Role of Osteitis in Chronic Rhinosinusitis: A Predictive Marker of Disease Severity?

Abstract

Introduction Chronic rhinosinusitis (CRS) not only affects the overlying mucosa but also involve the underlying sinus bone termed as osteitis. The role of osteitic bone in severity and persistence of disease has received little attention. Thus understanding of this can help in formulating better treatment plan for CRS. We conceived this study with an aim to assess correlation of osteitis with severity of disease and short term disease outcome by examining the various parameters concerned with CRS. Material and Methods This prospective cohort study included 40 participants as clinically diagnosed CRS cases and 20 participants as controls. Various pre and post-operative parameters concerning CRS were assessed like pre and post-operative Sino-Nasal Outcome Test (SNOT) 20 symptom score, Lund-Kennedy endoscopy and Lund Mackay CT scores, bone density / Hounsfield unit (HU), radiological bone thickness and histopathological mucosal and bone grading. Correlation between osteitis and all these parameters were analyzed. Results Osteitis / bone grade was found to have statistically significant, moderate and positive correlation with the preoperative Lund and Mackay CT score and mucosal grade. The osteitis / bone grade was found to be weakly and positively correlated to the Lund and Kennedy score and weakly but negatively correlated to change in SNOT- 20 values (both statistically insignificant). Conclusion There are high chances of harbouring severe osteitis underneath high grade mucosal disease in CRS. Preoperative Lund and Mackay CT score can serve as a surrogate marker for osteitis. Symptomatic severity of disease does not correlate with osteitis. Osteitis affects disease outcome negatively.