A Study on Exacerbation Factors of Symptoms Using a Nasal Symptoms Questionnaire in Patients with Chronic Rhinosinusitis

We developed a nasal symptoms questionnaire (NSQ), consisting of 10 items, to grasp the subjective symptoms of patients with chronic rhinosinusitis (CRS). In this study, we investigated the factors causing exacerbation of nasal symptoms in patients with CRS by examining the results of the NSQ, the patients’ background, and the clinical findings. The subjects were 287 patients who underwent endoscopic sinus surgery for CRS from June 2015 to December 2018. Based on the JESREC diagnostic criteria, 125 patients were classified into the eosinophilic chronic rhinosinusitis (ECRS) group (87 men and 38 women; mean age 50.7 years) and 162 patients were classified into the non-eosinophilic chronic rhinosinusitis (non-ECRS) group (89 men and 73 women; mean age 50.6 years). The relationships between the NSQ score and the 10 items that were considered as potential exacerbating clinical factors (age, sex, presence/absence of asthma, respiratory dysfunction, blood eosinophilia (%), results of active rhinomanometry, serum total IgE level, presence of perennial or seasonal allergic rhinitis, CT score according to the Lund-Mackay staging system, and the nasal polyp score) were analyzed by calculating the Spearman’s rank correlation coefficient. Furthermore, multiple regression analysis was performed using factors that were identified as being statistically significant (p<0.05) based on the Spearman’s rank correlation coefficient. In the ECRS group, presence of asthma, age, and blood eosinophilia were significantly correlated with the NSQ scores. In the non-ECRS group, age, blood eosinophilia, results of active rhinomanometry, and the CT score were significantly correlated with the NSQ scores. The results of multiple regression analysis showed that presence of asthma and age were significant factors in the ECRS group, while age alone was identified as a significant factor in the non-ECRS group. Based on the results of this study, we concluded that symptoms associated with ­rhinosinusitis become milder as the patients get older.