INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 06,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 919
DIAGNOSTIC VALUE OF KEY SYMPTOMS IN CHRONIC RHINOSINUSITIS
DURING PREGNANCY: PAIN, NASAL OBSTRUCTION, AND NASAL DISCHARGE
Kasimova Shahnoza Oybekovna
Andijan State Medical institute
Rashitova Kamola
Master’s Degree Student at Andijan State Medical Institute
Abstract:
Chronic rhinosinusitis (CRS) is a common inflammatory condition of the nasal and
paranasal mucosa, characterized by persistent or recurrent symptoms lasting more than 12
weeks. Among its cardinal manifestations, facial pain or pressure, nasal obstruction, and nasal
discharge are considered essential for clinical diagnosis. This study explores the diagnostic
relevance of these symptoms, analyzing their frequency, severity, and correlation with
radiological and endoscopic findings. The presence and intensity of each symptom vary across
individuals, but a combination of nasal obstruction and purulent discharge strongly correlates
with objective signs of sinus inflammation. Recognizing the diagnostic patterns of these
symptoms is crucial for early detection, appropriate treatment, and prevention of complications
in CRS patients.
Key words:
chronic rhinosinusitis, nasal obstruction, nasal discharge, facial pain,
symptomatology, diagnostic criteria, ENT diseases, sinus inflammation.
Chronic rhinosinusitis (CRS) is a prolonged inflammatory condition of the nasal and paranasal
sinus mucosa, lasting more than 12 consecutive weeks despite medical treatment. It is a
significant global health problem, affecting approximately 10–12% of the adult population,
with substantial impact on quality of life, work productivity, and healthcare costs. Accurate
diagnosis of CRS remains a clinical challenge due to symptom overlap with other upper
respiratory tract disorders, such as allergic rhinitis and viral upper respiratory infections[1]
The diagnosis of CRS is primarily based on the presence of cardinal symptoms, supported by
objective findings such as nasal endoscopy and imaging. Among these, nasal obstruction, nasal
discharge (anterior or posterior), and facial pain or pressure are considered the most clinically
relevant. However, their individual diagnostic value and their combined predictive power vary
depending on disease severity and phenotype, such as CRS with or without nasal polyps.
Understanding the diagnostic significance of these core symptoms is essential for early
detection and classification of CRS, as well as for the selection of appropriate therapeutic
strategies. This paper aims to analyze the role of these symptoms—pain, nasal obstruction, and
nasal discharge—in diagnosing chronic rhinosinusitis and correlating them with objective
clinical indicators.
The clinical evaluation of chronic rhinosinusitis largely relies on patient-reported symptoms,
which are subjective but often correlate with underlying mucosal inflammation. The three key
symptoms under consideration—facial pain, nasal obstruction, and nasal discharge—are each
associated with distinct pathophysiological mechanisms and clinical implications.
Nasal Obstruction:
This is the most frequently reported symptom in CRS. It results from mucosal edema, increased
mucus production, or structural blockages within the nasal passages. In clinical practice, nasal
obstruction is often a persistent and dominant complaint. Studies have shown that its presence
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 06,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 920
is highly predictive of objective findings on endoscopy and CT scan, especially mucosal
thickening and ostiomeatal complex obstruction[2]
Nasal Discharge:
This includes both anterior rhinorrhea and postnasal drip. Mucopurulent discharge is strongly
suggestive of bacterial infection or advanced mucosal disease. In CRS, persistent nasal
discharge correlates with neutrophilic infiltration and biofilm presence. It is also a key symptom
in distinguishing CRS from other forms of non-infectious rhinitis.
Facial Pain or Pressure:
While often reported by patients, facial pain has lower specificity in CRS diagnosis. It may be
associated with sinus pressure, barometric changes, or neuropathic components, and is more
commonly reported in acute exacerbations of CRS. However, when present in conjunction with
nasal obstruction and discharge, it strengthens the clinical suspicion of CRS.
Several diagnostic algorithms, such as the EPOS guidelines (European Position Paper on
Rhinosinusitis and Nasal Polyps), emphasize the importance of symptom clustering. According
to these guidelines, the diagnosis of CRS requires at least two symptoms—one of which must
be either nasal blockage or discharge—persisting for 12 weeks, along with objective evidence
of sinus disease[3]
Chronic rhinosinusitis (CRS) is characterized by long-standing inflammation of the nasal and
paranasal sinus mucosa. One of the central clinical dilemmas in otolaryngology is accurately
diagnosing CRS based on symptom presentation, especially in primary care settings where
access to advanced imaging may be limited. Therefore, understanding the diagnostic
significance of core symptoms—namely nasal obstruction, nasal discharge, and facial pain or
pressure—is critical.
Studies suggest that nasal obstruction is the most consistently reported and diagnostically useful
symptom, especially when persistent. It often reflects mucosal thickening, polyp formation, or
anatomical variations that block sinus drainage. When combined with nasal discharge,
particularly mucopurulent in nature, the likelihood of CRS increases substantially. Nasal
discharge reflects mucosal secretory activity and bacterial colonization, and its presence often
correlates with findings on nasal endoscopy or computed tomography (CT).
Facial pain or pressure, however, presents a diagnostic challenge. Although frequently reported,
its specificity is limited. Pain may also occur in migraines, tension headaches, or
temporomandibular joint disorders, leading to diagnostic confusion. Nevertheless, in CRS with
acute exacerbation, facial pressure intensifies and serves as an important clinical clue.
The EPOS 2020 guidelines emphasize that the diagnosis of CRS requires a combination of at
least two symptoms—one of which must be nasal blockage or discharge—and objective
confirmation (endoscopy or CT). This highlights the importance of symptom clustering rather
than relying on individual signs[4]
Recent studies also underline that symptom severity scores (e.g., SNOT-22) can help quantify
symptom burden and monitor treatment outcomes. Additionally, symptom patterns may differ
in CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP), further guiding
personalized therapy.
Ultimately, while subjective in nature, these three cardinal symptoms—when assessed in
combination and context—remain a cost-effective, accessible, and reliable starting point in
CRS evaluation, especially where radiological tools are limited.
The diagnostic evaluation of chronic rhinosinusitis relies heavily on the recognition of its
hallmark symptoms: nasal obstruction, nasal discharge, and facial pain or pressure. Among
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 06,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 921
these, nasal obstruction and purulent discharge are the most predictive of objective disease,
while facial pain requires careful differential assessment.
A combined assessment of these symptoms, aligned with established clinical guidelines,
enhances diagnostic accuracy and informs timely management decisions. Physicians should
remain vigilant in assessing the pattern, duration, and severity of these symptoms to distinguish
CRS from other overlapping conditions.
Further research is recommended to refine symptom-based scoring tools and validate non-
invasive diagnostic models that can be used in primary care settings, particularly in resource-
limited environments.
References:
1. Fokkens, W. J., Lund, V. J., Hopkins, C., et al. (2020). European Position Paper on
Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). Rhinology Supplement, 29, 1–464.
2. DeConde, A. S., & Soler, Z. M. (2016). Chronic rhinosinusitis: Epidemiology and burden
of disease. American Journal of Rhinology & Allergy, 30(2), 134–139.
3. Sedaghat, A. R. (2017). Chronic rhinosinusitis. American Family Physician, 96(8), 500–
506.
4. Smith, T. L., Mendolia-Loffredo, S., Loehrl, T. A., et al. (2005). Predictive value of
symptoms in diagnosing chronic rhinosinusitis. Laryngoscope, 115(8), 1341–1347.
