Abstract：
UNASSIGNED: Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a diagnostic challenge due to its overlapping symptomatology with other sinonasal diseases. The objective of this study was to investigate whether items on the sinonasal outcome test (SNOT)-22 could suggest a diagnosis of spontaneous CSF rhinorrhea versus chronic rhinosinusitis without nasal polyps (CRSsNP).
UNASSIGNED: A multi-institutional retrospective chart review of patients with spontaneous CSF rhinorrhea and a control group of CRSsNP patients was performed. Individual SNOT-22 scores and domain scores were compared.
UNASSIGNED: One hundred fifteen patients were included in both cohorts. Of the patients in the CSF rhinorrhea group, 48% were misdiagnosed as chronic rhinosinusitis (CRS) prior to the correct identification of a CSF leak. On bivariate analysis, the CSF rhinorrhea group scored significantly higher on the SNOT-22 for runny nose (P < .001) and was more likely to designate this symptom as most important (P < .001). The CRSsNP group scored significantly higher in nasal blockage (P < .001), thick nasal discharge (P < .001), facial pain/pressure (P < .001), and in the ear/facial (P < .001) and rhinologic (P = .003) domains. Multivariable logistic regression revealed that runny nose (P < .001) was most predictive of spontaneous CSF rhinorrhea while nasal blockage (P < .001), thick nasal discharge (P < .001), and facial pain/pressure (P = .001) were predictive of CRSsNP after adjusting for relevant confounders. No significant difference was observed in total SNOT-22 scores between groups (P = .676).
UNASSIGNED: Spontaneous CSF rhinorrhea is commonly misdiagnosed as other sinonasal pathologies. However, individual SNOT-22 items can help aid in suggesting a CSF leak. Spontaneous CSF rhinorrhea should be suspected in patients who have high SNOT-22 scores for runny nose and report this symptom as most important, but have lower scores related to the other cardinal symptoms of CRS.
UNASSIGNED: A multi-institutional retrospective chart review of patients with spontaneous CSF rhinorrhea and a control group of CRSsNP patients was performed. Individual SNOT-22 scores and domain scores were compared.
UNASSIGNED: One hundred fifteen patients were included in both cohorts. Of the patients in the CSF rhinorrhea group, 48% were misdiagnosed as chronic rhinosinusitis (CRS) prior to the correct identification of a CSF leak. On bivariate analysis, the CSF rhinorrhea group scored significantly higher on the SNOT-22 for runny nose (P < .001) and was more likely to designate this symptom as most important (P < .001). The CRSsNP group scored significantly higher in nasal blockage (P < .001), thick nasal discharge (P < .001), facial pain/pressure (P < .001), and in the ear/facial (P < .001) and rhinologic (P = .003) domains. Multivariable logistic regression revealed that runny nose (P < .001) was most predictive of spontaneous CSF rhinorrhea while nasal blockage (P < .001), thick nasal discharge (P < .001), and facial pain/pressure (P = .001) were predictive of CRSsNP after adjusting for relevant confounders. No significant difference was observed in total SNOT-22 scores between groups (P = .676).
UNASSIGNED: Spontaneous CSF rhinorrhea is commonly misdiagnosed as other sinonasal pathologies. However, individual SNOT-22 items can help aid in suggesting a CSF leak. Spontaneous CSF rhinorrhea should be suspected in patients who have high SNOT-22 scores for runny nose and report this symptom as most important, but have lower scores related to the other cardinal symptoms of CRS.
摘要：
■自发性脑脊液（CSF）鼻漏是一种诊断挑战，因为它与其他鼻窦疾病的症状重叠。这项研究的目的是调查鼻窦结局测试（SNOT）-22中的项目是否可以提示自发性CSF鼻漏与无鼻息肉的慢性鼻窦炎（CRSsNP）的诊断。
■对自发性CSF鼻漏患者和对照组CRSsNP患者进行了多机构回顾性图表回顾。比较了单个SNOT-22得分和领域得分。
■两个队列中都有115名患者。在脑脊液鼻漏组的患者中，在正确识别CSF泄漏之前，有48％的人被误诊为慢性鼻-鼻窦炎（CRS）。在双变量分析中，在SNOT-22上，脑脊液鼻漏组的流涕得分明显更高（P<.001），并且更有可能将该症状指定为最重要的症状（P<.001）。CRSsNP组的鼻塞得分明显高于对照组(P<.001),厚鼻涕（P<.001），面部疼痛/压力（P<.001），以及耳/面部（P<.001）和鼻（P=.003）区域。多变量logistic回归分析显示流鼻涕(P<.001)对自发性脑脊液鼻漏的预测作用最大(P<.001),厚鼻涕（P<.001），和面部疼痛/压力(P=.001)在校正相关混杂因素后可预测CRSsNP。两组之间的总SNOT-22评分没有显着差异（P=.676）。
■自发性CSF鼻漏通常被误诊为其他鼻窦病变。然而,单个SNOT-22项目可以帮助提示CSF泄漏。对于流鼻涕的SNOT-22评分较高的患者，应怀疑自发性CSF鼻漏，并将此症状报告为最重要的症状，但与CRS的其他主要症状相关的评分较低。
■对自发性CSF鼻漏患者和对照组CRSsNP患者进行了多机构回顾性图表回顾。比较了单个SNOT-22得分和领域得分。
■两个队列中都有115名患者。在脑脊液鼻漏组的患者中，在正确识别CSF泄漏之前，有48％的人被误诊为慢性鼻-鼻窦炎（CRS）。在双变量分析中，在SNOT-22上，脑脊液鼻漏组的流涕得分明显更高（P<.001），并且更有可能将该症状指定为最重要的症状（P<.001）。CRSsNP组的鼻塞得分明显高于对照组(P<.001),厚鼻涕（P<.001），面部疼痛/压力（P<.001），以及耳/面部（P<.001）和鼻（P=.003）区域。多变量logistic回归分析显示流鼻涕(P<.001)对自发性脑脊液鼻漏的预测作用最大(P<.001),厚鼻涕（P<.001），和面部疼痛/压力(P=.001)在校正相关混杂因素后可预测CRSsNP。两组之间的总SNOT-22评分没有显着差异（P=.676）。
■自发性CSF鼻漏通常被误诊为其他鼻窦病变。然而,单个SNOT-22项目可以帮助提示CSF泄漏。对于流鼻涕的SNOT-22评分较高的患者，应怀疑自发性CSF鼻漏，并将此症状报告为最重要的症状，但与CRS的其他主要症状相关的评分较低。
