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Chronic rhinosinusitis CRS is a relevant and prevalent medical condition in Germany, Europe and the world. If analysed in detail, the prevalence of CRS shows regional and temporary variety. Risk factors like smoking and gastroesophageal reflux are discussed regarding their influence on CRS prevalence.
Moreover, comorbidities of CRS, like asthma, conditions of the cardiovascular system and depression are listed and their influence on CRS is discussed. Furthermore, data on CRS prevalence in special cohorts, like immunocompromised patients, are presented. To estimate the economic burden of CRS, current data e.
The basis of the following review article are Medline and PubMed listed publications as well as data Kiefer Pollen bei Diabetes on the internet pages of the National Institute of Health. Because of the fact that epidemiologic datasets cannot be found on centrally organized sources, this review article does not claim to be exhaustive or complete.
Reliable data on the epidemiology of chronic rhinosinusitis CRS and especially of their subtypes are still rare. Kiefer Pollen bei Diabetes is why the European Rhinologic Society made great efforts to improve this situation.
Numerous aspects, among others also the aspect of epidemiology, were assembled in the EPOS paper of [ 1 ] Kiefer Pollen bei Diabetes will be evaluated here from a German point of view and described in an actualized way. Unfortunately, the results cannot be communicated in the descriptive and easily comparable manner that would be desirable. This is especially due to the insufficient data situation, the varying methods of investigation, and the differences in the social and economic circumstances of the single countries.
Further, regional differences must be mentioned. In the following, evaluations are classified according to their origin: Germany and Europe, USA and Canada, Asiatic countries, and the rest of world if possible.
This gradual approach will take into consideration the regional differences with regard to pathophysiology of the chronic rhinosinusitis on the one hand and the nutritional habits, the Kiefer Pollen bei Diabetes and genetic differences of the population on the other hand. Despite all limitations, the following data on the epidemiology of chronic rhinosinusitis of the German ENT practice will allow a better view on all described diseases and serve as a basis for individual investigations.
CRS is a general term for a pathophysiologically heterogeneous group of diseases. However, in order to be able to give statements on subgroups of CRS, relative data, e. In the following, frequently used terms of the field of epidemiology will be presented in order to allow a better understanding of the data, e. This list Table 1 Tab. The table gives the typical epidemiologic terms, their definition, and if appropriate annotations for better differentiation and understanding.
The used terms are mathematically based on a fourfold table Figure 1 Fig. In synopsis of the formulas of Tab. In the scientific literature there are often hints to data of the Center of Disease Control CDC mentioned as source for the prevalence of chronic sinusitis. The CDC with its department of the National Center for Health Statistics NCHS carries out population-based investigations in the USA since regarding the incidence of diseases and hence can provide the oldest series of population-based data for example on the prevalence of sinusitis.
For —, chronic sinusitis — based on the encoding of the ICD codes for symptoms that persist for more than 8 weeks — is considered to be the second most common disease in the USA [ 2 ].
A current evaluation from South America reports The table gives epidemiologic parameters and their calculation formula based on a fourfold table. Table 3 Tab. The table shows the results from the USA over the years regarding the anamnestic incidence of sinusitis in the total population and classified according to the gender. It seems astonishing, that the extensive American investigations do not consider the difference between acute and chronic sinusitis.
Females seem to be more frequently affected than males. Based on the way of investigation, influences such as an easier access to sinusitis treatment for females or an increased health awareness of females as well as a different gender preference of various sinusitis types cannot be delineated.
For the USA, another evaluation came to the conclusion of a prevalence of recurrent acute rhinosinusitis of Kiefer Pollen bei Diabetes. Based on the economic crisis that has also reached the USA, this could also be an explanation for the reduced number of diagnoses of sinusitis during the last years.
The degree of selection effects by non-insurance of chronically affected US Americans cannot be estimated in a reliable way. Table 4 Tab. The cohort and the methods of data collection are also mentioned. Under epidemiologic aspects, the data collection in the representative population see Table 4 Tab. An increasing prevalence during the last years and significant regional differences of the incidence make it difficult Kiefer Pollen bei Diabetes assess the data from the German perspective [ 7 ].
Investigations from Korea are important Kiefer Pollen bei Diabetes this context: they show a clear increase in 7. However, this can also the explained by the method applied: in the more recent investigation, residents and improved video endoscopes were used enabling nasal endoscopy to identify before and after decongestion smaller quantities of secretion or polyps. Further the clinical definition of CRS was changed from originally 3 necessary symptoms nasal obstruction, smelling disorder, headaches or pressure, or rhinorrhea to 2 symptoms nasal obstruction and nasal secretion.
For Europe, a prevalence of CRS of Methodically, this investigation showed a high reliability of patient-related data for identification of CRS. This fact emphasizes the value of other, earlier evaluations from all mentioned tables of this review article that are only based on questionnaires and thus indicates an increased prevalence of CRS [ 11 ]. The correspondence of questionnaire-based and examination-based data of the prevalence was meanwhile described as sufficient kappa 0.
