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Sil A, Mackay I, Rowe-Jones J. Assessment of Predictive Prognostic Factors for Functional Endoscopic Sinus Surgery in a 5-Year Prospective Outcome Study. ACTA ACUST UNITED AC 2018; 21:289-96. [PMID: 17621811 DOI: 10.2500/ajr.2007.21.3027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Among numerous studies in the literature regarding prognostic factors that might determine outcome in functional endoscopic sinus surgery (FESS), very few have dealt with assessment of their predictive potential regarding outcome, and none have tried to find out the extent of such a prediction. We have developed a composite model to find out the predictive values of various prognostic factors, using an outcome measure based on the need for postoperative medical intervention. Methods One hundred nine patients were recruited for FESS and followed up at regular intervals for 5 years. Ten prognostic factors were identified and were correlated with prospectively recorded outcome measures. A discriminant analysis using SPSS software was performed to identify the prognostic factors that could “predict” the outcome. Results CT scan scores and polyp scores were the strongest predictors. Using our model, the probability to predict correctly the need for postoperative systemic medication was found to be 81.7%. Conclusion We have generated a model to predict the outcome of FESS, with a 5-year follow-up. CT scan scores and polyp scores were found to be the strongest predictors of the need for postoperative systemic medication.
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Affiliation(s)
- Arunesh Sil
- Department of ENT, Royal Sussex University Hospital, Brighton, United Kingdom.
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Wong K, Piraquive J, Troiano CA, Sulibhavi A, Grundfast KM, Levi JR. Are validated patient-reported outcomes used on children in pediatric otolaryngology? A systematic review. Int J Pediatr Otorhinolaryngol 2018; 105:63-71. [PMID: 29447822 DOI: 10.1016/j.ijporl.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/06/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Review the pediatric otolaryngology literature to 1) identify studies in which children completed patient-reported outcome (PRO) measures and 2) appraise the psychometric quality and validity of these PROs as they apply to pediatrics. METHODS In October 2016, a systematic review was performed by two reviewers on PubMed/MEDLINE and EMBASE for all otolaryngology-related studies that utilized PROs in children. Inclusion criteria included articles that required children (age<18) to complete PROs. Exclusion criteria included validation studies, reviews, and abstracts. Interreviewer agreement was determined using Cohen's kappa. Quality and rigor of validation testing for included PROs was determined using the COnsensus-based Standards for selection of health status Measurement Instruments. RESULTS Interrater agreement was very good (κ = 0.91; 95% CI, 0.85-0.98). Out of 316 articles retrieved, 11 met inclusion criteria. Eight PROs were identified. Six PROs were tested for validity and three of these PROs were tested for validity specifically within children. The most frequently utilized PRO was the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire. Two studies (18.2%) utilized PROs within the scope of their validation. Seven studies (63.6%) used PROs outside the scope of their validation. Two studies (18.2%) used non-validated PROs. CONCLUSIONS Patient-reported outcomes have become an integral part of research and quality improvement. There is a relative paucity of PROs directed towards children in pediatric otolaryngology and some studies utilized PROs that were not validated or not validated for use in this age group. Future efforts to design and validate more instruments may be warranted.
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Affiliation(s)
- Kevin Wong
- Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States; Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, United States.
| | - Jacquelyn Piraquive
- Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States; Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, United States
| | - Chelsea A Troiano
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, United States
| | - Anita Sulibhavi
- Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States; Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, United States
| | - Kenneth M Grundfast
- Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States; Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, United States
| | - Jessica R Levi
- Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States; Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, United States; Department of Pediatrics, Boston Medical Center, 850 Harrison Ave, Boston, MA 02118, United States
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Socher JA, Mello J, Baltha BB. Tomographical Findings in Adult Patients Undergoing Endoscopic Sinus Surgery Revision. Int Arch Otorhinolaryngol 2018; 22:73-80. [PMID: 29371902 PMCID: PMC5783681 DOI: 10.1055/s-0037-1601417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/22/2017] [Indexed: 10/29/2022] Open
Abstract
Introduction Many patients undergoing functional endoscopic sinus surgery still have an uncontrolled clinical disease in the late post-operative period. Up to 11.4% of the patients will require a revision surgery. Findings such as the residual uncinated process and the lateralization of the middle turbinate were considered by some studies as being responsible for failure in the primary surgery. Objectives To describe the tomographical findings in adult patients undergoing revision endoscopic sinus surgery, the profile of those patients, and verify the mucosal thickening level of the paranasal sinus. Methods Data were collected from medical records and computed tomography reports of 28 patients undergoing revision sinus surgery on a private service in the city of Blumenau between 2007 and 2014. The score of Lund-Mackay was used to verify the mucosal thickening level. Results Among the 28 patients, 23 were reoperated once, 3 were reoperated twice, and 2 were reoperated 3 times. The most relevant findings were mucosal thickening of the maxillary sinus (89.28%), deviated septum (75%), thickening of the ethmoid (50%) and sphenoidal sinuses (39.28%), and pneumatization of the middle turbinate (39.28%). The average obtained in the Lund-Mackay score was 5.71, with most patients classified in the lower range of punctuation. Conclusion The analysis of the computed tomography scans showed persistent structures that may be responsible for the failure of the primary surgery. Computed tomography is a useful tool to plan the surgery and quantify the post-operative success.
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Affiliation(s)
- Jan Alessandro Socher
- Department of Otorhinolaryngology, Universidade Regional de Blumenau (Furb), Blumenau, SC, Brazil
| | - Jonas Mello
- Medical Students, Furb, Blumenau, SC, Brazil
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Alanazy F, Dousary SA, Albosaily A, Aldriweesh T, Alsaleh S, Aldrees T. Psychometric Arabic Sino-Nasal Outcome Test-22: validation and translation in chronic rhinosinusitis patients. Ann Saudi Med 2018; 38:22-27. [PMID: 29419525 PMCID: PMC6074183 DOI: 10.5144/0256-4947.2018.22] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Sino-Nasal Outcome Test (SNOT)-22 has multiple items that reflect how nasal disease affects quality of life. Currently, no validated Arabic version of the SNOT-22 is available. OBJECTIVE . To develop an Arabic-validated version of SNOT-22. DESIGN Prospective. SETTING Tertiary care center. PATIENT AND METHODS This single-center validation study was conducted between 2015 and 2017 at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia. The SNOT-22 English version was translated into Arabic by the forward and backward method. The test and retest reliability, internal consistency, responsiveness to surgical treatment, discriminant validity, sensitivity and specificity all were tested. MAIN OUTCOME MEASURES Validated Arabic version of the SNOT-22. RESULTS Of 265 individuals, 171 were healthy volunteers and 94 were chronic rhinosinusitis patients. The Arabic version showed high internal consistency (Cronbach's of 0.94), and the ability to differentiate between diseased and healthy volunteers (P < .001). The translated versions demonstrated the ability to detect the change scores significantly in response to intervention (P < .001). CONCLUSION This is the first validated Arabic version of SNOT-22. The instrument can be used among the Arabic population. LIMITATIONS No subjects from other Arab countries.
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Affiliation(s)
| | | | | | | | | | - Turki Aldrees
- Turki Mohammed Aldrees, Department of Otolaryngology,, Head and Neck Surgery,, Prince Sattam bin Abdulaziz University, College of Medicine, Al Kharj, 173, Saudi Arabia, T: +966-583953446, , ORCID: http://orcid.org/0000.0002-8955-1778
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Epistaxis 2016: national audit of management. The Journal of Laryngology & Otology 2017; 131:1131-1141. [DOI: 10.1017/s002221511700202x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Epistaxis is a common condition that can be associated with significant morbidity, and it places a considerable burden on our healthcare system. This national audit of management sought to assess current practice against newly created consensus recommendations and to expand our current evidence base.Methods:The management of epistaxis patients who met the inclusion criteria, at 113 registered sites across the UK, was compared with audit standards during a 30-day window. Data were further utilised for explorative analysis.Results:Data for 1826 cases were uploaded to the database, representing 94 per cent of all cases that met the inclusion criteria at participating sites. Sixty-two per cent of patients were successfully treated by ENT clinicians within 24 hours. The 30-day recurrent presentation rate across the dataset was 13.9 per cent. Significant event analysis revealed an all-cause 30-day mortality rate of 3.4 per cent.Conclusion:Audit findings demonstrate a varying alignment with consensus guidance, with explorative analysis countering some previously well-established tenets of management.
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Soler ZM, Jones R, Le P, Rudmik L, Mattos JL, Nguyen SA, Schlosser RJ. Sino-Nasal outcome test-22 outcomes after sinus surgery: A systematic review and meta-analysis. Laryngoscope 2017; 128:581-592. [PMID: 29164622 DOI: 10.1002/lary.27008] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS The goal of the study was to perform a systematic review with meta-analysis to determine the mean change in the 22-item Sino-Nasal Outcome Test (SNOT-22) across patients who have had endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in the literature. METHODS A literature search was performed to identify studies that assessed SNOT-22 scores before and after ESS in adult patients with CRS. A random effects model with inverse variance weighting was used to generate the mean change after surgery, along with the forest plot and 95% confidence interval (CI). The impact of patient-specific factors across studies was assessed using a mixed-effects meta-regression. RESULTS The final study list included 40 unique patient cohorts published from 2008 to 2016. All studies showed a statistically significant change in mean SNOT-22 scores between baseline and postoperative time points (P < .001), ranging from 12.7 to 44.8, at an average follow-up of 10.6 months. The summary change in mean SNOT-22 across all studies was 24.4 (95% CI: 22.0-26.8). After forward, step-wise multivariate modeling, studies with higher mean preoperative SNOT-22 score and higher asthma prevalence were associated with greater changes in SNOT-22 score after ESS, whereas studies with longer mean follow-up had smaller changes in SNOT-22 score. CONCLUSIONS Studies evaluating quality-of-life outcomes after sinus surgery using the SNOT-22 instrument universally show significant improvement after ESS. Across the published literature, the magnitude of change is quite variable and appears to be influenced by a number of factors including baseline SNOT-22 score, asthma prevalence, and length of follow-up. Laryngoscope, 128:581-592, 2018.
