2018 Section 5 - Rhinology and Allergic Disorders

3D image analysis in CRS

TABLE 1. Linear regression models for LM (with/without OMC) and Chicago MLM score vs TNSS and SNOT-22

TABLE 2. Multivariate regression models for Chicago MLM score vs TNSS

TNSS vs. age vs tobacco β = 0.476 p = 0.030 a R 2 = 0.073 β = 0.023 p = 0.582 β = − 3.468

Model

LM (without OMC)

LM (with OMC)

Chicago MLM

TNSS vs age TNSS vs tobacco

TNSS

β = 0.139 p = 0.465 R 2 = 0.013 β = 0.034 p = 0.145 R 2 = 0.049

β = 0.165 p = 0.500 R 2 = 0.011 β = 0.051 p = 0.094 R 2 = 0.064

β = 0.455 p = 0.037 a R 2 = 0.098 β = 0.072 p = 0.007 a

TNSS

β = 0.467 p = 0.034 a R 2 = 0.063 β = 0.025 p = 0.552

β = 0.465 p = 0.032 a R 2 = 0.089

SNOT-22

Age

R 2 = 0.156 LM = Lund-Mackay; MLM = modified Lund-Mackay; OMC = osteomeatal complex; R 2 = multiple R -squared; SNOT-22 = Sino-Nasal Outcome Test-22;

Tobacco use (currently)

β = − 3.531

p = 0.218 p = 0.230 MLM = modified Lund-Mackay; R 2 = adjusted R -squared; TNSS = Total Nasal Symptom Score. a Statistically significant ( p < 0.05).

TNSS = Total Nasal Symptom Score. a Statistically significant ( p < 0.05).

of a cold within 3 weeks prior to the scan, season, mean time spent outside per day, outdoor occupation, and expo- sure to chemicals or pollutants. Multivariate linear regres- sion models were constructed to include age and tobacco use; these covariates were chosen as they may affect mu- cosal inflammation. 15–19 Associations between LMwithout OMC scores and TNSS and SNOT-22 scores were evalu- ated in a similar fashion. Last, associations between indi- vidual sinus Chicago MLM scores and TNSS or SNOT-22 scores were evaluated. All analyses were performed using R-Console (www.r-project.org; R Foundation for Statisti- cal Computing, Vienna, Austria). There were 45 subjects (23 males, 22 females) who met the entry criteria. Their mean age was 49.3 years. Patients’ de- mographic data are summarized in Table S1 in the Supple- mentary Material available online. The median LM score with OMC was 8 (range, 4 to 21), reflecting mild to mod- erate disease. The median LM without OMC score was 7 (range, 1 to 17), whereas the median Chicago MLM score was 4.28 (range, 1.30 to 18.03) (see Table S1 online). This difference was statistically significant as the LM method generally overestimated the extent of inflammation com- pared with the Chicago MLM in our study group ( p = 0.015). In univariate models, increased mucosal inflammation, as captured by the Chicago MLM score, was significantly as- sociated with increased symptoms (ie, greater TNSS scores) as well as worse quality of life (ie, increased SNOT-22 scores) ( β = 0.455, p = 0.037; β = 0.072, p = 0.007, respectively) (Table 1). These associations remained sig- nificant after adjustment for age and smoking status in multivariate models (Tables 2 and 3). In contrast, the Results Subjects’ demographics and CT staging Relationship between CT staging, symptoms, and quality of life

TABLE 3. Multivariable regression models for Chicago MLM score vs SNOT-22

SNOT-22 vs. tobacco

SNOT-22 vs. age vs. tobacco

SNOT-22 vs age

SNOT-22

β = 0.075

β = 0.070

β = 0.073

p = 0.006 a

p = 0.009 a

p = 0.008 a

R 2 = 0.1296)

R 2 = 0.136

R 2 = 0.128

Age

β = 0.033

β = 0.031

p = 0.418

p = 0.449

Tobacco use (currently)

β = − 2.744 p = 0.325

β = − 2.630 p = 0.348

MLM = modified Lund-Mackay; R 2 = adjusted R -squared; SNOT-22 = Sino-Nasal Outcome Test-22. a Statistically significant ( p < 0.05).

associations between LM without OMC scores and TNSS or SNOT-22 scores failed to achieve statistical significance ( β = 0.139, p = 0.465; β = 0.034, p = 0.145, respectively) (Table 1). Inclusion of the OMC in the LM score (as orig- inally described in its scoring) did not alter these results (Table 1). The association between Chicago MLM scores and TNSS or between Chicago MLM scores and SNOT-22 was not affected by the following comorbidities or demo- graphics: age; presence of hay fever/allergic rhinitis; tobacco use; presence of cold on the day of or within 3 weeks prior to the scan; outdoor occupation; hours spent outside; and exposure to chemicals or pollutants (data not shown). The correlations remained significant ( p < 0.05) with improved β values when LM cutoff was increased to 5 and to 6. At the LM cutoff of 6, LM and LM without OMC scores vs SNOT-22 also approached significant p values (see Tables S7-1 and S7-2 online). Next, the association of Chicago MLM scores with specific subdomains of the SNOT-22 was examined. Chicago MLM scores tended to correlate with sinonasal-specific components such as

International Forum of Allergy & Rhinology, Vol. 7, No. 11, November 2017

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