 and also that intrasinus quantity and density of opacification may correlate with QoL measures. 79 Although both endoscopic and radiographic measures may be further refined in the future to better correlate with QoL measures and outcomes, it seems clear that they are not measuring exactly the same constructs, and failure to identify a high level of correlation with symptoms does not imply that the measure is not useful.…”

Effect of ESS on Olfactory Threshold of Patients with CRS without Nasal Polyps

“…The effect of ESS on improving olfactory dysfunction has remained controversial due to lack of comprehensive evidence. Range of improvement has been reported from 25% to100% according to some prior studies; while others have reported no improvement or even reduced olfactory function following ESS [7][8][9][10] .…”

Chronic Rhinosinusitis: Time to Revise the Definition and Phenotypes

“…This could explain the recurrence of the mucosal disease after surgical treatment and may indicate that these osteitic lesions act as the source of the chronic inflammation with worse baseline measures of disease severity and inflammation [3][4][5][6][7]. Other investigators found that the incidence of osteitis reaches 64% in patients with recalcitrant CRS [8].…”