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Allergy. 2015 Aug;70(8):995-1003. doi: 10.1111/all.12644. Epub 2015 May 26.

Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study.

Author information

1
Department of Otorhinolaryngology Head & Neck Surgery, University of Fukui, Fukui, Japan.
2
Department of Otolaryngology Head & Neck Surgery, Okayama University Graduate School of Medicine, Okayama, Japan.
3
Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.
4
Department of Otorhinolaryngology-Head & Neck Surgery, Hiroshima University, Hiroshima, Japan.
5
Department of Otorhinolaryngology, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan.
6
Department of Otorhinolaryngology Head & Neck Surgery, Dokkyo Medical University, Tochigi, Japan.
7
Department of Otolaryngology, Sapporo Medical University, Hokkaido, Japan.
8
Department of Otorhinolaryngology, Juntendo University, Tokyo, Japan.
9
Department of Otorhinolaryngology, Yokohama City Medical Center, Kanagawa, Japan.
10
Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
11
Department of Otolaryngology Head & Neck Surgery, Osaka Medical College, Osaka, Japan.
12
Department of Otorhinolaryngology, Shimane University, Shimane, Japan.
13
Department of Otorhinolaryngology Head & Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan.
14
Department of Otolaryngology, University of Tokyo, Tokyo, Japan.
15
Department of Otorhinolaryngology, Kanazawa Medical University, Ishikawa, Japan.
16
Department of Otorhinolaryngology, Toho University, Tokyo, Japan.
17
Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan.
18
Laboratory for Respiratory Diseases, Center for Genomic Medicine, Institute of Physical and Chemical Research (RIKEN), Kanagawa, Japan.
19
Department of Medical Genetics, University of Tsukuba, Ibaraki, Japan.

Abstract

BACKGROUND:

Chronic rhinosinusitis (CRS) can be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays more intense eosinophilic infiltration and the presence of Th2 cytokines. Mucosal eosinophilia is associated with more severe symptoms and often requires multiple surgeries because of recurrence; however, even in eosinophilic CRS (ECRS), clinical course is variable. In this study, we wanted to set objective clinical criteria for the diagnosis of refractory CRS.

METHODS:

This was a retrospective study conducted by 15 institutions participating in the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC). We evaluated patients with CRS treated with endoscopic sinus surgery (ESS), and risk of recurrence was estimated using Cox proportional hazard models. Multiple logistic regression models and receiver operating characteristics curves were constructed to create the diagnostic criterion for ECRS.

RESULTS:

We analyzed 1716 patients treated with ESS. To diagnose ECRS, the JESREC scoring system assessed unilateral or bilateral disease, the presence of nasal polyps, blood eosinophilia, and dominant shadow of ethmoid sinuses in computed tomography (CT) scans. The cutoff value of the score was 11 points (sensitivity: 83%, specificity: 66%). Blood eosinophilia (>5%), ethmoid sinus disease detected by CT scan, bronchial asthma, aspirin, and nonsteroidal anti-inflammatory drugs intolerance were associated significantly with recurrence.

CONCLUSION:

We subdivided CRSwNP in non-ECRS, mild, moderate, and severe ECRS according to our algorithm. This classification was significantly correlated with prognosis. It is notable that this algorithm may give useful information to clinicians in the refractoriness of CRS before ESS or biopsy.

KEYWORDS:

chronic rhinosinusitis severity; clinical diagnostic criterion; endoscopic sinus surgery; eosinophilic infiltration; refractory chronic rhinosinusitis

PMID:
25945591
PMCID:
PMC5032997
DOI:
10.1111/all.12644
[Indexed for MEDLINE]
Free PMC Article

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