2018 Section 5 - Rhinology and Allergic Disorders

Otolaryngology–Head and Neck Surgery 153(1)

identified in the literature, and we chose to use measures such as the number of surgeries, number of CT scans, results of allergen testing, and comorbid conditions such as asthma and allergic rhinitis. These measures of disease severity require fur- ther validation through research. The retrospective nature of our study also limited the amount of patient-specific demo- graphic and socioeconomic information we gained, requiring reliance on county-specific data. The external validity of our study may be limited to patient populations residing in North Carolina and those who ultimately sought treatment at a large academic institution. Despite these limitations, our study offers several new insights and clinical applicability. While Miller et al 15 studied the same AFRS population, our study focused on the distinct CRS population (which was further stratified into CRSwNP and CRSsNP) and their comparison to the AFRS group. Compared with the previous, similar study by Wise et al, 13 who investigated smaller cohorts (n = 54-58 patients) and only compared demographic variables, our study is the first to directly compare disease severity as well as socioeconomic and demographic differences between AFRS and CRS populations. The distinct associations between dis- ease severity and socioeconomic factors in the 3 groups, which have never been previously investigated, were also included in this study. In terms of clinical applicability, the understanding that AFRS may be a distinct subtype of CRS with unique his- tologic and pathophysiologic features, disease presentation, and patient population can aid clinicians in developing diag- noses, appropriate treatment modalities, and care coordination for these patients. Conclusion When compared with AFRS patients, CRS patients are older, are mostly white as opposed to African American, have higher income, have more access to primary care, and have lower markers of disease severity. Associations between disease severity and demographic and socioeco- nomic information are not as clear in CRS patients as they are in AFRS patients. We suggest that the differences can be explained by genetic predispositions, socioeconomic status, behavioral patterns, and health care accessibility. Our data further support the theory that AFRS merits classifica- tion as a distinct subtype of CRS. Prospective studies out- side of North Carolina and the southeastern United States are needed, including collection of patient-specific demo- graphic measurements and the validation of such measure- ments of disease severity for both CRS and AFRS to better elucidate their differences. Authors’ Note This work was performed at the University of North Carolina Hospitals, Chapel Hill, North Carolina.

the work; Justin D. Miller , data analysis, drafting, final approval, accountability for all aspects of the work; Brian D. Thorp , data analysis, drafting, final approval, accountability for all aspects of the work; Satyan B. Sreenath , data analysis, drafting, final approval, accountability for all aspects of the work; Stanley M. McClurg , data analysis, drafting, final approval, accountability for all aspects of the work; Brent A. Senior , data analysis, draft- ing, final approval, accountability for all aspects of the work; Adam M. Zanation , data analysis, drafting, final approval, accountability for all aspects of the work; Charles S. Ebert Jr , data analysis, drafting, final approval, accountability for all aspects of the work.

Disclosures Competing interests: None. Sponsorships: None. Funding source: None.

References

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Author Contributions

Yemeng Lu-Myers , data analysis, drafting, final approval, accountability for all aspects of the work; Allison M. Deal , data analysis, drafting, final approval, accountability for all aspects of

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