Adults with severe chronic rhinosinusitis with nasal polyps had significantly higher Beck Anxiety Inventory scores than control participants with completely resolved nasal problems, whereas Beck Depression Inventory-II scores did not differ significantly between the groups, according to a study published in the Journal of Inflammation Research.
Researchers prospectively enrolled 96 adults with bilateral, primary diffuse chronic rhinosinusitis with nasal polyps (CRSwNP) who were scheduled for endoscopic sinus surgery between January 2020 and April 2023. The control group included 40 otolaryngology outpatients undergoing follow-up for completely resolved nasal conditions, such as 3 months following surgery for nasal septal deviation.
Patients with CRSwNP had not responded adequately to conservative medical therapy, including intranasal corticosteroids and nasal irrigation. Patients with sinonasal neoplasms, immunologic disorders, mucociliary dysfunction, or a history of immunosuppressive treatment before enrollment were excluded.
Participants completed the 22-item Sinonasal Outcome Test (SNOT-22) questionnaire, Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II). The BAI and BDI-II are 21-item self-reported questionnaires with scores ranging from 0 to 63 to evaluate anxiety and depression in each patient. The researchers defined possible anxiety as a BAI score 7 and possible depression as a BDI-II score greater than 13.
Possible anxiety was identified in 32% of patients with CRSwNP and 20% of controls. The mean BAI score was 7 among patients with CRSwNP and 4 among controls, representing a statistically significant difference. Possible depression was identified in 13% and 5% of participants, respectively. Mean BDI-II scores did not differ statistically between the groups.
Patients with CRSwNP had higher scores on individual BAI items assessing fear of the worst happening, dizziness or lightheadedness, feeling of choking, and difficulty breathing. Although total depression scores did not differ, patients with CRSwNP had higher scores for loss of energy, changes in sleeping patterns, concentration difficulty, tiredness or fatigue, and loss of interest in sex.
Among patients with CRSwNP, asthma was present in 48% of those with possible anxiety and 8% of those without possible anxiety. Patients with possible anxiety also had higher SNOT-22 scores, serum eosinophil cationic protein levels, and blood eosinophil percentages than those without possible anxiety.
In univariate logistic regression, asthma, SNOT-22 score, and blood eosinophil percentage were statistically associated with possible anxiety. Following multivariable adjustment, asthma and SNOT-22 score remained statistically associated. Neither nasal polyp score nor Lund-Mackay score was statistically associated with possible anxiety in logistic regression analyses.
Receiver operating characteristic analysis identified an SNOT-22 score of 57 as the optimal cutoff for possible anxiety in this cohort, with 71% sensitivity and 77% specificity. The optimal cutoff value was determined by maximizing the sum of sensitivity and specificity.
BAI scores correlated with total SNOT-22 scores and the ear and facial, sleep, functional, and emotional domains. BAI scores did not correlate with the nasal symptom domain. Patients with possible anxiety also had higher scores in those four nonnasal domains, whereas nasal domain scores did not differ statistically.
The researchers noted that the study enrolled surgical patients at a tertiary referral center, whose disease may have been more severe than that of the broader CRSwNP population. Additional limitations included the exclusion of patients with chronic rhinosinusitis without nasal polyps, reliance on self-reported questionnaires, the smaller control group, and the control participants’ histories of resolved sinonasal conditions. The researchers also noted that future studies are needed in patients with chronic rhinosinusitis without nasal polyps, unilateral lesions, and those treated nonsurgically or with biologic agents.
“These findings may help clinicians better evaluate subjective symptoms when assessing the severity of sinonasal inflammation in patients with CRSwNP and provide optimal therapeutic strategies, particularly in an era when an increasing number of biological agents are being introduced for CRSwNP treatment,” wrote lead study researcher Pei-Wen Wu, MD, of the Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University in Taoyuan, Taiwan, School of Medicine, Chang Gung University in Taoyuan, Taiwan, and the Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital in Taoyuan, Taiwan, and colleagues.
The study was supported by grants from Chang Gung Memorial Hospital and the Taiwan National Science and Technology Council. The funding sources had no role in the study design, data collection or analysis, publication decision, or manuscript preparation. The researchers reported no conflicts of interest.
Source: Journal of Inflammation Research
