Subjective and Objective Measurements of Sinonasal Manifestations in Patients With Autoimmune Disorders

• Published in: The Laryngoscope Vol. 131; no. 2; pp. 255 - 259
• Main Authors: Makary, Chadi A., Gill, Brittany, Parman, Brock, Unsal, Aykut A., Holmes, Thomas, Reyes‐Gelves, Camilo, Kountakis, Stilianos E.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-02-2021; Wiley Subscription Services, Inc
• Subjects: Aged; Autoimmune diseases; Autoimmune Diseases - complications; Autoimmune Diseases - immunology; autoimmune disorders; Case-Control Studies; Chronic Disease; Chronic rhinosinusitis; Endoscopy; Epistaxis; Female; Humans; Laryngoscopy; Male; Middle Aged; Nasal Mucosa - diagnostic imaging; Nasal Mucosa - immunology; objective; Paranasal Sinuses - diagnostic imaging; Paranasal Sinuses - immunology; Retrospective Studies; Rhinitis; Rhinitis - diagnosis; Rhinitis - immunology; Severity of Illness Index; Sinusitis; Sinusitis - diagnosis; Sinusitis - immunology; subjective; presentation; autoimmune disorders; Chronic rhinosinusitis; subjective; objective
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.28693

Objectives/Hypothesis
A number of autoimmune disorders (ADs) are associated with a spectrum of sinonasal manifestations comparable to chronic rhinosinusitis (CRS). Our objective was to study the subjective and objective measurements of sinonasal manifestations of ADs.
Study Design
Retrospective cohort study.
Methods
All patients with ADs referred to our tertiary care rhinology clinic from 2008 to 2019 with sinonasal symptoms were compared to randomly selected cohorts of noneosinophilic CRS without nasal polyps (neCRSsNP) and eosinophilic CRSsNP (eCRSsNP). Demographic data, along with the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Lund‐Kennedy (LK) endoscopy score, Lund‐Mackay (LM) computed tomography (CT) score, nasal crusting, and epistaxis were reviewed at presentation.
Results
Fifty‐three patients with an AD (26 with sarcoidosis, 14 with systemic lupus erythematosus, 10 with granulomatosis with polyangiitis [GPA], and three with pemphigoid vulgaris) were identified, and compared to 75 randomly selected neCRSsNP patients and 75 eCRSsNP patients. Patients with an AD had an average SNOT‐22 score of 44.4 (confidence interval [CI]: 34.6‐51.2) compared to 25 (CI: 24.4‐25.1) and 29.7 (CI: 20.3‐29.7) for neCRSsNP and eCRSsNP patients, respectively (P < .0001), and an average LK endoscopy score of 5.3 (CI: 4.3‐6.3), compared to 3.4 (P = .005, CI: 2.7‐4) in neCRSsNP and 4.4 in eCRSsNP (P = .2, CI: 3.7‐5). There was no significant difference in the CT score compared to both groups. Patients with an AD also scored significantly worse on all four SNOT‐33 subdomains, nasal obstruction, nasal crusting, and epistaxis. Additionally, patients with GPA had the worst symptomatic and endoscopy scores.
Conclusions
Patients with ADs presenting with sinonasal symptoms have a more severe subjective and objective presentation than patients with CRS without nasal polyps.
Level of Evidence
4 Laryngoscope, 131:255–259, 2021