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Sinonasal anatomic variants and asthma are associated with faster development of chronic rhinosinusitis in patients with allergic rhinitis

Authors

  • Ahmad R. Sedaghat MD, PhD,

    Corresponding author
    1. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
    2. Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA
    3. Department of Otology and Laryngology, Harvard Medical School, Boston, MA
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  • Stacey T. Gray MD,

    1. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
    2. Department of Otology and Laryngology, Harvard Medical School, Boston, MA
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  • Kyle J. Chambers MD,

    1. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
    2. Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA
    3. Department of Otology and Laryngology, Harvard Medical School, Boston, MA
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  • Claus O. Wilke PhD,

    1. Section of Integrative Biology and Center for Computational Biology and Bioinformation, University of Texas at Austin, Austin, TX
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  • David S. Caradonna MD, DMD

    1. Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA
    2. Department of Otology and Laryngology, Harvard Medical School, Boston, MA
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  • Potential conflict of interest: None provided.

Abstract

Background

Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are a major burden to the healthcare system. Although no causal relationship has been established, previous work has demonstrated a strong association of AR with CRS. In this study, we sought to identify risk factors that may influence speed of development of CRS in patients with AR.

Methods

Retrospective review of all patients diagnosed with AR without CRS presenting to an otolaryngology clinic at a tertiary medical center as part of a multidisciplinary allergy evaluation between March 2004 and November 2011. Medical records were evaluated for clinicodemographic factors including age, gender, smoking history, medical comorbidities, categories of AR based on formal allergy testing, the presence of sinonasal anatomic variants on computed tomography as well as subsequent development of CRS.

Results

Faster progression to CRS in patients with AR was associated with comorbid asthma (hazard ratio [HR] = 3.97) as well as sinonasal anatomic variants, such as infraorbital cells (HR = 7.39), and frontal intersinus cells (HR = 68.03), on multivariate survival analysis. A statistically significant but negative interaction between infraorbital cells and frontal intersinus cells suggests that concomitant presence of both leads to a less than additive increase in the rate of CRS progression.

Conclusion

Sinonasal anatomical variants, infraorbital cells, and frontal intersinus cells, as well as comorbid asthma are associated with faster development of CRS in patients with AR. The presence of these clinical risk factors identifies patients who should be counseled on compliance with medical therapy for AR.

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