title: Management of non-invasive rhinosinusitis in the immunosuppressed patient population.
abstract: OBJECTIVE
  Rhinologists are seeing an increasing number of immunosuppressed patients. Currently, no treatment paradigm exists for treating acute and chronic noninvasive rhinosinusitis (ARS, CRS) in this growing population. This study aims to identify patient and treatment factors that affect rhinosinusitis outcomes in this vulnerable population.
  
  
  METHODS
  Prognostic retrospective cohort study.
  
  
  METHODS
  Immunocompromised patients treated by rhinologists for ARS or CRS 10/2007 to 10/2012 were identified by rhinosinusitis diagnostic codes, codes for transplant, cancer, HIV, diabetes, and codes indicating immunosuppression in the intensive care setting. Associations between patient factors and outcome were analyzed by logistic regression. Associations between treatment and outcome were analyzed by Firth logistic regression.
  
  
  RESULTS
  A total of 132 subjects were identified. Of those, 90.9% had CRS and 9.1% had ARS; 12.9% were transplant patients; 47% were diabetic; 37.9% were cancer patients; and 16.7% were in the intensive care unit. Patients with higher American Society of Anesthesiologists (ASA) scores had decreased disease resolution (odds ratio [OR] = 0.5, P = 0.021). Transplant patients (OR = 22.5, P = 0.001), diabetics patients (OR = 6.4, P = 0.017), cancer patients (OR = 5.4, P = 0.046), and patients with prior medical therapy for rhinosinusitis (OR = 5.84, P < 0.001) had increased disease resolution compared to immunosuppressed critical care patients. Patients treated with antibiotics alone had no statistically significant difference in disease resolution compared to those receiving no treatment. In contrast, treatment plans including surgery were associated with greater disease resolution.
  
  
  CONCLUSIONS
  This data indicates that surgical treatment provides improved outcomes for patients presenting with acute exacerbations of rhinosinusitis related to their immunocompromised state. Given the limited study population, these findings may not apply to HIV-positive or ARS patients, and further study should be undertaken in these groups.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Dao
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, U.S.A.
authors.forename: Shruthi K
authors.initials: SK
authors.lastname: Rereddy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Wise
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
authors.forename: John M
authors.initials: JM
authors.lastname: DelGaudio
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
authors.forename: Zara M
authors.identifier: http://orcid.org/0000-0003-2072-982X
authors.initials: ZM
authors.lastname: Patel
mesh_terms: D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010036:Otolaryngology / Q000379:methods*; D012189:Retrospective Studies; D012220:Rhinitis / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D012852:Sinusitis / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D014481:United States / Q000453:epidemiology
keywords: acute rhinosinusitis; cancer; chronic rhinosinusitis; diabetes; immunocompromised; immunosuppressed; intensive care unit; noninvasive rhinosinusitis; rhinosinusitis; transplant