title: Acute Exacerbations Mediate Quality of Life Impairment in Chronic Rhinosinusitis.
abstract: BACKGROUND
  Antibiotic usage in chronic rhinosinusitis (CRS) reflects poor disease control and may indicate the need for sinus surgery.
  
  
  OBJECTIVE
  The objective of this study was to (1) determine the association between CRS symptomatology, which reflects CRS pathophysiology, and sinusitis-related antibiotic usage, and (2) to determine the impact of antibiotic usage on quality of life (QOL).
  
  
  METHODS
  A prospective cross-sectional study enrolling 85 participants meeting consensus guideline criteria for CRS was conducted. Symptomatology was assessed using the 22-Item Sinonasal Outcomes Test (SNOT-22) and general health-related QOL was assessed using the EuroQol 5-dimensional visual analog scale (EQ5D-VAS). Association was sought between SNOT-22, the number of prescribed antibiotics for sinusitis in the past year, sinus infections in the past year, and EQ5D-VAS. Antibiotic usage and number of sinus infections were checked for mediation in the association between SNOT-22 and EQ5D-VAS.
  
  
  RESULTS
  The SNOT-22 score is associated with the number of antibiotics taken in the past year (relative risk = 1.02, 95% confidence interval [CI]: 1.01-1.03, P = .002) and EQ5D-VAS (β = -0.37, 95% CI: -0.52 to -0.22, P < .001). Having taken more than 2 antibiotics for sinusitis in the past year mediated 31% of the effect of SNOT-22 on EQ5D-VAS, through a mediation effect (P = .008). Antibiotic usage highly correlated with the number of reported sinus infections (ρ = 0.69, 95% CI: 0.54-0.80, P < .001), which also showed a similar statistically significant mediation effect between SNOT-22 and EQ5D-VAS.
  
  
  CONCLUSIONS
  Sinusitis-related antibiotic usage, likely reflecting the frequency of acute CRS exacerbations, mediates the association between CRS symptomatology and QOL. Reducing the frequency of acute exacerbations may significantly enhance QOL of CRS sufferers independent of baseline symptomatology.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Mass; Department of Otolaryngology, Harvard Medical School, Boston, Mass.
authors.forename: Katie M
authors.initials: KM
authors.lastname: Phillips
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Mass; Department of Otolaryngology, Harvard Medical School, Boston, Mass.
authors.forename: Lloyd P
authors.initials: LP
authors.lastname: Hoehle
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Mass; Department of Otolaryngology, Harvard Medical School, Boston, Mass.
authors.forename: Regan W
authors.initials: RW
authors.lastname: Bergmark
authors.affiliation: Department of Otolaryngology, Harvard Medical School, Boston, Mass; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Mass.
authors.forename: David S
authors.initials: DS
authors.lastname: Caradonna
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Mass; Department of Otolaryngology, Harvard Medical School, Boston, Mass.
authors.forename: Stacey T
authors.initials: ST
authors.lastname: Gray
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Mass; Department of Otolaryngology, Harvard Medical School, Boston, Mass; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Mass. Electronic address: ahmad_sedaghat@meei.harvard.edu.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012220:Rhinitis / Q000188:drug therapy* / Q000503:physiopathology*; D012852:Sinusitis / Q000188:drug therapy* / Q000503:physiopathology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute exacerbations; Acute rhinosinusitis; Antibiotics; Chronic rhinosinusitis; EQ-5D; Quality of life; SNOT-22; Symptomatology