Original contributionOn chronic rhinosinusitis and the prevalence of fungal sinus disease: problems of diagnostic accuracy and a proposed classification of chronic rhinosinusitis☆,☆☆
Introduction
Classification of chronic rhinosinusitis (CRS) has been an unresolved issue. There are several factors for the poor definition. As of 2012, we still do not have validated criteria to assess the presence and severity of sinusitis with confidence. Most symptoms used to categorize and classify sinus disease are not specific to the sinuses, reflecting the presence of nasal disease or lower respiratory tract disease. Even headaches and sinus pressure, the most commonly presumed associates of sinus disease, have not achieved relevance in our classification efforts because the sinuses do not seem to have pain sensory nerves. Similar limitations apply to imaging studies because comparing sinusitis symptom scores with computed tomographic (CT) scans to arrive at clinical relevance is not much better than random in predicting the presence or severity of CRS. Adding to the mentioned imperfections in our science, most research, analysis, and classification is conducted in academic tertiary centers, but most patients are treated by otolaryngologists in community hospitals, and results remain unreported and are not analyzed systematically. Many classification parameters used at academic centers are not part of clinical practice because of impracticality or inaccessibility to practitioners. Therefore, reports from academic centers may overestimate or underestimate distribution of disease. For any meaningful system of classification and calculations of prevalence and incidence, our research efforts need large standardized and comparable data sets. As the move to electronic health records gains momentum, usable research database can expand only if data acquisition through participation of community otolaryngologist and pathologists can be improved. To achieve this objective, a simpler, more feasible classification system based on objective parameters acquired through standardized methods using established practice patterns would have the easiest applicability and, therefore, the most impact. Such a system would use minimal subjective interpretation and rely in large part on histopathology. To demonstrate problems associated with data quality, this study includes a 4-year retrospective analysis of operative notes and surgical pathology reports of CRS submitted by 4 different surgeons and analyzed by 10 different pathologists. The focal point is selected as fungal sinus disease because this disease has relevant importance and high prevalence in the Southern United States [1]. Accuracy in diagnostic analysis and reporting for CRS and fungal sinus disease is crucial in identifying nuances that may have implications for our poorly evidenced classification attempts.
Section snippets
Fungal sinus disease
There are recognized difficulties in accurately estimating the frequency of a causal relationship between fungi and rhinosinusitis because quality and availability of data depend on the various diagnostic criteria and laboratory techniques selected [2], [3], [4].
Allergic fungal sinusitis (AFS) was first described in 1981 as allergic aspergillosis by Millar et al [5] and further defined by Katzenstein et al [6] in 1983. Others have published clinical, laboratory, and histopathologic criteria to
Methods
Institutional review board approval for retrospective chart review at a large private tertiary referral hospital (Scott & White Memorial Hospital, Temple, TX) in Central Texas was obtained. Operative records of 4 senior sinus surgeons from January 1, 2007, to December 31, 2010, were reviewed. All sinus surgical procedures were listed. A total of 178 procedures were identified to have been performed for treatment of chronic sinus disease and/or polyps unresponsive to medical treatment. The
Summary
There are several areas that need to be addressed in the relationship between the sinus surgeon and the reporting pathologist to provide meaningful results for the betterment of our understanding of sinus disease. The onus is first and foremost on the sinus surgeon. We need to provide accurate descriptions of the anatomical region where our samples are coming from and label each separately. Every attempt should be made to provide representative samples of all anatomical regions of dissection
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2015, Brazilian Journal of Otorhinolaryngology