Comparison of disease-specific quality-of-life instruments in the assessment of chronic rhinosinusitis

Longitudinal improvement and stability of the SNOT-22 survey in the evaluation of surgical management for chronic rhinosinusitis

BACKGROUND

Patients with chronic rhinosinusitis (CRS) have significant quality-of-life (QOL) improvements following endoscopic sinus surgery (ESS). These improvements remain stable and persist between 6 months and 20 months as measured by the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey. There has yet to be an evaluation of the longitudinal stability of the 22-item Sino-Nasal Outcome Test (SNOT-22) after ESS in patients with CRS.

METHODS

Adults with medically recalcitrant CRS who were considered surgical candidates were enrolled in a prospective, multicenter, observational cohort study from February 2011 to February 2013. Baseline evaluation of subjects included assessment of clinical characteristics, measures of CRS-specific disease severity, and QOL evaluation using the SNOT-22. Subjects were then re-evaluated at approximately 6-month, 12-month, and 18-month intervals postoperatively. Data was analyzed using repeated measures analysis of variance (ANOVA) with Bonferroni corrections for matched pairwise comparisons.

RESULTS

A total of 110 patients completed baseline evaluations and follow-up for all 3 postoperative time points. Significant improvement in SNOT-22 scores was seen between baseline and 6 months across both SNOT-22 total and subdomain scores (p < 0.001). There was no statistically significant difference between the 6-month, 12-month, and 18-month time points in the total SNOT-22 score or its domains (p ≥ 0.125) for both the entire cohort or subgroups (p ≥ 0.077).

CONCLUSION

Postoperative improvement in CRS-specific QOL and symptom severity, as measured by the SNOT-22, suggest stability and durability between 6 months and 18 months. Further study on the longitudinal stability of the SNOT-22 past the 18-month time frame will help further refine clinical study of CRS and provide further understanding of temporal improvements following ESS.

Quality of life improvement from sinus surgery in chronic rhinosinusitis patients with asthma and nasal polyps

BACKGROUND

It is unclear whether chronic rhinosinusitis (CRS) patients with both nasal polyps and asthma have different quality of life (QOL) improvement after functional endoscopic sinus surgery (FESS). We aimed to determine whether CRS patients with asthma and nasal polyps had a greater QOL improvement after FESS compared to patients without asthma or polyps.

METHODS

This retrospective analysis included adult CRS patients who underwent FESS between 2007 and 2011. QOL was measured using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, clinical factors, SNOT-22 scores before FESS, and 1 month, 3 months, and 6 months post-FESS. Groups tested were asthma alone, polyps alone, asthma and polyps, and no asthma or polyps. Linear mixed-effects regression model was performed to calculate β-coefficients, which represent the adjusted mean QOL differences.

RESULTS

Among the 376 patients included, 40.16% had both asthma and polyps (n = 151), 14.36% had asthma alone (n = 54), 19.45% had polyps alone (n = 75), and 25.53% had no asthma or polyps (n = 96). After adjusting for all factors, there were significantly more QOL improvements in patients with both asthma and nasal polyps from baseline to 1-month (β-coefficient = -10.05; 95% CI, -15.86 to -4.23; p = 0.001) and 3-month follow-up (β-coefficient = -8.27; 95% CI, -14.98 to -1.56; p = 0.016), and patients with asthma alone from baseline to 6-month follow-up (β-coefficient = -8.78; 95% CI, -17.45 to -0.11; p = 0.047), when compared to patients without asthma or nasal polyps.

CONCLUSION

CRS patients with both asthma and nasal polyps or asthma alone experience a larger QOL benefit from FESS immediately after FESS compared to CRS patients without asthma or polyps.

Three-dimensional volumetric computed tomographic scoring as an objective outcome measure for chronic rhinosinusitis: clinical correlations and comparison to Lund-Mackay scoring

BACKGROUND

We aimed to test the hypothesis that three-dimensional (3D) volume-based scoring of computed tomography (CT) images of the paranasal sinuses was superior to Lund-Mackay CT scoring of disease severity in chronic rhinosinusitis (CRS). We determined correlation between changes in CT scores (using each scoring system) with changes in other measures of disease severity (symptoms, endoscopic scoring, and quality of life) in patients with CRS treated with triamcinolone.

METHODS

The study group comprised 48 adult subjects with CRS. Baseline symptoms and quality of life were assessed. Endoscopy and CT scans were performed. Patients received a single systemic dose of intramuscular triamcinolone and were reevaluated 1 month later. Strengths of the correlations between changes in CT scores and changes in CRS signs and symptoms and quality of life were determined.

RESULTS

We observed some variability in degree of improvement for the different symptom, endoscopic, and quality-of-life parameters after treatment. Improvement of parameters was significantly correlated with improvement in CT disease score using both CT scoring methods. However, volumetric CT scoring had greater correlation with these parameters than Lund-Mackay scoring.

CONCLUSION

Volumetric scoring exhibited higher degree of correlation than Lund-Mackay scoring when comparing improvement in CT score with improvement in score for symptoms, endoscopic exam, and quality of life in this group of patients who received beneficial medical treatment for CRS.

The reliability and validity of the persian version of sinonasal outcome test 22 (snot 22) questionnaires

BACKGROUND

The quality of life (QOL) is an important indicator for disease-severity classification and outcome measurement in obtaining treatment sinonasal diseases. The sinonasal outcome test 22 (SNOT 22) questionnaire has been introduced as the best specific sinonasal instrument for QOL measurement.

OBJECTIVES

To prepare a valid and reliable Persian language version of SNOT 22 questionnaire.

PATIENTS AND METHODS

After forward and backward translation of the original version of SNOT 22 questionnaire from English to Persian, a group of patients with nasal septal deviation who need septal surgery and another group of healthy volunteers answered the Persian version of the questionnaire. The responsiveness rate, validity (Pearson correlations and differential validity) and reliability (internal consistency and test-retest reliability) of the 22 items of the questionnaire was calculated. P value < 0.05 was considered significant.

RESULTS

Thirty adults with nasal septal deviation need surgical correction and 30 healthy volunteers were included (mean age 30.4 ± 7.1 vs. 33 ± 6.7, P value = 0.148). The questionnaire was introduced to subjects two times with a two-week-period gap. Total responsiveness rate for 22 items was more than 97%. The total Cronbach's Alfa coefficient was 0.898 (ranging 0.890-0.903). The Pearson correlations were 0.85 and 0.96 for patients and healthy volunteers, respectively. The mean total score were 25.6 ± 13.3 (range 6-52) and 7.6 ± 9.1 (range 0-45) in patients and healthy volunteers, respectively (P < 0.0001). The subscales scores were also significantly different between two groups.

CONCLUSIONS

The Persian version of SNOT 22 questionnaire is a valid and reliable instrument for accessing sinonasal diseases in Persian-speaking people.