European investigations show incidences for the regions of Duisburg It must be criticised that the return rate in Duisburg was low with In Duisburg as well as in Brandenburg, the physician-based prevalence was significantly lower with 8.
Because of the fact that Brandenburg had a significantly lower CRS incidence than the European average, there seems to be a clear regional influence within Germany. Beside environmental influences a higher CRS prevalence was observed in urban regions all over Europe Kiefer Pollen bei Diabetes may also be regional Kiefer Pollen bei Diabetes as in rural regions such as Brandenburg ENT specialists are scarcely available.
The differences in the industrial development, the nutritional status, and the living conditions during the time of the division of German must also be mentioned as possible factors.
Unfortunately, nasal endoscopy which is associated with low stress for the patient is used only in few population-based studies [ 14 ]. In this investigation, the prevalence increased in higher ages [ 15 ]. The average age of the patients was 42 years [ 16 ], [ 17 ], [ 18 ].
Based on these data, the conclusion was drawn for England that in the course of a life 0. In this context, a increased Kiefer Pollen bei Diabetes was reported for higher ages up to 1.
Furthermore, a runny nose Otalgia Males 2. Because of the fact that the examination was performed without endonasal decongestion e. Kiefer Pollen bei Diabetes investigations allow an interesting Kiefer Pollen bei Diabetes into the health care situation of European patients suffering from CRSwNP. In Sweden, an advanced nasal obstruction and smelling disorder lead to the decision to seek medical assistance in cases of CRSwNP [ 25 ].
Medication was applied in two third of the patients and was still continued at the time of investigation. Surgery had already been performed in Further 1. The conclusion may be drawn that in about two third of the CRSwNP patients the treatment is successful in a singular sample.
In comparison to the evaluations using Kiefer Pollen bei Diabetes endoscopy, questionnaire-based evaluations tend to show higher prevalence rates Finland: 4. Kiefer Pollen bei Diabetes it seems to be appropriate to perform future questionnaire-based investigations, with applying nasal endoscopy whenever possible. Fungal sinusitis is classified into invasive Kiefer Pollen bei Diabetes non-invasive types based on the histology as well as clinically acute and chronic courses of the disease.
The chronic course requires symptoms persisting for more than 4 weeks [ 28 ]. A non-invasive, packed aggregation of fungal hyphae with inflammatory signs is called mycetoma. Often it is accompanied with mucous purulent secretion, without eosinophil mucin [ 29 ]. Typically it occurs as unilateral affection of the paranasal sinuses with calcification within the sinus in the CT scan of the paranasal sinuses [ 30 ]. A special importance is attributed to allergic fungal sinusitis AFS. According to Bent and Kuhn [ 31 ] it is defined by the following symptoms:.
Detection of allergic mucin in the nose Kiefer Pollen bei Diabetes paranasal sinuses with degenerated eosinophils with Charcot-Leyden crystals and branched fungal hyphae. Exclusion of an immune deficit as for example in diabetes mellitus or therapy with immunosuppressants. In the USA, the vast majority of the fungal sinusitis is non-invasive A clear preference of the gender could not be observed [ 34 ], [ 35 ]. A lower income is associated with more severe disease.
AFS and the role Kiefer Pollen bei Diabetes fungi is particularly important in scientific discussions. If granulomatous inflammation with giant cells is confirmed, the disease is called granulomatous invasive Kiefer Pollen bei Diabetes sinusitis.
The invasive fungal sinusitis in its acute course of the disease has a mortality of 7. This severe type of sinusitis occurs in Africa, Asia, and the Indian subcontinent also in immunocompetent patients.
It is caused by numerous pathogens, among others zygomycetes rhizopus, mucor, rhizomucor and aspergillus that are the most frequently detected species [ 38 ]. The delineation of the chronic course can be difficult in the individual case [ 38 ]. A clear majority of the literature in this context originates from Asia: fungal sinusitis in China [ 30 ] and India [ 39 ] is chronically invasive in about one third of the cases and non-invasive in about two third.
In general a significant increase of the Kiefer Pollen bei Diabetes on this subtype is observed in the literature [ 39 ]. Retrospective investigations in India revealed fungal sinusitis in Allergic fungal sinusitis is the main representative of the non-invasive type Table 7 Tab. However, the classification of fungal sinusitis used in Table 7 Tab. In contrast to Tab.
In comparison to CRS, fungal sinusitis in China affects more often female patients who are more than 40 years old. They report about suffering from the symptoms for less than three years that often occur Kiefer Pollen bei Diabetes headaches and bloody nasal secretion [ 30 ].
Statements on the incidence of dental genesis of CRS are not possible because of missing data on the clinically rare diagnosis [ 45 ]. For the USA, 2.