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Affiliation(s)
- Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Rabun Jones
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Phong Le
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jose L Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Elwany S, Atef A, Ibrahim AA, Ismail AS, Hussein WK, Youssef AS, Elwany M, Bazak R. Arabic translation and validation of SNOT-22. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2017. [DOI: 10.4103/ejo.ejo_63_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Stein NR, Jafari A, DeConde AS. Revision rates and time to revision following endoscopic sinus surgery: A large database analysis. Laryngoscope 2017; 128:31-36. [PMID: 28688189 DOI: 10.1002/lary.26741] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVES/HYPOTHESIS Endoscopic sinus surgery (ESS) is performed for patients with chronic rhinosinusitis (CRS) that have failed maximal medical therapy. This study seeks to determine the prevalence of revision surgery and factors predicting the need for revision after ESS using a large statewide surgery database. STUDY DESIGN Large retrospective cohort study using the State Ambulatory Surgery Database for the state of California between 2005 and 2011. METHODS We identified over 61,000 patients with CRS who underwent ESS, determined by Current Procedural Terminology code. We identified which patients underwent a repeat surgery, and performed multivariable modeling to determine which factors (nasal polyps, age, gender, insurance, hospital setting, ethnicity) predicted the need for revision. Adjusted odds ratios (AOR) and 95% confidence intervals are presented. RESULTS Of 61,339 patients who underwent ESS, 4,078 (6.65%) returned for revision ESS during the time period investigated. In a multivariable logistic regression model, positive predictors of revision were a diagnosis of nasal polyps (AOR: 1.20, 95% CI: 1.11-1.29, P < .001) and female gender (AOR: 1.20, 95% CI: 1.11-1.29, P < .001); public insurance was marginally predictive of increased reoperation (AOR: 1.10, 95% CI: 1.00-1.21, P = .048). Patients of Hispanic ethnicity were less likely to have revision surgery (AOR: 0.86, 95% CI: 0.77-0.97, P = .011). Age, income, and hospital setting were not significant predictors. CONCLUSIONS A minority of patients with CRS who undergo ESS will have a revision surgery. This likelihood is increased in female patients and those with nasal polyps, and decreased in patients of Hispanic ethnicity, even when controlling for income, insurance, and hospital setting. LEVEL OF EVIDENCE 4. Laryngoscope, 128:31-36, 2018.
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Affiliation(s)
- Nathan R Stein
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Aria Jafari
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
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Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR, Davis KS, Doghramji K, Farrior EH, Finestone SA, Ishman SL, Murphy RX, Park JG, Setzen M, Strike DJ, Walsh SA, Warner JP, Nnacheta LC. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg 2017; 156:S1-S30. [PMID: 28145823 DOI: 10.1177/0194599816683153] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age. Action Statements The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon's designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician's designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon's designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patients' satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The Guideline Development Group made recommendations against certain actions: (1) When a surgeon, or the surgeon's designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon's designee, may administer perioperative systemic steroids to the rhinoplasty patient.
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Affiliation(s)
- Lisa E Ishii
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Travis T Tollefson
- 2 University of California Davis Medical Center, Sacramento, California, USA
| | - Gregory J Basura
- 3 University of Michigan Medical Center, Taubman Center, Ann Arbor, Michigan, USA
| | | | | | - Scott R Chaiet
- 6 The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara S Davis
- 7 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karl Doghramji
- 8 Jefferson Sleep Disorder Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edward H Farrior
- 9 Farrior Facial Plastic and Cosmetic Surgery, Tampa, Florida, USA
| | | | - Stacey L Ishman
- 11 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert X Murphy
- 12 Lehigh Valley Health Network, Bethlehem, Pennsylvania, USA
| | - John G Park
- 13 Mayo Clinic Center for Sleep Medicine, Rochester, Minnesota, USA
| | - Michael Setzen
- 14 New York University School of Medicine, New York, New York, USA
| | - Deborah J Strike
- 15 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Sandra A Walsh
- 10 Consumers United for Evidence-Based Healthcare, Fredericton, Canada
| | - Jeremy P Warner
- 16 Division Plastic and Reconstructive Surgery, Northshore University Health System, Northbrook, Illinois, USA
| | - Lorraine C Nnacheta
- 17 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Bewick J, Morris S, Hopkins C, Erskine S, Philpott CM. Health utility reporting in chronic rhinosinusitis patients. Clin Otolaryngol 2017; 43:90-95. [PMID: 28498517 DOI: 10.1111/coa.12903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Direct comparison of different diseases allows clinicians and researchers to place the burden of symptoms and impact on quality of life of each condition in context. Generic health-related quality-of-life assessment tools allow such analysis, and limited data are available for British patients with chronic rhinosinusitis. DESIGN As part of a larger feasibility study, patients underwent baseline assessment using the SNOT-22, SF-12 and EQ-5D-5L tools. Data were analysed using Microsoft Excel and algorithms available for the analysis of the later two tools. We plotted EQ-5D-5L VAS and utility scores and SF-12 MCS and PCS scores separately against SNOT-22 scores and quantified associations using bivariate ordinary least squares regression analysis. SETTING Patients were prospectively recruited from six UK outpatient clinics. PARTICIPANTS Adult patients with chronic rhinosinusitis without nasal polyps (CRSsNPs). MAIN OUTCOME MEASURES Baseline SNOT-22, SF-12 and EQ-5D-5L scores. RESULTS Fifty-two adults were recruited with a mean age of 55 years, 51% were male. The mean SNOT-22 score was 43.82. Mental and physical component scores of the SF-12 were 46.53 and 46, respectively. Mean index score computed form the EQ-5D-5L was 0.75. Worse (higher) SNOT-22 scores were associated with lower EQ-5D-5L VAS and utility scores and SF-12 MCS and PCS scores. CONCLUSION The EQ-5D-5L suggests that British CRSsNPs patients are negatively impacted with regards to quality of life. We found the SF-12 to be less sensitive and conclude that the EQ-5D-5L tool is a quick and accessible method for assessing QOL in order it can be compared with other disease states.
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Affiliation(s)
- J Bewick
- James Paget University Hospital, Gorleston, UK
| | - S Morris
- University College London, London, UK
| | - C Hopkins
- Guys & St Thomas' Hospital, London, UK
| | - S Erskine
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - C M Philpott
- James Paget University Hospital, Gorleston, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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Ahmadi N, Christensen JM, Barham HP, Oakley GM, Sacks R, Harvey RJ. Allergic sensitization does not predispose to sinus inflammation in externalized paranasal sinuses. Am J Rhinol Allergy 2017; 31:3-6. [PMID: 28234140 DOI: 10.2500/ajra.2017.31.4388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has a multifactorial etiology, with a debate about the role of inhalant allergy in the pathogenesis of CRS. OBJECTIVE This study assessed the impact of allergy status on externalized paranasal sinuses after tumor resection to determine if a predisposition to inhalant allergy brought about additional inflammation after sinus surgery. METHODOLOGY A case-control study was performed on patients who had no history of CRS who underwent paranasal sinus tumor resection. Allergic sensitization was defined by a positive serum ImmunoCAP test result. Outcomes were measured at least 6 months after surgery by using the modified Lund-MacKay endoscopic score and the 22-item Sino-Nasal Outcome test, with rhinitis, sleep, psychological, ear and/or facial, and sinus subscores to assess the impact of allergy status on mucosal inflammation. RESULTS A total of 103 patients (53.44 ± 17.46 years; 46% women) were assessed. Of these, 61.17% were allergically sensitized at the time of surgery. Postsurgery endoscopic assessment was similar [the modified Lund-Mackay endoscopic score allergic sensitized 0.5 (1.7) versus nonallergic sensitized 0.0 (0.9); p = 0.15]. Sinonasal symptoms were also similar between the groups' 22-item Sino-Nasal Outcome test scores, allergic sensitized versus allergic nonsensitized, (allergic 28.9 ± 20.8 versus nonallergic 33.5 ± 19.7; p = 0.31), rhinitis score (5.9 ± 5.5 versus 6.4 ± 4.7; p = 0.66), sleep score (6.9 ± 5.9 versus 7.7 ± 4.8; p = 0.50), ear and/or facial symptom score (3.4 ± 3.6 versus 4.3 ± 3.3; p = 0.22), psychological score (6.9 ± 6.0 versus 8.3 ± 6.7; p = 0.29), and of nasal symptom score (6.4 ± 5.2 versus 7.0 ± 5.3; p = 0.61). CONCLUSIONS Externalization of the sinuses in patients with inhalant allergy did not bring about significant additional inflammation in patients after tumor surgery.
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Affiliation(s)
- Navid Ahmadi
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
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Kordjian HH, Schousboe LP. Sixty-three patient-based survey-Can Sino-Nasal Outcome Test-22 be a suitable evaluation method for septoplasty and turbinectomy? Clin Otolaryngol 2017; 42:1373-1377. [PMID: 28371145 DOI: 10.1111/coa.12881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 11/26/2022]
Affiliation(s)
- H H Kordjian
- Department of Otorhinolaryngology, Sygehus Lillebaelt, Vejle, Denmark
| | - L P Schousboe
- Department of Otorhinolaryngology, Sygehus Lillebaelt, Vejle, Denmark
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Reeves BC, Wells GA, Waddington H. Quasi-experimental study designs series-paper 5: a checklist for classifying studies evaluating the effects on health interventions-a taxonomy without labels. J Clin Epidemiol 2017; 89:30-42. [PMID: 28351692 PMCID: PMC5669452 DOI: 10.1016/j.jclinepi.2017.02.016] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 10/02/2016] [Accepted: 02/06/2017] [Indexed: 11/29/2022]
Abstract
Objectives The aim of the study was to extend a previously published checklist of study design features to include study designs often used by health systems researchers and economists. Our intention is to help review authors in any field to set eligibility criteria for studies to include in a systematic review that relate directly to the intrinsic strength of the studies in inferring causality. We also seek to clarify key equivalences and differences in terminology used by different research communities. Study Design and Setting Expert consensus meeting. Results The checklist comprises seven questions, each with a list of response items, addressing: clustering of an intervention as an aspect of allocation or due to the intrinsic nature of the delivery of the intervention; for whom, and when, outcome data are available; how the intervention effect was estimated; the principle underlying control for confounding; how groups were formed; the features of a study carried out after it was designed; and the variables measured before intervention. Conclusion The checklist clarifies the basis of credible quasi-experimental studies, reconciling different terminology used in different fields of investigation and facilitating communications across research communities. By applying the checklist, review authors' attention is also directed to the assumptions underpinning the methods for inferring causality.
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Affiliation(s)
- Barnaby C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7 Queen's Building, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
| | - George A Wells
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7
| | - Hugh Waddington
- International Initiative for Impact Evaluation (3ie), 202-203, Rectangle One, D-4, Saket District Centre, New Delhi, 110017, India
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Lourijsen ES, de Borgie CAJM, Vleming M, Fokkens WJ. Endoscopic sinus surgery in adult patients with chronic rhinosinusitis with nasal polyps (PolypESS): study protocol for a randomised controlled trial. Trials 2017; 18:39. [PMID: 28114954 PMCID: PMC5259992 DOI: 10.1186/s13063-016-1728-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/23/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps is a chronic disease frequently seen in otorhinolaryngological practice. Along with its chronic disease burden it creates high societal costs. Therapy consists of long-term use of medication and, if insufficient, endoscopic sinus surgery. No consensus exists on the right timing and extent of disease that warrants surgery. Furthermore, there is lack of clinical knowledge about the benefit of surgery over medication only. The current trial evaluates the clinical effectiveness and cost-effectiveness of endoscopic sinus surgery in addition to drug treatment versus medication exclusively in the adult patient group with nasal polyps. METHODS A prospective, multicentre, superiority, randomised controlled (PolypESS) trial in 238 patients aged 18 years or older selected for primary or revision endoscopic sinus surgery by the otorhinolaryngologist was designed. Patients will be randomised to either endoscopic sinus surgery in addition to medication or medical therapy only. Relevant data will be collected prior to randomisation, at baseline and 3, 6, 12, 18 and 24 months after start of treatment. Complete follow-up will be 24 months. Primary outcome is disease-specific Health-related Quality of Life quantified by the SNOT-22 after 12-month follow-up. Secondary outcomes are generic Health-related Quality of Life, cost-effectiveness, objective signs of disease and adverse effects of treatment. Subgroup analyses will be performed to verify whether treatment effects differ among patient phenotypes. DISCUSSION The PolypESS trial will investigate tailored care in adult patients with chronic rhinosinusitis with nasal polyps and will result in improved clinical pathways to help to determine in which circumstances to perform surgery. TRIAL REGISTRATION Dutch Trial Register, NTR4978 . Registered on 27 November 2014.
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Affiliation(s)
- Evelijn S. Lourijsen
- Department of Otorhinolaryngology, Academic Medical Centre, Meibergdreef 9, 1105 SZ Amsterdam, The Netherlands
| | | | - Marleen Vleming
- Department of Otorhinolaryngology, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Meibergdreef 9, 1105 SZ Amsterdam, The Netherlands
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Adouly T, Adnane C, Khallouk A, Chenguir M, Rouadi S, Abada RL, Roubal M, Mahtar M. Moroccan adaptation and validation of the rhinosinusitis quality-of-life survey. Eur Arch Otorhinolaryngol 2016; 274:1507-1513. [PMID: 27844221 DOI: 10.1007/s00405-016-4377-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
The aim of this study was to validate the Moroccan translation and sociocultural adaptation of the RhinoQOL questionnaire. The questionnaires were translated into Moroccan and then translated back into English. The final version was administered twice to an asymptomatic control population (n = 50) and once to a patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS) (n = 99). Both of the groups answered the questionnaire before and one year after surgery. The psychometric properties, reliability, validity with correlation to other clinical instruments and responsiveness to treatment, were analyzed. Univariate and multivariate analyses were performed. The test-retest reliability was excellent [intraclass correlation coefficient (ICC) >0.9], indicating a good reliability when administering the instrument on repeated occasions. The internal consistency was 0.80, 0.75 and 0.94 for the scores of the RhinoQOL sub-scales (frequency, bothersomeness, and impact, respectively). Firstly, our questionnaire was able to detect differences between patients with CRS and group of healthy volunteers (p < 0.0001) and secondly, it improved significantly after surgery (p < 0.0001), indicating a good responsiveness. A good correlation was found between the Moroccan version, the preoperative objective scores, and SNOT-22 and RSDI scores. The Moroccan RhinoQOL questionnaire appears to be culturally appropriate and psychometrically valid.
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Affiliation(s)
- Taoufik Adouly
- Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco.
| | - Choaib Adnane
- Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Amine Khallouk
- Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Meriem Chenguir
- Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Sami Rouadi
- Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Reda Lah Abada
- Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Mohamed Roubal
- Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Mohamed Mahtar
- Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
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Abstract
Rhinosinusitis affects a significant portion of the US population, and its management imposes a substantial burden on the healthcare system. The treatment of chronic rhinosinusitis includes initial medical management prior to consideration of surgical intervention. However, if surgery does become necessary, several factors must be considered in order to optimize outcomes. This review evaluates surgical patient selection, perioperative medical management, and the extent of operative intervention, with the goal of improving surgical results, decreasing the need for revision surgery, and enhancing the patient's quality of life. Specific variations in patient genotypes and phenotypes will be further explored with regard to their implications on surgical outcomes. Additionally, the evidence behind pre- and post-operative antibiotic and steroid use will be evaluated. Finally, we will review evolving surgical tools and techniques that are currently being utilized for the treatment of specific subsets of rhinosinusitis.
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Affiliation(s)
- Alexandria F Jaksha
- Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Erik K Weitzel
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio Military Medical Center, Houston, TX, 78234, USA
| | - Adrienne M Laury
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio Military Medical Center, Houston, TX, 78234, USA
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Sabino HAC, Valera FCP, Aragon DC, Fantucci MZ, Titoneli CC, Martinez R, Anselmo-Lima WT, Tamashiro E. Amoxicillin-clavulanate for patients with acute exacerbation of chronic rhinosinusitis: a prospective, double-blinded, placebo-controlled trial. Int Forum Allergy Rhinol 2016; 7:135-142. [DOI: 10.1002/alr.21846] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Henrique Augusto Cantareira Sabino
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery; Division of Otorhinolaryngology; Ribeirão Preto Medical School; University of São Paulo (USP); São Paulo Brazil
| | - Fabiana Cardoso Pereira Valera
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery; Division of Otorhinolaryngology; Ribeirão Preto Medical School; University of São Paulo (USP); São Paulo Brazil
| | - Davi Casale Aragon
- Department of Pediatrics; Ribeirão Preto Medical School; University of Sao Paulo; São Paulo Brazil
| | - Marina Zilio Fantucci
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery; Division of Otorhinolaryngology; Ribeirão Preto Medical School; University of São Paulo (USP); São Paulo Brazil
| | - Carolina Carneiro Titoneli
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery; Division of Otorhinolaryngology; Ribeirão Preto Medical School; University of São Paulo (USP); São Paulo Brazil
| | - Roberto Martinez
- Department of Internal Medicine; Ribeirão Preto Medical School; University of São Paulo (USP); São Paulo Brazil
| | - Wilma T. Anselmo-Lima
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery; Division of Otorhinolaryngology; Ribeirão Preto Medical School; University of São Paulo (USP); São Paulo Brazil
| | - Edwin Tamashiro
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery; Division of Otorhinolaryngology; Ribeirão Preto Medical School; University of São Paulo (USP); São Paulo Brazil
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Fishpool SJC, Amato-Watkins A, Hayhurst C. Free middle turbinate mucosal graft reconstruction after primary endoscopic endonasal pituitary surgery. Eur Arch Otorhinolaryngol 2016; 274:837-844. [DOI: 10.1007/s00405-016-4287-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
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Noon E, Hopkins C. Review article: outcomes in endoscopic sinus surgery. BMC EAR, NOSE, AND THROAT DISORDERS 2016; 16:9. [PMID: 27499699 PMCID: PMC4975882 DOI: 10.1186/s12901-016-0030-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/22/2016] [Indexed: 12/15/2022]
Abstract
Chronic rhinosinusitis has a significant impact on health-related and generic quality-of-life, has a high cost burden to both society and patients, and may be associated with absenteeism, loss of productivity and poor respiratory function. Though there is a paucity of level 1 evidence, endoscopic sinus surgery may be considered in medically refractory patients and a variety of objective and subjective outcome measures exist to assess the effectiveness of intervention. We outline the outcome measurements available and review in-depth the published outcomes to date. Furthermore we discuss the literature that indicates that endoscopic sinus surgery can have a positive effect on respiratory function in asthma. How patient selection, timing and extent of surgery, and post-operative care interventions may optimise surgical outcomes is explored.
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Affiliation(s)
- Edward Noon
- Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ UK
| | - Claire Hopkins
- Guy’s and St Thomas’ Hospital, Great Maze Pond, London, SE1 9RT UK
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Marambaia PP, Lima MG, Guimarães MB, Gomes ADM, Marambaia MP, Santos OMD, Gomes LM. Can we use the questionnaire SNOT-22 as a predictor for the indication of surgical treatment in chronic rhinosinusitis? Braz J Otorhinolaryngol 2016; 83:451-456. [PMID: 27381877 PMCID: PMC9442693 DOI: 10.1016/j.bjorl.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/06/2016] [Accepted: 05/30/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Chronic rhinosinusitis is a prevalent disease that has a negative impact on the lives of sufferers. SNOT-22 is considered the most appropriate questionnaire for assessing the quality of life of these patients and a very effective method of evaluating therapeutic interventions; however it is not used as a tool for decision-making. Objective To test the hypothesis that the SNOT-22 score can predict the outcome of surgical treatment. Methods A retrospective, longitudinal and analytical study. We evaluated the medical records of patients with chronic rhinosinusitis that completed the SNOT-22 at the time of diagnosis. All the patients were consecutively receiving care at an otolaryngology service in Salvador, Bahia from August 2011 to June 2012. The outcomes of the surgical treatment of these patients were obtained from their medical records. The initial score was compared to a group of patients who were not referred for surgery. All the patients completed and signed a consent form. Results Of the 88 patients with chronic rhinosinusitis, 26 had evolved to surgery over the last 3 years. The groups were homogeneous regarding gender and respiratory and medication allergies. The patients of the surgical group were 44.8 + 13.8 years old and the patients of the clinical group were 38.2 + 12.5 years old (p = 0.517). The average SNOT-22 score of the case group was 49 + 19 and the average score of the control group was 49 + 27 (p = 0.927). Conclusion The SNOT-22 was unable to predict the outcome of surgical patients with chronic rhinosinusitis.
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Affiliation(s)
- Pablo Pinillos Marambaia
- Escola Bahiana de Medicina e Saúde Pública (Bahiana), Programa de Pós-graduação, Salvador, BA, Brazil.
| | - Manuela Garcia Lima
- Escola Bahiana de Medicina e Saúde Pública (Bahiana), Programa de Pós-graduação, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | | | - Amaury de Machado Gomes
- Escola Bahiana de Medicina e Saúde Pública (Bahiana), Programa de Pós-graduação, Salvador, BA, Brazil
| | | | | | - Leonardo Marques Gomes
- Universidade Federal de São Paulo (UNIFESP), Programa de Pós-graduação em Otorrinolaringologia, São Paulo, SP, Brazil
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Bewick J, Egro FM, Masterson L, Javer AR, Philpott CM. Anatomic findings in revision endoscopic sinus surgery: Case series and review of contributory factors. ALLERGY & RHINOLOGY 2016; 7:151-157. [PMID: 28107148 PMCID: PMC5244272 DOI: 10.2500/ar.2016.7.0173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background: It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective: To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods: A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results: Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion: Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs.
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Wentzel JL, Virella-Lowell I, Schlosser RJ, Soler ZM. Quantitative sinonasal symptom assessment in an unselected pediatric population with cystic fibrosis. Am J Rhinol Allergy 2016; 29:357-61. [PMID: 26358346 DOI: 10.2500/ajra.2015.29.4196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to establish baseline sinonasal quality of life scores in an unselected pediatric population with cystic fibrosis (CF) and to test the correlation of those scores with various clinical outcome measurements. METHODS A total of 50 consecutive children, ages 2-12 years, seen routinely in a large CF clinic were evaluated by using the Sinus and Nasal Quality of Life Survey (SN-5) tool at the time of their visit. At this time, the parent or guardian of the child was also questioned about recent episodes of sinusitis, antibiotic prescriptions for sinusitis, recent hospitalizations, and days missed from school or recreational activities due to sinonasal symptoms. CF genotype, pulmonary function, recent sinus surgeries, and computed tomography scores were established by thorough chart review. RESULTS The average SN-5 score of this group was lower than published averages in children with baseline, preoperative, or postoperative chronic sinusitis, and demonstrated significant correlations with a visual analog scale, recent episodes of sinusitis, antibiotic prescriptions for sinusitis, and the number of days missed from school or recreational activities due to sinonasal symptoms, with a nonsignificant trend observed with previous sinus surgery. No correlations were seen with CF genotype, pulmonary function, or hospitalization days. Computed tomography results were overwhelmingly abnormal, and Lund-MacKay scores did not correlate with SN-5 scores or clinical outcome measurements. CONCLUSIONS The SN-5 tool provides a quick, safe, and reliable qualitative metric for monitoring sinonasal symptoms in young children with CF.
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Affiliation(s)
- Jennifer L Wentzel
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Browne JP, Hopkins C, Slack R, Cano SJ. The Sino-Nasal Outcome Test (SNOT): Can we Make it More Clinically Meaningful? Otolaryngol Head Neck Surg 2016; 136:736-41. [PMID: 17478207 DOI: 10.1016/j.otohns.2007.01.024] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 01/18/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE: To test whether subscales should be used when analyzing the Sino-Nasal Outcome Test (SNOT). STUDY DESIGN AND SETTING: Prospective cohort study involved 87 acute NHS hospitals in England and Wales. RESULTS: With the use of exploratory factor analysis we found evidence for the existence of four unique constructs within the SNOT. Two constructs address symptoms (rhinologic and ear/facial) and two address aspects of health-related quality of life (psychological issues and sleep function). Subscales of the SNOT that correspond to these constructs provided clinically meaningful information over and above that provided by the SNOT total score on the type of surgical benefits gained by patients with different sino-nasal conditions. CONCLUSION: The SNOT is not unidimensional and a SNOT total score will mask variation in the true underlying constructs. SIGNIFICANCE: The SNOT would have greatly improved clinical use if it was scored with appropriate subscales. Such a measure would allow us to tease out the differential impact of sino-nasal conditions, in addition to allowing greater understanding of treatment effects.
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Affiliation(s)
- John Patrick Browne
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
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75
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Dessouky O, Hopkins C. Surgical versus medical interventions in CRS and nasal polyps: comparative evidence between medical and surgical efficacy. Curr Allergy Asthma Rep 2016; 15:66. [PMID: 26411803 DOI: 10.1007/s11882-015-0566-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CRS with nasal polyps (CRSwNP) is a subgroup of CRS, where polyps can be visualised in the middle meatus. In the general population, the prevalence is estimated to lie between 0.2 and 4 %. Up to 15 % of patients with asthma have nasal polyps and up to 45 % of patients with nasal polyps have asthma. The management of CRSwNP involves primary medical management, with surgery normally reserved for recalcitrant cases. Surgical techniques for CRSwNP range from simple polypectomy and endoscopic sinus surgery (ESS) to radical nasalisation with removal of the middle turbinates. We have reviewed the comparative literature regarding medical and surgical interventions in CRSwNP, with emphasis on outcomes, complications, cost-effectiveness and on the timing of surgery. Similar outcomes are reported for medical and surgical management, but there is sufficient evidence to support the role of surgery once symptoms have failed to adequately respond. There is insufficient evidence to define the optimal timing and extent of surgery.
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Mortazavi H, Khalighi H, Goljanian A, Noormohammadi R, Mojahedi S, Sabour S. Intra-oral low level laser therapy in chronic maxillary sinusitis: A new and effective recommended technique. J Clin Exp Dent 2015; 7:e557-62. [PMID: 26644829 PMCID: PMC4663055 DOI: 10.4317/jced.52282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 08/16/2015] [Indexed: 01/19/2023] Open
Abstract
Background Chronic sinusitis is one of the most common chronic diseases involving different age groups. Because the nature and etiology of chronic sinusitis are not completely known, there is not any standard treatment for this disease. It has been suggested that low-level laser can be used in treating chronic sinusitis but there are limited studies about its usage. In this research, intra-oral radiation of low-level laser has been described and implemented for the first time. Suggested hypotheses about the efficacy of this type of radiation (intra-oral) in treating chronic maxillary sinusitis includes this fact that the depth of maxilla’s vestibule is also the floor of maxillary sinus and sinus discharges collect in this area because of gravity effect. Therefore, with considering suitable radiation angle, this area gets the most benefits of laser’s anti-inflammatory effects. Material and Methods In this study, 20 patients with chronic maxillary sinusitis were included. They were assessed before and after treatment. Treatment plan was performed in 8 sessions every other days using low-level diode laser with 810 nm. Snot-22 questionnaire and rhinomanometry were used for evaluating patients. Changes of signs and symptoms were recorded in questionnaire every session and 6 months after treatment. Friedman and Wilcoxon tests were used for data analyses. In this study, P
value < 0.05 was considered statistically significant. Results All variables and all symptoms of patients were improved using intra-oral low-level laser and this improvement was statistically significant (P
value<0.05). There was also significant decrease in nasal airway resistance and significant increase in air flow (P
value<0.05). Six month after treatment completion, there was no significant difference between the results of completion and the results of 8th treatment session (P
value< 0.05). Conclusions Using intra-oral low-level laser is a suitable way to treat patients with chronic maxillary sinusitis. Key words:Chronic sinusitis, maxillary sinusitis, low-level laser.
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Affiliation(s)
- Hamed Mortazavi
- Associate Professor of Department of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Khalighi
- Assistant Professor of Department of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Goljanian
- Assistant Professor of Department of Otolaryngology, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Robab Noormohammadi
- Assistant Professor of Department of Oral Medicine, Dental School, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Saeed Mojahedi
- Associate Professor of Department of Laser, Dental School, Shahid Beheshti, University of Medical Sciences, Tehran, Iran
| | - Siamak Sabour
- Associate Professor of Department of Clinical Epidemiology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis: Focus on nasal polyposis. J Allergy Clin Immunol 2015; 136:1431-1440. [DOI: 10.1016/j.jaci.2015.10.010] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/16/2015] [Accepted: 10/21/2015] [Indexed: 01/10/2023]
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Benninger MS, Sindwani R, Holy CE, Hopkins C. Impact of medically recalcitrant chronic rhinosinusitis on incidence of asthma. Int Forum Allergy Rhinol 2015; 6:124-9. [PMID: 26624856 DOI: 10.1002/alr.21652] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/20/2015] [Accepted: 08/18/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The long-term impact of chronic rhinosinusitis (CRS) with or without allergic rhinitis (AR) on asthma is poorly documented. This study analyzed potential associations of ongoing CRS and AR on asthma. METHODS Using the MarketScan™ claims database, patients with CRS and endoscopic sinus surgery (ESS) in 2010 were identified. The date of first sinusitis was determined for all. Patients with asthma at time of first sinusitis diagnosis were excluded. The remaining patients were grouped based on duration of sinusitis, from first diagnosis to surgery-group 1: 1 to <2 years (n = 181); group 2: 2 to <3 years (n = 195); group 3: 3 to <4 years (n = 292); and group 4: 4 to <5 years (n = 536). Yearly incidence and prevalence of newly diagnosed asthmatics was analyzed for all groups. A secondary analysis evaluated the association between AR and asthma. RESULTS Preoperatively, yearly incidence of patients with new asthma diagnoses averaged 4.48% (95% confidence interval [CI], 3.93% to 5.11%) and was significantly greater for patients with AR (5.93%; 95% CI, 4.56% to 7.66%) vs non-AR (4.15%; 95% CI, 3.56% to 4.82%); p = 0.03. Postoperatively, yearly incidence of asthma was 0.42% (95% CI, 0.18% to 0.88%). No patient had asthma at time of first diagnosis; however, by time of surgery, 9.4%, 12.8%, 18.2%, and 22.40% of patients had been diagnosed with asthma, in groups 1 through 4, respectively. CONCLUSION AR was a significant risk factor for asthma in patients with CRS. Medically recalcitrant CRS was associated with high incidence rates of asthma, which declined post-operatively. Patients operated earlier in the disease continuum were therefore at decreased risk of developing asthma.
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Affiliation(s)
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH
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80
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Cerejeira R, Veloso-Teles R, Lousan N, Moura CP. The Portuguese version of the RhinoQOL Questionnaire: validation and clinical application. Braz J Otorhinolaryngol 2015; 81:630-5. [PMID: 26482870 PMCID: PMC9442752 DOI: 10.1016/j.bjorl.2015.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/08/2014] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Rhinosinusitis constitutes an important health problem, with significant interference in personal, professional, and social functioning. This study presents the validation process of the Portuguese version of the RhinoQOL, to be used as a routine procedure in the assessment of patients with chronic rhinosinusitis. OBJECTIVE To demonstrate that the Portuguese version of the RhinoQOL is as valid as the English version to measure symptoms and health-related quality of life in chronic rhinosinusitis. METHODS The Portuguese version of the RhinoQOL was administered consecutively to 58 patients with chronic rhinosinusitis with and without nasal polyps, assessed for endoscopic sinus surgery. A follow-up survey was completed three months after surgery. Statistical analysis was performed to determine its psychometric properties. RESULTS Face and content validity were confirmed by similar internal consistency as the original questionnaire for each sub-scale, and strong correlation between individual items and total score. The questionnaire was easy and quick to administer (5.5min). At three months, there was a significant decrease from baseline for all sub-scale scores, indicating clinical improvement, with an effect size considered as large. CONCLUSION This study provides a questionnaire that is equivalent to the original English version, with good responsiveness to change, which can be especially valuable to measure the outcome of surgery.
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Affiliation(s)
- Rui Cerejeira
- Department of Genetics, Faculty of Medicine, University of Porto, Portugal; Department of Otorhinolaryngology, Tâmega e Sousa Hospital Center, Penafiel, Portugal.
| | - Rafaela Veloso-Teles
- Department of Otorhinolaryngology, Alto Ave Hospital Center, Guimarães, Portugal
| | - Nuno Lousan
- Department of Otorhinolaryngology, Tâmega e Sousa Hospital Center, Penafiel, Portugal
| | - Carla Pinto Moura
- Department of Genetics, Faculty of Medicine, University of Porto, Portugal; Department of Otorhinolaryngology, São João Hospital Center, Porto, Portugal
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Ference EH, Tan BK, Hulse KE, Chandra RK, Smith SB, Kern RC, Conley DB, Smith SS. Commentary on gender differences in prevalence, treatment, and quality of life of patients with chronic rhinosinusitis. ALLERGY & RHINOLOGY 2015; 6:82-8. [PMID: 26302727 PMCID: PMC4541639 DOI: 10.2500/ar.2015.6.0120] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: To examine the existing evidence on gender differences in the prevalence, treatment, and quality of life of patients with chronic rhinosinusitis (CRS). Methods: Review of the literature and expert opinion. Results: From a sociologic standpoint, women have historically been considered more likely to report symptoms, seek medical care, and give poorer self-evaluation of health, which may bias data toward increased prevalence and a greater effect of CRS on quality of life in women. However, the influence of gender seems to be restricted primarily to the evaluation of general quality of life, whereas the disease-specific health-related quality of life is not different between genders. Furthermore, migraine headaches, which are more common among women, may be misdiagnosed as CRS, which contributes to gender differences in the prevalence of CRS. The degree to which reported differences in prevalence and health utilization represent biologic or physiologic differences between genders is not known; however, differences in anatomic size, tobacco susceptibility, and hormonal factors have been speculated to increase the overall susceptibility to CRS in women compared with men. Conclusions: Focused research that examines the effect of gender on the development, treatment, and outcomes of CRS is warranted.
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Affiliation(s)
- Elisabeth H Ference
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois,, USA
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Symptom-Based Clustering in Chronic Rhinosinusitis Relates to History of Aspirin Sensitivity and Postsurgical Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015. [PMID: 26216252 DOI: 10.1016/j.jaip.2015.06.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Symptoms burden in chronic rhinosinusitis (CRS) may be assessed by interviews or by means of validated tools such as the 22-item SinoNasal Outcome Test (SNOT-22). However, when only the total SNOT-22 scores are used, the pattern of symptom distribution and heterogeneity in patient symptoms is lost. OBJECTIVES To use a standardized symptom assessment tool (SNOT-22) on preoperative symptoms to understand symptom heterogeneity in CRS and to aid in characterization of distinguishing clinical features between subgroups. METHODS This was a retrospective review of 97 surgical patients with CRS. Symptom-based clusters were derived on the basis of presurgical SNOT-22 scores using unsupervised analysis and network graphs. Comparison between clusters was performed for clinical and demographic parameters, postsurgical symptom scores, and presence or absence of a history of aspirin sensitivity. RESULTS Unsupervised analysis reveals coclustering of specific symptoms in the SNOT-22 tool. Using symptom-based clustering, patients with CRS were stratified into severe overall (mean total score, 90.8), severe sinonasal (score, 62), moderate sinonasal (score, 40), moderate nonsinonasal (score, 37) and mild sinonasal (score, 16) clusters. The last 2 clusters were associated with lack of history of aspirin sensitivity. The first cluster had a rapid relapse in symptoms postoperatively, and the last cluster demonstrated minimal symptomatic improvement after surgery. CONCLUSION Symptom-based clusters in CRS reveal a distinct grouping of symptom burden that may relate to aspirin sensitivity and treatment outcomes.
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Brescia G, Marioni G, Franchella S, Ramacciotti G, Pendolino AL, Callegaro F, Giacomelli L, Marino F, Martini A. Post-operative steroid treatment for eosinophilic-type sinonasal polyposis. Acta Otolaryngol 2015; 135:1200-4. [PMID: 26149297 DOI: 10.3109/00016489.2015.1063784] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS The preliminary finding of significantly lower eosinophilic-type CRSwNP recurrence rates in patients with associated asthma or ASA intolerance treated post-operatively with local nasal and oral steroids warrants further investigation in larger, prospective series. OBJECTIVE A high recurrence rate after functional endoscopic sinus surgery (FESS) has been widely reported in patients with eosinophilic-type chronic rhinosinusitis with nasal polyps (CRSwNP). This study compared the influence of two post-operative medical treatments - local nasal steroids alone vs local nasal and oral steroids - on the recurrence of eosinophilic-type CRSwNP. METHOD Between January 2009-December 2010, 32 patients with eosinophilic-type CRSwNP received local steroid nasal therapy after FESS (Group A); from January 2011 onwards, another 28 patients were treated post-operatively with the same nasal treatment plus two cycles a year of oral steroids (Group B). All patients in both groups had a follow-up of at least 36 months. RESULTS Groups A and B did not differ significantly in recurrence rate (31.25% vs 32.14%, p = 1) or disease-free interval (p = 0.91), but Group B patients who were asthmatic or ASA-intolerant had a significantly lower recurrence rate than Group A patients with asthma or ASA intolerance (p = 0.04 and p = 0.004, respectively).
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Affiliation(s)
- Giuseppe Brescia
- a 1 Department of Neurosciences DNS, Otolaryngology Section, Padova University , Padova, Italy
| | - Gino Marioni
- a 1 Department of Neurosciences DNS, Otolaryngology Section, Padova University , Padova, Italy
| | - Sebastiano Franchella
- a 1 Department of Neurosciences DNS, Otolaryngology Section, Padova University , Padova, Italy
| | - Giulia Ramacciotti
- a 1 Department of Neurosciences DNS, Otolaryngology Section, Padova University , Padova, Italy
| | - Alfonso Luca Pendolino
- a 1 Department of Neurosciences DNS, Otolaryngology Section, Padova University , Padova, Italy
| | - Filippo Callegaro
- a 1 Department of Neurosciences DNS, Otolaryngology Section, Padova University , Padova, Italy
| | | | - Filippo Marino
- b 2 Department of Medicine DIMED, Padova University , Padova, Italy
| | - Alessandro Martini
- a 1 Department of Neurosciences DNS, Otolaryngology Section, Padova University , Padova, Italy
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Brescia G, Marioni G, Franchella S, Ramacciotti G, Velardita C, Giacomelli L, Marino F, Martini A. Can a panel of clinical, laboratory, and pathological variables pinpoint patients with sinonasal polyposis at higher risk of recurrence after surgery? Am J Otolaryngol 2015; 36:554-8. [PMID: 25702570 DOI: 10.1016/j.amjoto.2015.01.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Despite improved surgical and medical therapies, recurrence remains a significant problem in chronic rhinosinusitis with nasal polyps (CRSwNP), given a recently-reported long-term revision rate of 15%-20%. In this prospective study uni- and multivariate statistical analyses were used to identify clinical, laboratory and conventional pathological parameters for pinpointing CRSwNP patients at higher risk of recurrence after functional endoscopic sinus surgery (FESS). MATERIALS AND METHODS The investigation concerned 179 consecutive patients undergoing FESS for CRSwNP, and 24 of them developed recurrent CRSwNP after FESS. RESULTS A univariate statistical model disclosed significant associations between recurrent CRSwNP and serum basophil counts (p=0.03) and percentages (p=0.02). The recurrence rate was higher for patients with eosinophilic-type CRSwNP (p=0.01). In a multivariate logistic model, eosinophilic-type CRSwNP (p=0.025) and serum basophil percentage (statistical trend, p=0.079) retained their independent prognostic significance in relation to CRSwNP recurrence. The discriminatory power of a three-variable panel (age <65 years, serum basophil percentage and eosinophilic type) featured an AUC (ROC) of 0.7028 (an acceptable discriminatory power according to the Hosmer-Lemeshow scale). CONCLUSIONS Although our panel achieved an acceptable discriminatory power for CRSwNP recurrence, other parameters (including biomarkers) capable of predicting outcome and orienting postoperative treatment decisions need to be investigated in CRSwNP.
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Affiliation(s)
- Giuseppe Brescia
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy.
| | - Gino Marioni
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
| | - Sebastiano Franchella
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
| | - Giulia Ramacciotti
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
| | - Carmelita Velardita
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
| | | | - Filippo Marino
- Department of Medicine DIMED, Padova University, Padova, Italy
| | - Alessandro Martini
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
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Lind H, Joergensen G, Lange B, Svendstrup F, Kjeldsen AD. Efficacy of ESS in chronic rhinosinusitis with and without nasal polyposis: a Danish cohort study. Eur Arch Otorhinolaryngol 2015; 273:911-9. [PMID: 26031891 DOI: 10.1007/s00405-015-3667-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/22/2015] [Indexed: 11/25/2022]
Abstract
Endoscopic sinus surgery (ESS) for patients with severe chronic rhinosinusitis (CRS) has become a well-established treatment in cases where medical therapy fails. Even though CRS patients are divided into two subgroups, CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP), most studies present only results for the total cohort. This prospective cohort study evaluated the efficacy of ESS on both quality of life and olfactory function measures, in a cohort of Danish CRS patients diagnosed according to the EPOS criteria, with results analysed separately for the CRSwNP and CRSsNP subgroups. All 97 CRS patients who underwent ESS over an 18-month trial period were evaluated preoperative by SNOT-22 score, Sniffin' Sticks score, modified Lund-Kennedy endoscopic score and Lund-Mackay CT score. Patient outcomes were reevaluated at clinical follow-up 1 and 6 months postoperative. ESS efficiently and immediately improved quality of life for both CRSwNP and CRSsNP patients, with over 50 % reduction in SNOT-22 score 1 month after surgery, which sustained 6 months postoperative. Olfactory function measured by Sniffin' Sticks score showed overall improvement in both groups. ESS efficiently improved quality of life in both CRSwNP and CRSsNP patients, and surgery lead to an overall improvement in olfactory function. However, a minor proportion of patients experienced deterioration in olfactory function after ESS.
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Affiliation(s)
- Henrik Lind
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark.
| | - G Joergensen
- Department of Otorhinolaryngology, Svendborg Hospital, Svendborg, Denmark
| | - B Lange
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark
| | - F Svendstrup
- Department of Otorhinolaryngology, Svendborg Hospital, Svendborg, Denmark
| | - A D Kjeldsen
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark
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Philpott C, Hopkins C, Erskine S, Kumar N, Robertson A, Farboud A, Ahmed S, Anari S, Cathcart R, Khalil H, Jervis P, Carrie S, Kara N, Prinsley P, Almeyda R, Mansell N, Sunkaraneni S, Salam M, Ray J, Panesaar J, Hobson J, Clark A, Morris S. The burden of revision sinonasal surgery in the UK-data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study. BMJ Open 2015; 5:e006680. [PMID: 25926143 PMCID: PMC4420947 DOI: 10.1136/bmjopen-2014-006680] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the surgical revision rate in patients with chronic rhinosinusitis (CRS) in the UK CRS Epidemiology Study (CRES). Previous evidence from National Sinonasal Audit showed that 1459 patients with CRS demonstrated a surgical revision rate 19.1% at 5 years, with highest rates seen in those with polyps (20.6%). SETTING Thirty secondary care centres around the UK. PARTICIPANTS A total of 221 controls and 1249 patients with CRS were recruited to the study including those with polyps (CRSwNPs), without polyps (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS). INTERVENTIONS Self-administered questionnaire. PRIMARY OUTCOME MEASURE The need for previous sinonasal surgery. RESULTS A total of 651 patients with CRSwNPs, 553 with CRSsNPs and 45 with AFRS were included. A total of 396 (57%) patients with CRSwNPs/AFRS reported having undergone previous endoscopic nasal polypectomy (ENP), of which 182 of the 396 (46%) reported having received more than one operation. The mean number of previous surgeries per patient in the revision group was 3.3 (range 2-30) and a mean duration of time of 10 years since the last procedure. The average length of time since their first operation up to inclusion in the study was 15.5 years (range 0-74). Only 27.9% of all patients reporting a prior ENP had received concurrent endoscopic sinus surgery (ESS; n=102). For comparison, surgical rates in patients with CRSsNPs were significantly lower; 13% of cases specifically reported ESS, and of those only 30% reported multiple procedures (χ(2) p<0.001). CONCLUSIONS This study demonstrated that there is a high burden of both primary and revision surgery in patients with CRS, worst in those with AFRS and least in those with CRSsNPs. The burden of revision surgery appears unchanged in the decade since the Sinonasal Audit.
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Affiliation(s)
- Carl Philpott
- James Paget University Hospital NHS Foundation Trust, Gorleston, UK
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- Spire Norwich Hospital, Norwich, Norfolk, UK
| | | | - Sally Erskine
- James Paget University Hospital NHS Foundation Trust, Gorleston, UK
| | - Nirmal Kumar
- Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UK
| | | | | | | | - Shahram Anari
- Heart of England NHS Foundation Trust, Birmingham, UK
| | | | | | - Paul Jervis
- Northampton General Hospital, Northampton, UK
| | | | | | | | | | | | | | | | - Jaydip Ray
- Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Jonathan Hobson
- Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | | | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
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Hopkins C, Rudmik L, Lund VJ. The predictive value of the preoperative Sinonasal outcome test-22 score in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 2015; 125:1779-84. [DOI: 10.1002/lary.25318] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Claire Hopkins
- Department of Otolaryngology; Guy's and St. Thomas' National Health Service Trust; London United Kingdom
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery; Richmond Road Diagnostic and Treatment Centre, University of Calgary; Calgary Alberta Canada
| | - Valerie J. Lund
- Department of Otolaryngology; Royal National Throat Nose & Ear Hospital; London United Kingdom
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A prospective investigation of predictive parameters for post-surgical recurrences in sinonasal polyposis. Eur Arch Otorhinolaryngol 2015; 273:655-60. [PMID: 25763571 DOI: 10.1007/s00405-015-3598-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
Even after appropriate surgical therapy, a significant number of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) experience recurrences. The end-point of this prospective study was to apply univariate and multivariate statistical models to identify clinical, pathological, and laboratory variables that could predict CRSwNP recurrence after endoscopic sinus surgery. The study enrolled 143 patients between 2010 and 2013, who were all treated by the same surgeon for CRSwNP. Twenty-one patients developed recurrent polyposis. The recurrence rate was significantly higher for the eosinophilic than for the non-eosinophilic type (p = 0.020). Among the patients who developed a recurrence, the disease-free interval was significantly shorter for those with eosinophilic-type polyposis (p = 0.003). Univariate statistical analysis disclosed significant associations between CRSwNP recurrence and age (p = 0.035), allergy (p = 0.014), and eosinophilic granulomatosis with polyangiitis (p = 0.01). The multivariate model showed that only histological evidence of the eosinophilic type of CRSwNP retained an independent prognostic significance in relation to recurrent polyposis (p = 0.033). Judging from our results, it is reasonable to consider both stricter follow-up protocols and postoperative adjuvant medical treatments for patients with a histological diagnosis of eosinophilic-type CRSwNP.
