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Heiland LD, Farmer HG, Nguyen SA, Soler ZM, Schlosser RJ. Headache and Facial Pain/Pressure in the Chronic Rhinosinusitis Population: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024. [PMID: 38895867 DOI: 10.1002/ohn.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To evaluate the severity and prevalence of headache and facial pain/pressurere in the chronic rhinosinusitis (CRS) population. DATA SOURCES CINAHL, PubMed, Scopus. REVIEW METHODS The literature was searched from inception through June 2023 for English language articles documenting "headache" or "facial pain/pressure" and "chronic rhinosinusitis." Data collected included Lund-MacKay computed tomography score, Lund-Kennedy endoscopy score, sinonasal outcome test, and visual analog scale. Meta-analyses were performed on continuous measures (mean), proportions (%), and regression. RESULTS A total of 69 studies were included with 8643 CRS patients and 703 control patients. The CRS group had a mean age of 44.1 (range: 16-82; 95% confidence interval [CI]: 40.3-48) and 86.1% [95% CI: 76.4-93.5] with nasal polyposis. The control group had a mean age of 39.2 (range: 17-88; 95% CI: 28.7-49.8). All CRS subgroups had significantly more severe headache and facial pain/pressure when compared to the control (P < .0001). Patients without polyps had significantly more severe facial pain/pressure and headache when compared to patients with polyps (P < .0001). Facial pain/pressure is a moderate problem or worse in 29.8% of polypoid patients versus 56.4% of nonpolypoid patients; Δ26.6% [95% CI: 0.7-50; P = .045]. CONCLUSIONS Across all outcome metrics, CRS patients experience significantly more severe headache and facial pain/pressure when compared to a control population. Nonpolypoid patients experience significantly more severe facial pain/pressure and headache when compared to polypoid patients. The majority of nonpolypoid patients experience facial pain/pressure that is moderate in severity or worse.
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Affiliation(s)
- Luke D Heiland
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Hannah G Farmer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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Hildebrandt ME, Møller PR, Fjældstad AW, Ovesen T. Postinfectious conditions challenge disease-specificity of SNOT-22. Eur Arch Otorhinolaryngol 2024; 281:2395-2402. [PMID: 38177896 DOI: 10.1007/s00405-023-08385-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The Sino-Nasal-Outcome-Test 22 (SNOT-22) questionnaire assesses treatment outcome and health-related quality of life (HRQOL) in patients with chronic rhinosinusitis (CRS). However, given the overlap between CRS and olfaction in terms of nasal function and the definition of CRS, a fundamental question arises: can patients with olfactory dysfunction (OD) stemming from other causes attain SNOT-22 scores similar to those seen in CRS, even in the absence of CRS? Our study aimed to explore whether OD arising from various postinfectious mechanisms challenges the disease-specificity of SNOT-22 for CRS. If so, could focus on scores within specific symptom domains of SNOT-22 prove valuable in distinguishing between different etiologies. METHODS The study adopted an observational, retrospective cohort design based on prospectively registered patients and related variables using the REDCap platform. 460 patients experiencing OD due to either (1) simple or (2) complex post-COVID-19, (3) postinfectious non-COVID-19, and (4) CRS, were included in the analysis. RESULTS The study revealed that the total SNOT-22 score lacks disease-specificity for CRS. This is evident, because complex postinfectious mechanisms resulting from COVID-19 can produce similar symptoms in patients. Notably, elevated total scores were primarily driven by high subdomain scores within the "sleep and cognition" domain. CONCLUSIONS The application of SNOT-22 as a screening tool needs to be approached with caution, as the total score alone does not provide disease-specific insights. A more thorough exploration of the four symptom domains and the identification of distinctive scoring patterns within the clinical context may prove pivotal in effectively differentiating between various underlying causes.
