Demographic and Comorbidity Associations With Disease Severity and Bony Dehiscence in AFRS

The purpose of this study is to explore and describe possible demographic factors and comorbidities as they relate to disease severity of allergic fungal rhinosinusitis (AFRS) on initial presentation.

A retrospective review was conducted on 153 patients with AFRS seen at a tertiary care center. Demographics, comorbidities, SNOT-22 scores, Lund-Kennedy endoscopy scores, and Lund-Mackay CT scores, and presence of bony dehiscence at various skull base and orbital sites were recorded. Patients who had previous sinus surgery were excluded. Statistical analyses included t-tests and ANOVA.

Within our cohort (n = 153), older age was found to be significantly associated with worse SNOT-22 scores (p = 0.0146) while younger age was found to be significantly associated with Lund-Mackay scores (p = 0.0372). African-American race was found to be associated with worsened Lund-Mackay scores (p = 0.041). Analysis of a subset of patients (n = 25) which had bony dehiscence at various subsites demonstrated that asthma was the only comorbidity present more frequently in the group with bony dehiscence compared with the group without. Asthma was also associated with increased disease severity based on the Lund-Kennedy (p = 0.038) and Lund-Mackay scores (p = 0.032).

In our patient cohort with AFRS, African-American race and age were significantly associated with worse presentation of disease based on both subjective (SNOT-22 scores) and objective (Lund-Mackay scores) data. When looking specifically at patients with evidence of bony erosion on presentation, we also found asthma to be associated with more severe disease. These findings suggest that comorbid asthma may be a useful marker for identifying patients at greater risk of greater disease severity at initial presentation.

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