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Sharma R, Lakhani R, Rimmer J, Hopkins C. Surgical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database Syst Rev 2014; 2014:CD006990. [PMID: 25410644 PMCID: PMC11166467 DOI: 10.1002/14651858.cd006990.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Surgical treatment of chronic rhinosinusitis with nasal polyps is an established treatment for medically resistant nasal polyp disease. Whether a nasal polypectomy with additional sinus dissection offers any advantage over an isolated nasal polypectomy has not been systematically reviewed. OBJECTIVES To assess the effectiveness of simple polyp surgery versus more extensive surgical clearance in chronic rhinosinusitis with nasal polyps. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 1); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 February 2014. SELECTION CRITERIA Randomised and quasi-randomised controlled trials in patients over 16 with chronic rhinosinusitis with nasal polyps, who have failed a course of medical management and who have not previously undergone any previous surgical intervention for their nasal disease. Studies compared nasal polypectomy with more extensive sinus clearance in this patient cohort. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We identified no trials which met our inclusion criteria. Six controlled trials (five randomised) met some but not all of the inclusion criteria and were therefore excluded from the review. AUTHORS' CONCLUSIONS We are unable to reach any conclusions as to whether isolated nasal polypectomy or more extensive sinus surgery is a superior surgical treatment modality for chronic rhinosinusitis with nasal polyps. There is a need for high-quality randomised controlled trials to assess whether additional sinus surgery confers any benefit when compared to nasal polypectomy performed in isolation.
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Affiliation(s)
- Rishi Sharma
- Guy's HospitalENT Department3rd Floor Southwark WingGreat Maze PondLondonUKSE1 9RT
| | - Raj Lakhani
- St George's HospitalDepartment of OtolaryngologyBlackshaw RoadLondonUKSW17 0QT
| | - Joanne Rimmer
- Guy's HospitalENT Department3rd Floor Southwark WingGreat Maze PondLondonUKSE1 9RT
| | - Claire Hopkins
- Guy's HospitalENT Department3rd Floor Southwark WingGreat Maze PondLondonUKSE1 9RT
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Kapoor K, Hopkins C. Underutilisation of the British Rhinological Society minimum electronic dataset in an age of mandatory reporting; an investigation. Clin Otolaryngol 2014; 40:140-2. [PMID: 25333571 DOI: 10.1111/coa.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
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Taulu R, Numminen J, Bizaki A, Rautiainen M. Image-guided, navigation-assisted Relieva Stratus MicroFlow Spacer insertion into the ethmoid sinus. Eur Arch Otorhinolaryngol 2014; 272:2335-40. [PMID: 25325931 DOI: 10.1007/s00405-014-3334-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/11/2014] [Indexed: 11/24/2022]
Abstract
Anatomical complexity presents the main challenge in the administration of topical corticosteroid therapy to the paranasal sinus mucosa. This often leads to suboptimal drug delivery due to low concentrations of the therapeutic agent to the intended target area. The Relieva Stratus™ MicroFlow Spacer (Relieva Stratus) is a drug-eluting stent that is temporarily implanted into the ethmoid sinus. The reservoir of the stent is filled with triamcinolone acetonide, which is then slowly released from the device into the ethmoid sinus mucosa. The Relieva Stratus provides local and targeted delivery of the anti-inflammatory agent to the diseased mucosa. This minimally invasive implant is an option when treating ethmoid sinusitis. From January 2011 to November 2013, a total of 52 Relieva Stratus implantations into the ethmoidal cells were performed at the Department of Ear and Oral Diseases at Tampere University Hospital, Finland. C-arm fluoroscopy guidance was employed for 26 sinuses (13 patients) and optical image-guided surgery (IGS)-assisted insertions were performed on another 26 sinuses (13 patients). The accuracy of fluoroscopic insertion is not optimal, but this method is accurate enough to prevent the violation of the skull base and lamina papyracea. IGS enables the precise treatment of the diseased cells. From a technical perspective, IGS-guided insertion is a faster, safer and more exact procedure that guarantees the optimal positioning and efficacy of the implant. Moreover, IGS guidance does not entail the use of ionizing radiation.
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Affiliation(s)
- Rami Taulu
- Department of Ear and Oral Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland,
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Effects of functional endoscopic sinus surgery on chronic rhinosinusitis resistant to medication. The Journal of Laryngology & Otology 2014; 128:976-80. [DOI: 10.1017/s002221511400228x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To evaluate the therapeutic effects of functional endoscopic sinus surgery in patients with chronic rhinosinusitis who were unresponsive to medical treatment.Methods:A total of 232 patients were divided into 2 groups: a functional endoscopic sinus surgery group (n = 162) and a conservative therapy group (n = 70). Efficacy was assessed in terms of Lund–Kennedy endoscopy scores and Sino-Nasal Outcome Test 20 symptom scores.Results:In the functional endoscopic sinus surgery group, Lund–Kennedy and Sino-Nasal Outcome Test 20 scores were significantly lower at 3, 6 and 12 months post-surgery compared with baseline scores. In the conservative therapy group, both sets of scores were significantly lower at 3 months, but not at 12 months. In this latter group, the Lund–Kennedy scores decreased only slightly and the Sino-Nasal Outcome Test 20 scores significantly decreased at six months compared with initial scores, indicating disparity between the subjective and objective measures. Patient-reported symptom improvement was better in the functional endoscopic sinus surgery group than in the medication group at 12 months (p < 0.001).Conclusion:These findings suggest that functional endoscopic sinus surgery has better efficacy over a longer period compared with conservative therapy.
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Drilling A, Coombs GW, Tan HL, Pearson JC, Boase S, Psaltis A, Speck P, Vreugde S, Wormald PJ. Cousins, siblings, or copies: the genomics of recurrent Staphylococcus aureus infections in chronic rhinosinusitis. Int Forum Allergy Rhinol 2014; 4:953-60. [PMID: 25271410 DOI: 10.1002/alr.21423] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 08/05/2014] [Accepted: 08/26/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Staphylococcus aureus infection is known to play a role in recalcitrant chronic rhinosinusitis (CRS). However, it is unknown if recurrent S. aureus infections are caused by the same strain or are due to independent acquisitions of different strains. METHODS Samples were collected from patients with CRS from July 2011 to August 2012. S. aureus was isolated from mucosal swabs and tissue specimens from patients who underwent surgery during the study period, or from swabs of areas of purulence taken in the postoperative period under endoscopic guidance. Pulsed-field gel electrophoresis was used to characterize S. aureus isolates. RESULTS Thirty-four patients were included in the study; 79% showed persistence of the same S. aureus strain in their paranasal sinuses (p = 0.001; H1 ≠ 50%). Furthermore, a significantly high frequency of patients with known biofilm status were positive for S. aureus biofilm (p = 0.002; H1 ≠ 50%). When patients were stratified according to disease evolution postsurgery, certain strains appeared to be more commonly associated with symptom persistence. CONCLUSION The same S. aureus strain appears to persist in the paranasal sinuses of CRS patients despite multiple courses of culture-directed antibiotics. This suggests that conventional antimicrobial therapies in patients with CRS may not eliminate the organism. This may be partly explained by the formation of biofilms in the paranasal sinus region.
