title: A case-control study of medical, psychological and socio-economic factors influencing the severity of chronic rhinosinusitis.
abstract: Chronic rhinosinusitis (CRS) is a common and debilitating disorder. Little is known about the epidemiology of this disease. The aims of the study were to identify differences in socio-economic variables and quality of life between patients with chronic rhinosinusitis and healthy controls, to identify any significant associations between CRS and other medical co-morbidities, psychiatric disease or environmental exposure and to explore the experience of CRS from the perspective of CRS sufferers.
  
  
  
  Participants were recruited from ENT clinics from 30 centres across the UK. They completed a study-specific questionnaire considering environmental, medical and socio-economic factors, and SF-36 and SNOT-22 scores. All participants with CRS were diagnosed by a clinician and categorised as having CRS (with polyposis, without polyposis or allergic fungal rhinosinusitis (AFRS)). Controls included family and friends of those attending ENT outpatient clinics and hospital staff who had no diagnosis of nose or sinus problems and had not been admitted to hospital in the previous 12 months.
  
  
  
  A total of 1470 study participants (1249 patients and 221 controls) were included in the final analysis. Highly significant differences were seen in generic and disease-specific quality of life scores between CRS sufferers and controls; mean SNOT-22 score 45.0 for CRS compared with 12.1 amongst controls. There were no clear differences in socioeconomic variables including social class, index of multiple deprivation and educational attainment between cases and controls. Common comorbidities with a clear association included respiratory and psychiatric disorders, with a higher frequency of reported upper respiratory tract infections.
  
  
  
  CRS is associated with significant impairment in quality of life and with certain medical co-morbidities. In contrast to other common ENT disorders, no socioeconomic differences were found between patients and controls in this study.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Carl
authors.initials: C
authors.lastname: Philpott
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Erskine
authors.affiliation: ENT Department, Guys and St Thomas NHS Foundation Trust, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Hopkins
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Coombes
authors.affiliation: ENT Department, Darlington Memorial Hospitals NHS Foundation Trust, Darlington, UK.
authors.forename: Naveed
authors.initials: N
authors.lastname: Kara
authors.affiliation: ENT Department, Royal Surrey County Hospital, Surrey, UK.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Sunkareneni
authors.affiliation: ENT Department, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Shahram
authors.initials: S
authors.lastname: Anari
authors.affiliation: ENT Department, Ipswich Hospital NHS Trust, Ipswich, UK.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Salam
authors.affiliation: ENT Department, Betsi Cadwaladr University Health Board Wrexham Maelor Hospital, Wrexham, UK.
authors.forename: Amir
authors.initials: A
authors.lastname: Farboud
authors.forename: Allan
authors.initials: A
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002908:Chronic Disease; D015897:Comorbidity; D004522:Educational Status; D004739:England / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D009790:Occupations / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012220:Rhinitis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D065631:Rhinitis, Allergic / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D012424:Rural Population / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012852:Sinusitis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult