Differential perception and tolerance of chronic rhinosinusitis symptoms as a confounder of gender-disparate disease burden.

BACKGROUND

Previous studies have consistently shown that females with chronic rhinosinusitis (CRS) have a greater CRS symptom burden than males with CRS. Our objective was to determine whether differential disease perception could explain this phenomenon.

METHODS

A total of 500 participants (239 males, 261 females) with CRS were recruited. CRS symptom burden was assessed with the 22-item Sino-Nasal Outcome Test (SNOT-22). General health-related quality of life was assessed with the visual analog scale of the 5-dimensional EuroQol questionnaire (EQ-5D VAS). Participants were asked to rate their CRS symptom control as "Not at all," "A little," "Somewhat," "Very," and "Completely." "Not at all," "A little," and "Somewhat" controlled symptoms were considered to reflect poorly controlled symptoms.

RESULTS

SNOT-22 score was significantly more severe (p < 0.001) among females (mean, 44.0; standard deviation [SD], 22.5) than males (mean, 36.3; SD, 20.2). However, there was no significant difference in male- vs female-reported CRS symptom control (p = 0.154). In addition, there was no significant difference (p = 0.109) in EQ-5D VAS score between males (mean, 70.9; SD, 19.0) and females (mean, 68.4; SD, 19.5). Although a SNOT-22 score of ≥25 was predictive of poorly controlled symptoms in males (sensitivity, 82.6%; specificity, 62.5%), a SNOT-22 score of ≥30 was predictive of poorly controlled symptoms in women (sensitivity, 82.4%; specificity, 64.5%).

CONCLUSION

Females with CRS reported more severe SNOT-22 scores, despite reporting a similar level of symptom control and general health-related quality of life as men. Women had a higher SNOT-22 threshold for poorly controlled symptoms. Female CRS patients may have greater perception and tolerance of CRS symptoms without a corresponding significant, disparate downstream impairment.