PREVALENCE OF CHRONIC RHINO SINUSITIS AND IT'S RECURRENT AFTER TREATMENT COMPARE TO ITS RECURRENT AFTER SURGERY AT SAUDI ARABIA

Dr. Shahad Abdulelah Abualnasr, Dr. Abdullah Mohammed Alattas, Dr. Abdullah Abdulelah Abualnasr, Dr. Haifa Abdulmohsen Alsrisri and Dr.Talal Aljeraisi. Otorhinolarygology , Head & Neck Sergery Department,Faculty Of Medicine,Taibah University, KSA. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Introduction:-
Chronic rhinosinusitis (CRS) is one of the most common chronic diseases which is defined as inflammation of the nose and paranasal sinuses that persists for 12 weeks or longer with two or more of the following symptoms: nasal congestion or blockade, anterior or posterior nasal discharge, facial pain or pressure, reduction or loss of smell, and complementary endoscopic signs and CT changes.Disturbing the quality of life of the affected people and causing a high financial burden on society. The ostiomeatal complex plays a fundamental role in the pathogenesis of rhinosinusitis (Fokkens, 2012). (1)(2) In Saudi Arabia, chronic rhinosinusitis is prevalent in the eastern province and affects people from all age groups. In the past few years, there has been an increase in the chronic rhinosinusitis incidences in Saudi Arabia (El-Banna&Jiman-Fatani, (2013). (3) Chronic rhinosinusitis has several subtypes, such as where it can exist with or without nasal polyps. There is also fungal sinusitis, dental sinusitis, pediatric CRS, biofilms as well as MRSA among others.There is a large incidence of allergies in people suffering from chronic rhinosinusitis, particularly those for dust mites, molds, cockroaches and animal dander. Poorly controlled allergies can cause the deterioration of chronic rhinosinusitis symptoms. According to Dutre, Al Dousary, Zhang and Bachert (2013). (4) Exposure to airborne irritants such as formaldehyde or tobacco smoke increases the risk of chronic rhinosinusitis. People with particular problems in their immune systems have increased risk of getting chronic rhinosinusitis. One of the most common problems with regard to chronic sinusitis is hypogammaglobinemia or antibody deficiency.
People with subtle issues with their immune defenses mainly affecting the lungs, noses and sinuses also face a greater risk of acquiring chronic rhinosinusitis. Repeated infections by viruses increase the risk of getting chronic rhinosinusitis like common cold. However, it is unclear whether or not the infections are responsible for the rhinosinusitis. A deviated septum also increases the risk of getting chronic sinusitis (Hamid, Joseph & Al-Qahtani, 2015). (5) A deviated septum may be present since birth or develop in later years of life because of a nasal injury. A deviated septum results in nasal blockage causing the blockage of one or both nostrils.People with chronic rhinosinusitis usually need lifelong treatment to keep the symptoms in check . Several treatment options are available for people with chronic rhinosinusitis. Yet there are many challenges to the management of CRS especially in the case of the more severe and refractory forms of the disease. As a consequence a wide range of medical and surgical therapies have been used to treat CRS. (6)(7) researches evaluating the comparative efficiency of various treatments for chronic rhinosinusitis (CRS) is scanty.
This study aimed to assess the prevalence of Chronic Rhinosinusitis in Saudi Arabia, identify the most affected age group and Gender, and assess the most common risk factors for Rhinosinusitis.Determine Recurrent of Rhinosinusitis After Treatment and After Surgery and to Compare them.

Methodology:-
This is a cross-sectional study which was conducted through a random sampling. The population was people lives in Saudi Arabia during 2016. All recruited subjects of this study were from Saudi Arabia. Subjects who are not were excluded from the study analysis.
A pre-designed structured English and Arabic languages questionnaire was used in this cross-sectional survey. The used questionnaire includes 20 questions and was formulated to include demographic aspects, clinical features, risk, medical and surgical history. The questionnaire items were designed and written to suit the tradition and the Islamic culture. The questionnaires were electronically on a large scale to get the effective sampling. The questionnaires with missing data more than 50% were excluded from the study analysis. The final study sample size 434 person.

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Approval was taken from the ethics committee at faculty of medicine, Taibah University. Ethical consideration was considered to avoid physical or emotional harm in the study questionnaire. The confidentiality and privacy of the collected data were ensured through the use of anonymous questionnaire and during data entry and analysis. People were provided with information on the study aims and methods.

Population & Sample of the Study:-
The study population includes all residents in the Kingdom of Saudi Arabia till the research year (2016), a random sample of (438) participants was selected, they answered the questionnaire electronically, (216) persons of them were infected with chronic sinusitis, they are nearly half of the selected sample, while (222) aren't infected with sinusitis, table (1) shows the participants properties according to their personal information: We also can notice that 55.6% of the ages of those who suffer chronic sinusitis were between (21-30) years old, while 18.1% of them were between (31-40) years old, 12.5% of them were between (11-20) years old, 9.7% of them were between (42-50) years old, and 4.2% of them were between (51-60) years old.
The next diagram concludes the previous results.   And according to the side of disease, 87.1% answered that it is in both their face sides, while 6.7% of them told that it is in their left side of their faces, and 6.2% of them suffer from the right side of their faces.

