Validity of European Position Paper on Rhinosinusitis Disease Control Assessment and Modifications in Chronic Rhinosinusitis

Abstract

Objectives To develop a chronic rhinosinusitis (CRS) disease control staging system that predicts patient and physician opinion. This involved exploring the predictive capacity of the proposed European Position Paper on Rhinosinusitis (EPOS) 2012 staging system and other potential scoring systems based on patient symptoms and objective criteria. Study Design Prospective study. Setting Tertiary hospitals. Subjects and Methods Adults CRS patients undergoing sinus surgery were prospectively enrolled from a tertiary clinic. The Sino-Nasal Outcome Test 22, endoscopy score, and systemic medication were recorded at 6 and 12 months. A physician and patient report of their condition as either “controlled,”“partly controlled,” or “uncontrolled” was also recorded. Ordinal regression was used for modeling a staging system. The EPOS criteria and various combinations were assessed. Kappa agreements between the staging systems and patient/physician reports were analyzed. Results One hundred six patients were assessed. Nasal obstruction ( P = .02), endoscopic mucosal inflammation ( P < .001), and thick and/or purulent discharge ( P = .01) associated with progress reports. A modified staging system of Nasal Obstruction, Systemic medication used, and Endoscopic inflammation (NOSE) was selected on predictive strengths. The EPOS and NOSE had significant agreement with physician’s ( k = 0.29, P < .01, and k = 0.45, P < .01) and patient’s report ( k = 0.18, P = .01, and k = 0.32, P < .01). Conclusions The disease control assessment by EPOS has slight agreement with patients and a physician. A simpler NOSE system using nasal obstruction, mucosa, and discharge is proposed.