Kliničko značenje nalaza kompjutorizirane tomografije paranazalnih sinusa u bolesnika s kroničnim rinosinuitisom [Clinical significance of paranasal sinus computed tomography findings in chronic rhinosinusitis]

Gregurić, Tomislav (2017) Kliničko značenje nalaza kompjutorizirane tomografije paranazalnih sinusa u bolesnika s kroničnim rinosinuitisom [Clinical significance of paranasal sinus computed tomography findings in chronic rhinosinusitis]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Introduction: Subjective severity of chronic rhinosinusitis (CRS) is commonly measured by validated disease-specific instruments, while “objective” severity may be assessed with endoscopy and/or CT scores. Aim: This study evaluated the correlation between subjective symptom severity and disease severity on CT scan in different clinical CRS phenotyps, compared to control patients and evaluated association between symptom scores and anatomical variations. Patients and methods: Total 160 patients were included in the study, 50 CRS patients without nasal polyps, 50 CRS patients with nasal polys and 60 control patients. Each patient was completed two questionnaires to grade their subjective symptoms, the visual analog scale (VAS) and Sino-Nasal Outcome test-22 questionnaire. The extent of sinus opacification was graded according to the Lund-Mackay staging system. Radiologic evidence of osteitis was assessed by Global Osteitis Scoring Scale (GOSS). The correlations between VAS symptom scores, CT score, and osteitis score were calculated. Differences in symptom scores between groups with and without anatomic variations were evaluated. Results: In CRS group without nasal polyps, significant positive correlation was found between Lund-Mackay score and smell impairment and cough. In CRS group with nasal polyps significant correlation was found between Lund-Mackay score and smell impairment and nasal obstruction. In CRS group with nasal polyps, patients with Haller cell had significantly higher facial fullness. In CRS group without nasal polyps, patients with paradoxical middle turbinate had significantly higher postnasal secretion. Conclusion: Smell impairment, nasal obstruction and cough are symptoms that shows positive correlation with CT score in CRS patients. Some anatomic variations may be associated with symptom burden in CRS patients.

Abstract in Croatian

Uvod: Težina subjektivnih simptoma mjeri se specifičnim upitnicima za sinusnu bolest, a težina „objektivnih“ znakova bolesti analizira se endoskopskim pregledom ili stupnjem bolesti na nalazu CT-a. Cilj istraživanja: Istražiti povezanost između intenziteta subjektivnih simptoma i težine bolesti na nalazu CT-a u različitim kliničkim fenotipovima KRS-a u komparaciji s kontrolnom skupinom bolesnika i istražiti povezanost intenziteta simptoma s anatomskim varijacijama paranazalnih sinusa. Ispitanici i metode: Ukupno je 160 bolesnika sudjelovalo u istraživanju, 50 bolesnika s KRS-om bez nosnih polipa, 50 bolesnika s KRS-om s nosnim polipima i 60 bolesnika kontrolne skupine. Svi su bolesnici ispunili upitnik vizualne analogne skale (VAS) za ocjenu težine simptoma i upitnik Sino-Nasal Outcome Test-22 (SNOT-22). CT promjene u sinusima stupnjevane su prema Lund-Mackayevu sistemu stupnjevanja. Radiološke promjene osteitisa stupnjevane su prema sistemu stupnjevanja Global Osteitis Scoring Scale (GOSS). Istražena je povezanost između CT stupnja, intenziteta simptoma mjerenog stupnjem VAS i stupnja osteitisa. Analizirane su razlike u intenzitetu simptoma između skupina bolesnika s anatomskim varijacijama i bez njih. Rezultati: U skupini bolesnika s KRS-om bez nosnih polipa dobivena je značajna korelacija između Lund-Mackayeva stupnja i smanjenog osjeta mirisa i kašlja. U skupini bolesnika s KRS-om s nosnim polipima dobivena je značajna korelacija između Lund-Mackayeva stupnja i smanjenog osjeta mirisa i nosne začepljenosti. U bolesnika s KRS-om s nosnim polipima, bolesnici s Hallerovom celulom imali su značajno veći osjećaj punoće u licu, a u skupini bolesnika bez nosnih polipa bolesnici s paradoksalno oblikovanom srednjom nosnom školjkom imali su značajno veću postnazalnu sekreciju u odnosu na bolesnike bez anatomske varijacije. Zaključak: Smanjen osjet mirisa, nosna začepljenost i kašalj, simptomi su koji su pokazali značajnu povezanost s CT stupnjem u bolesnika s KRS-om. Neke anatomske varijacije mogu biti povezane s težinom pojedinih simptoma sinusne bolesti.

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