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Affiliation(s)
- Amanda Drilling
- Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
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94
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Awad Z, Touska P, Arora A, Ziprin P, Darzi A, Tolley NS. Face and content validity of sheep heads in endoscopic rhinology training. Int Forum Allergy Rhinol 2014; 4:851-8. [DOI: 10.1002/alr.21362] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/21/2014] [Accepted: 05/29/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Zaid Awad
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology-Head and Neck Surgery; St Mary's Hospital, Imperial College Healthcare National Health Service (NHS) Trust; London UK
| | - Philip Touska
- Department of Otolaryngology-Head and Neck Surgery; St Mary's Hospital, Imperial College Healthcare National Health Service (NHS) Trust; London UK
| | - Asit Arora
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology-Head and Neck Surgery; St Mary's Hospital, Imperial College Healthcare National Health Service (NHS) Trust; London UK
| | - Paul Ziprin
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology-Head and Neck Surgery; St Mary's Hospital, Imperial College Healthcare National Health Service (NHS) Trust; London UK
| | - Ara Darzi
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology-Head and Neck Surgery; St Mary's Hospital, Imperial College Healthcare National Health Service (NHS) Trust; London UK
| | - Neil Samuel Tolley
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology-Head and Neck Surgery; St Mary's Hospital, Imperial College Healthcare National Health Service (NHS) Trust; London UK
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95
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Nguyen DT, Guillemin F, Arous F, Jankowski R. Assessment of quality-of-life outcomes after surgery for nasal polyposis with the DyNaChron questionnaire. Eur Arch Otorhinolaryngol 2014; 272:367-75. [PMID: 24899410 DOI: 10.1007/s00405-014-3109-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/19/2014] [Indexed: 01/11/2023]
Abstract
This prospective study assesses outcomes at 6 weeks and 7 months after radical ethmoid surgery in 65 patients with nasal polyposis using a new and detailed instrument, the DyNaChron questionnaire, which was filled in the day prior to surgery and at 6 weeks and 7 months after surgery at follow-up visits. Before surgery, the leading bothersome symptoms were olfactory disturbances (7.74 ± 2.81) and nasal obstruction (6.66 ± 2.28). After surgery (6th week and 7th month), there was a clear improvement of all symptoms including nasal obstruction, olfactory disturbances, anterior rhinorrhea, postnasal discharge, facial pain/headache and cough in comparison to baseline (p < 0.0001). Nasal obstruction was the most improved symptom (effect size of 2.24). At 7th post-operative month, the sense of smell continued to improve slightly. By contrast, the postnasal discharge score that was significantly improved at 6th post-operative week tended to worsen at 7 months (p = 0.0045). Before surgery, strong psychosocial impacts were observed in association with nasal obstruction and anterior rhinorrhea. The physical impacts of each symptom were proportionally correlated to the symptom score before and after surgery. The quality of life (QOL) related to each symptom was clearly better at 6 weeks and remained steady at 7 months after surgery. In conclusion, olfactory disorders and postnasal rhinorrhea were the main remaining symptoms after sinus surgery despite a global improvement of symptoms and quality of life. The earlier time point to stabilize QOL outcomes of endoscopic sinus surgery could be suggested at 6 weeks after surgery.
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Affiliation(s)
- Duc Trung Nguyen
- Departments of ENT, Head and Neck Surgery, Nancy University Hospital - Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29, Av. du Maréchal de Lattre de Tassigny, 54000, Nancy, France,
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96
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Georgalas C, Cornet M, Adriaensen G, Reinartz S, Holland C, Prokopakis E, Fokkens W. Evidence-based surgery for chronic rhinosinusitis with and without nasal polyps. Curr Allergy Asthma Rep 2014; 14:427. [PMID: 24557748 DOI: 10.1007/s11882-014-0427-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Meta-analysis of both large outcome studies as well as cohort studies support the safety and efficacy of Endoscopic Sinus Surgery for Chronic Rhinosinusitis. The efficacy of endoscopic sinus surgery is demonstrated in the improvement of both disease-specific and generic QOL as well as objective measures. However, this must be interpreted together with a well-recognized long-term 15-20 % revision rate, seen more often in patients with ASA trias and cystic fibrosis as well as osteitis and previous surgery. The effect of surgery is higher in managing nasal obstruction (effect size 1.7) and less so hyposmia (effect size 0.8). Allergy has an additive role on the symptomatology of CRS; however, its role if any on the outcome of ESS for CRS is unclear. The concurrent presence of aspiring sensitivity and asthma is associated with increased disease burden and more revision surgeries. Improved phenotyping of CRS may lead in the future to better tailoring of surgical treatments.
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Affiliation(s)
- Christos Georgalas
- Department of Otorhinolaryngology, Academic Medical Centre, A2-228, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands,
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97
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Betz CS, Braun T. [Nasal polyps--what the general practitioner should know]. MMW Fortschr Med 2014; 156:39-41. [PMID: 24938062 DOI: 10.1007/s15006-014-2658-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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98
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Benninger MS, Holy CE. Endoscopic Sinus Surgery Provides Effective Relief as Observed by Health Care Use Pre- and Postoperatively. Otolaryngol Head Neck Surg 2014; 150:893-900. [DOI: 10.1177/0194599814522419] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To analyze the impact of endoscopic sinus surgery (ESS) on overall health care utilization for the treatment of chronic rhinosinusitis (CRS). Study Design Retrospective administrative database analysis. Setting All US-based primary and secondary sites of care. Subjects and Methods A cohort of patients with ESS ( Current Procedural Terminology codes 31254-31288) in 2008 and at least 5 years of continuous medical and drug plan enrollment were included (n = 9105). Inpatient and outpatient medical history (including prescriptions) was analyzed from weeks −104 to +104 postoperatively. Results Health care utilization was constant up to −6 months preoperatively, at a per-patient per-week (PPPW) average of $11.75 (prescriptions, $2.44 [95% confidence interval (CI), $2.32-$2.56]; inpatient care, $ 0.82 [95% CI, $ 0.43-$1.20]; outpatient care, $8.49 [95% CI, $7.90-$9.08]). At −26 weeks preoperatively, a continuous increase from baseline levels was observed up to week −3, reaching an average PPPW of $95.37 (prescriptions, $13.74 [95% CI, $12.51-$14.96]; inpatient care, $2.73 [95% CI, $1.76-$3.70]; and outpatient care, $78.90 [95% CI, 73.65-$84.14]). From week −3 to surgery, outpatient events and prescriptions increased significantly, suggesting a decision to operate and costs associated with preoperative management. Postoperatively, costs declined rapidly, reaching baseline levels by 13 weeks postoperatively. Adverse events were reported in 388 patients (2.94% cases of hemorrhage, 0.14% cases of cerebrospinal fluid leak, 0.58% cases of orbital complications), and 572 (6.28%) patients had revision surgery. Conclusion Patients with CRS incur ongoing, baseline levels of health care utilization. Preoperatively, CRS-related health care needs are more than 8-fold greater than those at baseline. Following ESS, health care needs declined rapidly and reached baseline levels within 13 weeks postoperatively.
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99
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Wentzel JL, Soler ZM, DeYoung K, Nguyen SA, Lohia S, Schlosser RJ. Leukotriene antagonists in nasal polyposis: a meta-analysis and systematic review. Am J Rhinol Allergy 2013; 27:482-9. [PMID: 24274224 PMCID: PMC3899527 DOI: 10.2500/ajra.2013.27.3976] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Leukotriene antagonists (LTAs) provide a potential strategy for the management of chronic rhinosinusitis with nasal polyposis (CRSwNP), which is often refractory to medical and surgical treatment. The purpose of this study is to determine the impact of LTA treatment alone and in conjunction with intranasal corticosteroids (INCSs) on nasal symptoms, objective clinical outcomes, and immune parameters in CRSwNP. METHODS A systematic review was performed including studies that assessed the effectiveness of LTAs on clinical outcome measures of CRSwNP. Exclusion criteria were trials assessing LTAs in CRS without nasal polyps or asthma symptoms only. Quantitative analysis was performed using a random effects model. RESULTS Twelve studies fulfilled eligibility: five randomized control trials and seven case series. LTAs showed significant improvements in CRSwNP symptoms over placebo; however, these randomized trials were unable to be combined via meta-analysis. The two studies used in meta-analysis showed a standardized mean difference of pooled overall symptom scores of 0.02 (95% confidence interval, -0.39-0.44) between LTA and INCS study arms, indicating no difference between the treatment modalities. Improvement was described by all studies in symptoms, clinical outcomes, and/or immune parameters after LTA treatment, with greater improvements in a subset of symptoms beyond that observed with INCSs. Concomitant asthma, aspirin-exacerbated respiratory disease, and atopy did not significantly or consistently affect these results. CONCLUSION LTAs are an effective tool for treating CRSwNP, with limited benefit as an adjunctive therapy. Additional study is required to determine the most beneficial strategy and patient population for their use.
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Affiliation(s)
- Jennifer L. Wentzel
- From the Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Zachary M. Soler
- From the Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kristen DeYoung
- From the Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shaun A. Nguyen
- From the Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shivangi Lohia
- From the Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Rodney J. Schlosser
- From the Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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100
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Mascarenhas JG, da Fonseca VMG, Chen VG, Itamoto CH, Silva CAPD, Gregório LC, Kosugi EM. Long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyps. Braz J Otorhinolaryngol 2013; 79:306-11. [PMID: 23743745 PMCID: PMC9443906 DOI: 10.5935/1808-8694.20130055] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/28/2013] [Indexed: 11/20/2022] Open
Abstract
Chronic rhinosinusitis (CRS) significantly affects patient quality of life. Medical and surgical treatments aim to clinically manage the condition. Objective To assess the long-term quality of life and clinical management of CRS in patients submitted to endoscopic sinus surgery. Method This prospective cross-sectional cohort study enrolled 38 patients and looked into the follow-up data of subjects diagnosed with CRS before surgery, three months after surgery, and at least two years after surgery. The Sinonasal Outcome Test 22 (SNOT-22) was used to assess response to treatment and long-term clinical management of the disease. Results Significant improvements in the SNOT-22 scores were seen between the preoperative (61.3) and postoperative assessments with three (16.9) and 24 (32.3) months. No statistically significant differences were seen when patients with polyps were compared to polyp-free subjects. Few patients were controlled in both groups, and 7.89% of the subjects had revision surgery during the study. Conclusion Endoscopic sinus surgery significantly improved the quality of life of patients with chronic rhinosinusitis. Clinical control of the condition was acceptable, with few patients requiring re-operation within two years of the first surgery.
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