RSS Channels IndexSinusitis Symptoms Differ with Age
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Source: American Academy of Otolaryngology Head and Neck Surgery (AAOHNS)
Newswise — Rhinosinusitis, or as it is more commonly known, sinusitis, is known to be one of the most common chronic illnesses in the United States. Despite the prevalence of this disorder, the cause and exact definition of chronic sinusitis is still be debated. Inflammation of the sinuses may be triggered by allergic or non-allergic stimuli and the overall incidence of allergy and asthma is known to be highest in children and adolescence and decline substantially after age 35 years.
The role of the osteomeatal unit (OMU), or bony channel in the sinuses is central for the development of infections. The OMU can be blocked by anatomic structural variants or by soft tissue due to inflammation. The role of these anatomic variants in the pathogenesis of chronic sinusitis is controversial. These variants, including non-traumatic septal deviation, typically develop around puberty at the time of facial growth and completion of paranasal sinus pneumatization (the development of air cells such as those of the mastoid and ethmoidal bones). Hence, one would expect that persons who possess one or more of these anatomic variants present with inflammatory paranasal sinus disease at an earlier age compared to those who lack them.
The typical symptoms of inflammatory paranasal sinus disease are facial pain or pressure, headache, nasal obstruction, nasal drainage (anterior rhinorrhea or postnasal drip), dysosmia, and/or visual changes. The symptoms complex is diagnosis-dependent. Determining the cause and hence the appropriate treatment of facial pain and headache can be a clinical challenge. The headache can have a cause that is not paranasal sinus-related but which can co-exist with, and mutually impact the inflammatory paranasal sinus disease. The prevalence of migraine, cluster headache, myofascial pain, and psychiatric illnesses that can cause or exacerbate facial pain and headache vary with age. For instance, approximately 90 percent of patients with migraine headache experience their first attack before age 40 and the incidence decreases after age 40 in both sexes. The presence of one or more of these illnesses can impact the presenting symptom-complex of the paranasal sinus disease.
The purpose of this study is to determine the impact of the patient's age at presentation on the presenting symptoms, anatomic findings, co-morbidities, diagnosis, and surgical outcome of inflammatory paranasal sinus disease. The authors of "The Impact of a Patient's Age on the Clinical Presentation of Inflammatory Sinus Disease," are Nicolas Y. Busaba MD, Hyeijung Shin MD, and Salah D. Salman MD, all representing the the Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, and the Department of Otolaryngology and Laryngology, Harvard Medical School, Boston, Massachusetts. Dr. Busaba is also affiliated with the Division of Otolaryngology, VA Boston HealthCare System. Their findings are to be presented at the 109th Annual Meeting & OTO EXPO of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, being held September 25-28, 2005, at the Los Angeles Convention Center, Los Angeles, CA.
Methodology: This prospective study involved 514 adult patients with inflammatory paranasal sinus disease at a single tertiary care facility. The term inflammatory paranasal sinus disease is used to encompass CRS, CRS with polyposis, recurrent acute rhinosinusitis, barosinusitis, mucoceles or mucopyoceles, and antral-choanal polyp. The patients were divided into three groups based on their age at presentation. Group 1 (n=203) comprised of patients whose ages were between 18 and 39 years, group 2 (n=213) comprised of patients whose ages were between 40 and 59 years, and group 3 (n=98) comprised of patients whose ages were ≥ 60 years.
The following data were collected: patient demographics (age and gender), presenting symptoms, co-morbidities (environmental allergy, asthma, and psychiatric illness), physical examination and nasal endoscopy findings, computed tomography (CT) findings, diagnosis, operative findings, and surgical outcome. The presenting symptoms were facial pain / headache (pressure, pulsating, pricking or stabbing pain), nasal drainage (anterior rhinorrhea and/or postnasal drip), nasal congestion / obstruction, and dysosmia. We noted the following anatomic variants on physical examination and CT: septal deviation / spur, paradoxical middle turbinate, concha bullosa, agger nasi cells, and haller cells. Surgical outcome was based on a questionnaire that was filled by the patients eight weeks to three months following the operation and that asked about change in the presenting symptoms: better, same, or worse.
Statistical analysis using chi square test was performed to determine differences in the incidence of the above variables among the three age groups. Statistical significance was set at a p value of < 0.05.
Results: A total of 514 adult patients (273 women and 241 men) were evaluated in this study. The mean age was 45.5 years old (range: 18-86 years). Group 1 consisted of 203 patients (112 females and 91 males), group 2 consisted of 213 patients (107 females and 106 males), and group 3 consisted of 98 patients (54 females and 44 males).
Among the presenting symptoms, facial pain and rhinorrhea (nasal discharge) were most common among group 1 and least common among group 3 patients (p < 0.05), while dysosmia (altered sense of smell) was most common among group 3 patients (p < 0.05). Environmental allergy, but not asthma, was more prevalent in groups 1 and 2 compared to group 3 (p < 0.05). There was no statistically significant difference in the prevalence of psychiatric illness among the three groups. Anatomic abnormalities combined (septal deviation, paradoxical middle turbinate, concha bullosa, haller cell, agger nasi cell) were more common in groups 1 and 2 compared to group 3 (p < 0.05). Chronic rhinosinusitis (CRS) without polyposis was the most common diagnosis in group 1 and CRS with polyposis was the most common diagnosis in groups 2 and 3 (p < 0.05). There was no difference in the relative prevalence of antral-choanal polyp, barosinusitis and mucocele among the groups. The vast majority of the patients in the study and in all age groups reported improvement in all the presenting symptoms following surgery. However, group 3 patients reported more improvement in nasal drainage following endoscopic sinus surgery (p<0.05), while group 1 patients reported higher rate of improvement in olfactory function (p < 0.05). There was no statistically significant difference in the improvement of other presenting symptoms including facial pain among the groups.
Conclusions: The clinical presentation of inflammatory paranasal sinus disease varies with age. The younger patients are more likely to complain of facial pain or headache, have allergic rhinitis, and have anatomic obstruction of the OMU. The older patients report more dysosmia on presentation and are more likely to have nasal polyposis. The vast majority of the patients in the study and in all age groups reported improvement in all the presenting symptoms following surgery; however, olfactory function is more likely to improve in the younger patients, while nasal drainage is more likely to improve in the older patients.
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