title: Identifying clinical symptoms for improving the symptomatic diagnosis of chronic rhinosinusitis.
abstract: BACKGROUND
  Current symptom criteria for identifying patients with chronic rhinosinusitis (CRS) has poor specificity. The objective of this study was to test the hypothesis that symptoms drawn from the Task Force on Rhinosinusitis (RSTF) criteria and the International Headache Society (IHS) criteria for primary headaches can differentiate CRS patients from those with CRS-symptoms but no evidence for inflammation (non-CRS).
  
  
  METHODS
  A retrospective cohort study from a total of 140 charts of patients who received a diagnostic computed tomography (CT) scan for CRS symptoms in a tertiary care clinic. The study was conducted in 2 phases: (1) using a retrospective review of otolaryngologist-documented symptoms (ODS) in the medical record; and (2) using patient-reported symptoms (PRS) on a prospectively collected customized review of systems form from a separate cohort. A radiographic gold standard differentiated CRS from non-CRS patients.
  
  
  RESULTS
  Subjects in the CRS and non-CRS group were matched for age and race and almost universally met symptomatic criteria as defined by the RSTF in both study phases. In both study phases, facial pain, but not facial pressure, was negatively predictive for CRS (p < 0.05). Similarly, hyposmia was positively predictive, whereas facial pain of a pulsating quality and photophobia were negatively predictive (p < 0.05), although analysis of PRS was significant only when symptom frequency was considered. Nonetheless, significant overlap exists between the prevalence and frequency of symptoms in both groups.
  
  
  CONCLUSIONS
  The symptom-based diagnosis of CRS is challenging but symptoms of hyposmia is positively predictive while facial pain, a throbbing quality, headaches and photophobia are negatively predictive and show promise for improving the specificity of CRS diagnosis. Further validation studies are needed.
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Hsueh
authors.forename: David B
authors.initials: DB
authors.lastname: Conley
authors.forename: Haena
authors.initials: H
authors.lastname: Kim
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shintani-Smith
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Chandra
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kern
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Tan
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D005157:Facial Pain / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D000857:Olfaction Disorders / Q000209:etiology; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed