When It's Not Allergic Rhinitis: Clinical Signs to Raise a Patient's Suspicion for Chronic Rhinosinusitis

Abstract

AbstractObjectiveTo identify predictors of chronic rhinosinusitis (CRS) in patients presenting with the chief complaint of nasal allergies.Study DesignCross‐sectional study.SettingTertiary care, academic center.MethodsClinical and demographic characteristics were collected from participants who were patients presenting with the chief complaint of nasal allergies. From all participants, a 22‐item Sinonasal Outcome Test (SNOT‐22) was collected, and a modified Lund‐Kennedy endoscopy score was calculated from nasal endoscopy. Association was sought between having CRS and variables of clinical and demographic characteristics, SNOT‐22, and endoscopy score.ResultsA total of 219 patients were recruited and 91.3% were diagnosed with allergic rhinitis; 45.2% were also diagnosed with CRS. Approximately half of the patients with CRS reported no intranasal corticosteroid usage. Having CRS was associated with male sex (odds ratio [OR] = 2.29, 95% confidence interval [CI]: 1.30‐4.04, P = .004), endoscopy score (OR = 1.96, 95% CI: 1.59‐2.42, P < .001), and the SNOT‐22 nasal subdomain score (OR = 1.07, 95% CI: 1.03‐1.11, P = .001) related to SNOT‐22 items: “need to blow nose,” “thick nasal discharge,” “sense of taste/smell,” and “blockage/congestion of nose.” At least moderate (item score ≥3) “blockage/congestion of nose” or “thick nasal discharge,” mild “need to blow nose” (item score ≥2) or very mild decreased “sense of taste/smell” (item score ≥1), and any nasal endoscopy findings (endoscopy score ≥1) were statistically significant predictors of CRS.ConclusionModerate or more severe nasal obstruction or discharge symptoms, any decreased sense of smell/taste, or positive nasal endoscopy findings in patients believing they have allergic rhinitis should prompt further evaluation of CRS to avoid delays in treatment.