Discussion
Chronic rhino sinusitis appears to be prevalent in the Middle East
regions more than others across the world. This study reported high
prevalence of CRS (59.9%) using EP3OS, which is relatively close and a
little higher than that observed in previous Saudi study 2017 which
reveal a prevalence of 50% (18), and the
self-reported previously doctor diagnosed chronic rhinosinusitis in our
study represented 25.4% of the study population. This reported
prevalence are higher than that observed in a USA study which revealed
prevalence of 11.9% in 2017, and two Canadian studies that also showed
a lower prevalence of CRS in comparison to our study (5% and
18.8-23.3% respectively). (19-20-21) However, an
Iranian study reported a prevalence of 28.4% according to the criteria
of EPOS, and 20% based on the clinical diagnosed CRS.(22) This relatively high prevalence of CRS in our
region could be attributable to Jazan weather that has a dusty season
each year.
Our results found that CRS was significantly associated with age group
difference (p <0.05), which is similar to a Korean study in
2011, and other two Chinese and Canadian studies that showed significant
association between the distribution of age and having CRS.(20- 23) No significant association between gender,
residency, marital status or level of education and CRS was observed in
contrast to that in China 2012, that revealed CRS is differ
significantly with gender in agreement also with the Canadian and Korean
results. (23)
CRS significantly impair health related quality of life of patients that
lead to lost productivity secondary to absenteeism and subsequent risk
of depression. (24)Many international studies have
shown that CRS impair quality of life. However, to the best of our
knowledge, this is first population-based study in Jazan Province
evaluating health related quality of life, loss of productivity and risk
of depression in patients with CRS. In the present study, MMS
classification of quality of life affection by using (SNOT-22) show 159
(24.77%) of patients in moderate category with 483 (75.23%) which form
the majority of patients classified as severe. A study by
Sahlstrand-Johnson et al. revealed that CRS severity and quality of life
affection in patients as 9.8% mild, 37.6% moderate and 52.7 and the
patients in our study had statistically significantly higher SNOT-22
score (mean 69.14 + 24.6 vs 51.8). (25) Depression is
the second most common mental health in patients with CRS as previous
studies on relationship between CRS and depression has shown a
significant association between the two diseases, Schlosser et al.,
found that 24.4% of patients with CRS at risk of developing depression
using PHQ-2. (9)
The prevalence of depression in patient with CRS is approximately
between 9% and 40%. (12) In our study we found that
507 (78.97%) of CRS patients are at risk of depression.
This prevalence is very similar to that reported in Taiwan
population-based cohort study conducted by Nyaiteera et
al.(14), which demonstrated that the overall
prevalence of depression was 77% using a different validated screening
instrument. There have been reports on cost effect of lost productivity
secondary to CRS. A study conducted by Beswick et al., found that the
mean of loss productivity was 5.1 days as a result of allergic rhinitis
and common cold. (16)
Another recent study published by Wasan et al. , reported the mean of
lost days of productivity in last three months was 3.1 due to CRS which
is consistent with the result in this study that show the mean number of
absence days and lost productivity in the preceding three months was
3.30 due to CRS. (11) Sahlstrand-Johnson et al., fount
that over half of participants 57% reported absenteeism secondary to
sinus problems. (25)In our study only 215 (33.5%) of
patients report absenteeism due to CRS which is lower in comparison with
previous literature. In the present study we are interested to measure
the association of risk of major depressive disorders and loss of
productivity with the affection quality of life of CRS patients. A
significant difference in risk of depression was present between levels
of quality of life affection where, it has been observed that 425 (88%)
patients with severely affected quality of life (SNOT-22 score
> 50) are at higher risk of depression. Our study is
consistent with many previous studies that reported a strong association
between the total SNOT-22 score and depression scores.(9-13) there was also an observed significant
difference in the absences from work due to CRS within the levels of
quality of life affection in the present study as higher rates of
absences were found in the group with severely affected quality of life.
Hoehle et al., reported that the significant lost productivity was
associated with worsening of CRS symptoms severity and QoL.(8)