Chronic rhinosinusitis: Epidemiology and burden of disease

Background: Chronic rhinosinusitis (CRS) is based on sinonasal symptoms coupled with sinonasal tissue inflammation. Establishing the epidemiology and prevalence of CRS, therefore, is challenging given that confirming objective evidence of sinonasal inflammation on a large scale is not feasible. Although the sinonasal symptoms are well documented at the sinonasal level, analysis of emerging data indicates that the impact on the general-health-related domains of health are the symptoms that are most bothersome to patients' quality of life. Objective: To review the literature on the epidemiology and the societal and individual burdens of CRS. Methods: A literature review. Results: A refinement of questionnaire-based surveys coupled with sampling of respondents for accuracy likely provides the most accurate assessment of prevalence. There is geographic variation, but, in North American and European countries, the rates range from 4.5 to 12%. Although CRS is marked by sinonasal symptoms, the most problematic symptoms for patients seem to be the symptoms that affect general-health-related domains. Diminished sleep, productivity, cognition, mood, and fatigue are associated with the decision to elect surgical intervention and are associated with diminished healthy utility values. Direct costs of CRS have been well documented, but new data on the indirect costs of decreased productivity surpass direct costs, at $12.8 billion dollars per year in the United States. Conclusion: CRS is a common disease with a large and vast symptom burden with high indirect costs. Although clinicians are focused by guidelines on sinus-specific symptoms, patients seem to be most impacted by the general-health-related consequences of CRS. An expanded understanding of the extent and costs of these symptoms will allow for a cost-effective allocation of limited health care resources.