Minor symptoms a big deal in nasal polyposis

Asthma does not have any significant influence on quality of life (QoL) among patients with nasal polyposis (NP), but it may increase the intensity of individual minor symptoms such as headache, or fullness in the ears, report researchers.

"Generally, insufficient attention is paid to minor symptoms in the literature," write Zoran Dudvarski (Clinical Center of Serbia, Belgrade) and colleagues in the European Archives of Otorhinolaryngology. "Some [symptoms] may be potentiated by the associated asthma and thus, owing to their intensity may have the same clinical significance as individual major symptoms."

According to some studies the prevalence of asthma among NP patients is 45%, say the authors. However, few studies have investigated the influence of asthma on QoL, despite previous research having shown that NP may lead to significant limitations in physical, emotional, and social aspects of life, they add.

In a cross-sectional analysis of 88 patients with bilateral NP, 35 (40%) of whom had asthma, there were no significant between-group differences regarding mean scores for the major health domains of physical function, physical role, body pain, general health, vitality, social function, emotional role, and mental health, as assessed by the Short Form-36 Health Survey.

However, the mean scores for minor symptoms of headache, fatigue/malaise, and cough were significantly higher in those with versus without asthma, at 2.69 versus 2.40, 4.71 versus 4.00, and 3.20 versus 2.32, respectively.

Although these symptoms are only minor NP symptoms, they represent significant symptoms in other lower respiratory tract diseases, note Dudvarski et al. "Therefore, it may be expected to a certain extent for them to be more prominent in the group of NP patients with asthma."

The team also compared endoscopic and computerized tomography (CT) sinus findings in NP patients with and without asthma. This did not reveal any significant between-group differences in mean endoscopic score (grading of polyps, secretion, edema, crusts, and adhesions), but did reveal a significant difference in CT score (grading of opacification and obstruction), at a mean of 20.4 in those with asthma, compared with 17.5 in those without the condition.

The score for another minor symptom, fullness or pressure in the ears, was also significantly higher in those with than without asthma, at a mean of 3.00 versus 2.15. This is probably the result of a higher degree of inflammation, which is clinically reflected in greater polyp volume as well as significant CT findings, says the team.

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