Severity staging in chronic sinusitis: Are CT scan findings related to patient symptoms?

Chronic sinusitis is a prevalent problem. The symptoms of CS cause patients to seek medical attention, and therefore the presence of symptoms drives t he use of health care resources. There is widespread clinical belief that c omputed tomography (CT) scan findings may be a reasonable proxy for disease severity in chronic sinusitis, and many authors have proposed that CT scan findings make up the key component in severity staging systems for chronic sinusitis. However, the relationship between symptom severity and CT scan findings in chronic sinusitis has not been well explained to date. To explo re this relationship further, we examined data from consecutive patients wi th both a CT scan and a sinusitis symptom score, from ongoing prospective o utcomes studies at two large academic centers in different cities (n = 254) . CT scans were graded using two validated staging systems; symptom severit y was assessed using two validated health status instruments and summary it ems. In addition, we explored multiple statistical modifications and permut ations of CT staging to identify potential relationships between the two va riables. In summary, no association between CT scan findings and symptom se verity could be identified using both CT staging systems and patient-based symptom instruments. For instance, CT scans were examined: after eliminatin g normal scans, using different scoring algorithms, by worst side, by nonli near association, when grouped into strata, and by eliminating patients wit h very severe disease; no statistical association was found between CT find ings and patient-bused symptoms using any of those techniques. Since sympto m severity is a pivotal outcome measure in chronic sinusitis, these finding s have significant implications for outcomes research and the development o f severity staging systems.