Race and Ethnicity Affect Symptom and Endoscopy Associations in CT-Confirmed Chronic Rhinosinusitis.

Abstract

To investigate demographic differences in the association between chronic rhinosinusitis (CRS) symptoms and endoscopic findings with CT-confirmed CRS. Consecutive adult patients presenting to outpatient rhinology clinics with chronic cardinal sinonasal symptoms who underwent nasal endoscopy and a sinus CT scan were included. Demographics, cardinal symptoms, SNOT-22, and Lund-Kennedy (LK) endoscopic scores were extracted from electronic medical records. Logistic regression was used to assess associations between predictors and CT-confirmed CRS (CT-CRS) with prespecified stratified analyses by race and ethnicity. Among 314 included patients (mean age 48 ± 17 years, 51% female), 228 met criteria for CT-CRS. Hyposmia and LK endoscopic scores were associated with CT-CRS. However, in subgroup analyses, the associations of hyposmia and LK endoscopic scores with CT-CRS were not significant among Asian and Hispanic patients. Among patients with a negative nasal endoscopy, 62.6% had CT-CRS. In this subgroup, patient-reported nasal discharge and the presence of ≥ 2 cardinal symptoms were associated with reduced odds of CT-CRS. Associations between symptoms and nasal endoscopy findings with CT-CRS were not significant among Asian and Hispanic patients, suggesting limitations of symptom and endoscopy-based assessments in these subgroups. Among patients with a negative nasal endoscopy, symptoms demonstrated limited ability to identify CT-CRS. These findings suggest CT imaging could be considered earlier in selected clinical contexts.