2018 Section 5 - Rhinology and Allergic Disorders

Reprinted by permission of Otolaryngol Head Neck Surg. 2015; 153(1):137-143.

Original Research—Sinonasal Disorders

Otolaryngology– Head and Neck Surgery 2015, Vol. 153(1) 137–143 American Academy of Otolaryngology—Head and Neck

Comparison of Socioeconomic and Demographic Factors in Patients with Chronic Rhinosinusitis and Allergic Fungal Rhinosinusitis Yemeng Lu-Myers, MPH 1 , Allison M. Deal, MS 1 , Justin D. Miller, MD 1 , Brian D. Thorp, MD 1 , Satyan B. Sreenath 1 , Stanley M. McClurg, MD 1 , Brent A. Senior, MD 1 , Adam M. Zanation, MD 1 , and Charles S. Ebert Jr, MPH, MD 1

Surgery Foundation 2015 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815580978 http://otojournal.org

Received December 18, 2014; revised March 10, 2015; accepted March 18, 2015.

No sponsorships or competing interests have been disclosed for this article.

Abstract Objective. The primary objective of this study is to evaluate the differences in socioeconomic, demographic, and disease severity factors between patients with chronic rhinosinusitis (CRS) and those with allergic fungal rhinosinusitis (AFRS). Setting. The study was conducted at the hospital of the University of North Carolina at Chapel Hill. Subjects and Methods. A total of 186 patients were included (93 AFRS, 93 CRS with and without nasal polyps). Socio- economic and demographic data were obtained from the North Carolina State Data Center. Indicators of disease sever- ity were measured by Lund-Mackay scores, serum immunoglo- bulin E (IgE) levels, diagnosis of asthma and/or allergic rhinitis, and the number of surgeries and computed tomography scans performed. Associations were analyzed with Fisher’s exact, Wilcoxon rank sum, and Pearson’s correlations tests. Results. Compared with patients with AFRS, patients in both CRS groups were predominantly white ( P \ .0001), were older at the time of diagnosis ( P \ .0001), had higher county-based income per capita ( P = .004), had lower quan- titative serum IgE level ( P \ .001), and had lower Lund- Mackay scores ( P \ .0001). No associations between disease severity, socioeconomic status, and demographic factors were found within the CRS groups. Conclusion. Within our cohort of patients residing in North Carolina, those with CRS have higher income, more access to primary care, and lower markers of disease severity than those with AFRS. These data continue to support the notion that AFRS merits classification as a distinct subtype of CRS. Keywords sinusitis, chronic rhinosinusitis, demography, epidemiology, fungus, race, gender Study Design. A retrospective cohort analysis was performed.

Introduction In the United States, chronic rhinosinusitis (CRS) affected 4.9% of the general population as of 2007, and this condi- tion is responsible for substantial health care utilization and expenditure. 1 Like other chronic diseases such as diabetes mellitus and hypertension, CRS and its various subtypes result in not only debilitating physical symptoms but also significant quality of life impairment. 2 CRS is defined as inflammation of the nasal cavity and paranasal sinuses that is medically refractory after at least 3 weeks of maximal medical therapy, with at least 2 characteristic symptoms (facial pain, nasal discharge, nasal blockage, reduced smell) and endoscopic or radiographic disease confirmation. 3 CRS is further classified into CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP), which, in general, have presumed different origins and histologic and pathophysio- logic characteristics. Allergic fungal rhinosinusitis (AFRS), a unique subtype of CRS, is a 3-decade-old clinical condition first described in 1981 by Millar et al 4 as allergic bronchopulmonary asper- gillosis of the paranasal sinuses. Since this original descrip- tion, the true pathophysiologic and etiologic components of AFRS have been the topic of much discussion. 5-7 Bent and Kuhn 8 developed the current diagnostic criteria for AFRS centered on radiographic, histologic, and immunologic char- acteristics. These criteria are as follows: history of type I

1 Department of Otolaryngology–Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA

Corresponding Author: Charles S. Ebert Jr, MPH, MD, Department of Otolaryngology–Head and Neck Surgery, University of North Carolina, 170 Manning Drive, Physicians Office Building, Ground Floor, CB#7070, Chapel Hill, NC 27599-7070, USA. Email: cebert@med.unc.edu

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