How do you diagnose?
And according to the way they have their disease diagnosis, 57% of the infected ones were diagnosed by the doctor, while 33% of them diagnosed themselves, 8% of them were diagnosed by a friend who is suffering from the same symptoms , and 2% of them were diagnosed by a pharmacist. It is noticed from the previous table that 96.9% of the infected ones have the inflammation many times after having drugs as a way of treatment, while 3.1% of them have the inflammation many times after having surgical treatment but it is very important to clarify that the first case's percentage is much higher than the second; because most of the infected people use the medical drugs as a way of treatment not the surgical treatment, the researcher think that result to that the sinusitis is a chronic disease and it is not easy to be completely cared. From the previous table we can conclude to:- 17.1% of sinusitis infected ones suffer from severe Sneezing, while 35.2% of them suffer mildly from Sneezing.  18.5% of sinusitis infected ones suffer from severe Cough, while 32.4% of them suffer mildly from it.  10.6% of sinusitis infected ones suffer from severely Nasal congestion, while 31.5% of them suffer mildly from it.  14.4% of sinusitis infected ones suffer from severely Runny Nose, while 30.6% of them suffer mildly from it.  3.2% of sinusitis infected ones suffer from severely Nasal Obstruction, while 44% of them never suffer from it.  6% of sinusitis infected ones suffer from severely Loss of Smell or Taste, while 36.1% of them never suffer from it.  6.9% of sinusitis infected ones suffer from severely Post-Nasal Discharge, while 29.2% of them suffer mildly from it.  8.3% of sinusitis infected ones suffer from severely Post-Nasal Discharge, while 32.9% of them never suffer from it.  14.4% of sinusitis infected ones suffer from severely Ear Fullness or pain, while 27.8% of them suffer mildly from it.  13% of sinusitis infected ones suffer from severely Facial Pain/Pressure, while 31.9% of them suffer mildly from it.  14.8% of sinusitis infected ones suffer from severely Difficulty Falling Asleep or Wake Up At Night, while 31% of them suffer mildly from it.  7.4% of sinusitis infected ones suffer from severely Fatigue, while 38.9% of them never suffer from that.

Discussion:-
Chronic rhinosinusitis (CRS), one of the most common chronic diseases, CRS is associated with a substantially impaired quality of life. (8) reduced workplace productivity and serious medical treatment costs. (9,10) Identified several risk factors for CRS, including influenza vaccination, septal deviation and allergic rhinitis. Moreover, there were significantly increased prevalence of chronic rhinosinusitis in plant and machinery operators and assemblers, craft and related trade workers and the unemployed. (11) Therefore this study aimed to assess the prevalence of Chronic Rhinosinusitis in Saudi Arabia, identify the most affected age group and Gender, and assess the most common risk factors for Rhinosinusitis.
In the present study about half of the respondents had infected with chronic sinusitis. This considered a very high prevalence. This rate is higher than in many previous studies in different countries, it was 12% in the USA. (12) 10.9% in Europe. (13) this difference in results may be because CRS is difficult to study as the disease is difficult to define and diagnose. Without neglect the role of weather at this difference, there is some evidence that CRS is more prevalent in the warm than in the colder places. (14) Regarding to demographic data the majority of infected respondents 61.6% were females. confirming earlier data from the US National Health Interview Survey (NHIS), (13) and Canada. (14) but this finding unlike results of study in china which reported that The prevalence chronic rhinosinusitis among males was higher than that among females in the general population. (15) More than half 55.6% of infected respondents were between (21-30) years old. this finding conform with Kim et al. whose found that A relatively higher prevalence was seen in those aged 15-34. (16) This could be due to this age group are the most vulnerable to risk factors of chronic rhinosinusitis.

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The majority of our respondents suffer from Sinuses Safavid, regarding side of disease the most had it in both their face sides. But just about half of the respondents diagnosed their infection by the doctor, this may be one of the reasons of the behind the answer of large number of participants that they were infected with the disease, because not all of them diagnosed their infection by the doctor.
Chronic rhinosinusitis (CRS) is one of the most common chronic diseases which is defined as inflammation of the nose and paranasal sinuses that persists for 12 weeks or longer with two or more of the following symptoms: nasal congestion or blockade, anterior or posterior nasal discharge, facial pain or pressure, reduction or loss of smell, and complementary endoscopic signs and CT changes. (1)(2) But in our study just 31.9% of infected respondents still having the inflammation without complications for more than three months. 97.6% of infected respondents are treated using medical drugs, while 6.1% of them had surgical operations after the infection. Due to recurrent symptoms, many patients presenting with CRS require repeated medical treatment and even surgical interventions. So in our study 96.9% of the infected respondents have the inflammation many times after having drugs as a way of treatment, and 3.1% of them have the inflammation many times after having surgical treatment.
Previous studies found that smoking and allergies are potent risk factors for CRS. (14) Lieu and Feinstein found a significant association between current smoking and rhinosinusitis in women but not men. (10) Lotvall J, et al. foundrevealed a 20 % increased risk of rhinosinusitis in current smokers. (17) The most of our infected respondents weren't smokers, but this does not negate the possibility of exposure to secondhand smoke.
In Shi et al., cross-sectional investigation, they reported that having asthma or a nasal allergy significantly increased the risk of CRS. (15) which was consistent with some studies discovering positive associations between sinus disease or CRS and asthma. (18,19) This conform our finding 61.6% of infected respondents suffer from sensitivity.
CRS is classified into two types based on the presence or absence of nasal polyps: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). (20,21) In this study 82.9% of infected respondents hadn't nasal polyps, while 13.9% suffered from it.
The Canadian Clinical Practice Guidelines for Acute and Chronic Rhinosinusitis recommend the presence of at least two major symptoms (nasal congestion, facial pain or pressure, nasal obstruction, anterior or posterior nasal discharge, and loss of sense of smell). (22) our study showed that for symptoms among the majority of infected respondents were absent or mild.