Criteria to screen for chronic sinonasal disease.
BACKGROUND
Sinusitis and rhinitis are associated with uncontrolled asthma. There are no simple, validated tools to screen for these diseases. The objective of this study was to assess instruments to assist in the diagnosis of chronic sinonasal disease.


METHODS
Participants without acute sinonasal symptoms underwent an extensive evaluation. The results were submitted to an expert panel that used the Delphi method to achieve consensus. Using the consensus diagnosis of the panel, we determined the sensitivity and specificity of test procedures to diagnose chronic sinonasal disease. We determined the reproducibility of the most sensitive and specific instrument in a separate cohort.


RESULTS
Fifty-nine participants were evaluated, and the expert panel reached consensus for all (42 participants with chronic sinonasal disease, 17 participants without chronic sinonasal disease). A six-item questionnaire based on the frequency of nasal symptoms was the most sensitive tool used to diagnose sinonasal disease (minimum specificity, 0.90). Reproducibility testing in a separate cohort of 63 participants (41 chronic sinonasal disease with asthma, 22 chronic sinonasal disease without asthma) showed a concordance correlation coefficient of 0.91 (95% CI, 0.85 to 0.94) when this questionnaire was limited to five items (ie, excluding a question on smell). This five-item questionnaire had a sensitivity of 0.90 (95% CI, 0.77 to 0.97), a specificity of 0.94 (95% CI, 0.71 to 1.00), and an area under the receiver operating characteristic curve of 0.97 (95% CI, 0.93 to 1.0). Sinus CT scans and nasal endoscopy lacked sensitivity for use in the diagnosis of chronic sinonasal disease.


CONCLUSIONS
We have developed a sensitive, specific, and reproducible instrument to screen for chronic sinonasal disease. Validation studies of this five-item questionnaire are needed, including in patients with asthma.
Dixon
Anne E
AE
Department of Medicine, University of Vermont, Burlington, VT. Electronic address: anne.dixon@uvm.edu.
Sugar
Elizabeth A
EA
Johns Hopkins University, Baltimore, MD.
Zinreich
S James
SJ
Johns Hopkins University, Baltimore, MD.
Slavin
Raymond G
RG
Saint Louis University, St. Louis, MO.
Corren
Jonathan
J
University of California Los Angeles, Los Angeles, CA.
Naclerio
Robert M
RM
Department of Surgery, University of Chicago, Chicago, IL.
Ishii
Masaru
M
Johns Hopkins University, Baltimore, MD.
Cohen
Rubin I
RI
Department of Pulmonary and Sleep Medicine, North Shore-Long Island Jewish Medical Center, New Hyde Park, NY.
Brown
Ellen D
ED
Johns Hopkins University, Baltimore, MD.
Wise
Robert A
RA
Johns Hopkins University, Baltimore, MD.
Irvin
Charles G
CG
Department of Medicine, University of Vermont, Burlington, VT.
D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009668:Nose Diseases / Q000453:epidemiology* / Q000503:physiopathology; D012372:ROC Curve; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D012852:Sinusitis / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D055815:Young Adult