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Affiliation(s)
- Mascha E Hildebrandt
- Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, University Clinic for Balance, Flavour and Sleep, Hospitalsparken 15, 7400, Herning, Denmark.
| | - Patrick R Møller
- Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, University Clinic for Balance, Flavour and Sleep, Hospitalsparken 15, 7400, Herning, Denmark
| | - Alexander W Fjældstad
- Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, University Clinic for Balance, Flavour and Sleep, Hospitalsparken 15, 7400, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen's Boulevard 82, 8200, Aarhus N, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, University Clinic for Balance, Flavour and Sleep, Hospitalsparken 15, 7400, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen's Boulevard 82, 8200, Aarhus N, Denmark
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Miller JE, Chung HR, Uy BR, Kosaraju N, Shih RM, Ko M, Esswein SR, Abiri A, Khosravi P, Huck N, Nguyen CH, Hsu T, Kim MG, Hsu FPK, Kim W, Lee JK, Suh JD, Bergsneider M, Kuan EC, Wang MB. Comparison of patient-reported outcomes and clinical characteristics among patients with pituitary macroadenomas and giant adenomas. Int Forum Allergy Rhinol 2024. [PMID: 38646913 DOI: 10.1002/alr.23354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
KEY POINTS Patients with giant adenomas are more likely to have tumor extension into the paranasal sinuses. Compared to macroadenomas, giant adenomas are not associated with worse preoperative SNOT-22 scores.
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Affiliation(s)
- Jessa E Miller
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Hye Rhyn Chung
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Benjamin R Uy
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Nikitha Kosaraju
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ryan M Shih
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Myungjun Ko
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Shannon R Esswein
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Arash Abiri
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Pooya Khosravi
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Nolan Huck
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Cecilia H Nguyen
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Timothy Hsu
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Michael G Kim
- Department of Neurosurgery, University of California, Irvine, California, USA
| | - Frank P K Hsu
- Department of Neurosurgery, University of California, Irvine, California, USA
| | - Won Kim
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Jivianne K Lee
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Marvin Bergsneider
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
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4
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Fleseriu CM, Beswick DM, Maoz SL, Hwang PH, Choby G, Kuan EC, Chan EP, Adappa ND, Geltzeiler M, Getz AE, Humphries IM, Le CH, Abuzeid WM, Chang EH, Jafari A, Kingdom TT, Kohanski MA, Lee JK, Nabavizadeh SA, Nayak JV, Palmer JN, Patel ZM, Pinheiro-Neto CD, Resnick AC, Smith TL, Snyderman CH, St John MA, Storm J, Suh JD, Wang MB, Wang EW. Predictive factors for decreased baseline quality of life in patients with sinonasal malignancies. Int Forum Allergy Rhinol 2024; 14:775-785. [PMID: 37646428 DOI: 10.1002/alr.23261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/18/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The impact of sinonasal malignancies (SNMs) on quality of life (QOL) at presentation is poorly understood. The Sinonasal Outcome Test (SNOT-22) and University of Washington Quality of Life (UWQOL) are validated QOL instruments with distinctive subdomains. This study aims to identify factors impacting pretreatment QOL in SNM patients to personalize multidisciplinary management and counseling. METHODS Patients with previously untreated SNMs were prospectively enrolled (2015-2022) in a multicenter observational study. Baseline pretreatment QOL instruments (SNOT-22, UWQOL) were obtained along with demographics, comorbidities, histopathology/staging, tumor involvement, and symptoms. Multivariable regression models identified factors associated with reduced baseline QOL. RESULTS Among 204 patients, presenting baseline QOL was significantly reduced. Multivariable regression showed worse total SNOT-22 QOL in patients with skull base erosion (p = 0.02). SNOT-rhinologic QOL was worse in women (p = 0.009), patients with epistaxis (p = 0.036), and industrial exposure (p = 0.005). SNOT extranasal QOL was worse in patients with industrial exposure (p = 0.016); worse SNOT ear/facial QOL if perineural invasion (PNI) (p = 0.027). Squamous cell carcinoma pathology (p = 0.037), palate involvement (p = 0.012), and pain (p = 0.017) were associated with worse SNOT sleep QOL scores. SNOT psychological subdomain scores were significantly worse in patients with palate lesions (p = 0.022), skull base erosion (p = 0.025), and T1 staging (p = 0.023). Low QOL was more likely in the presence of PNI on UW health (p = 0.019) and orbital erosion on UW overall (p = 0.03). UW social QOL was worse if palatal involvement (p = 0.023) or PNI (p = 0.005). CONCLUSIONS Our findings demonstrate a negative impact on baseline QOL in patients with SNMs and suggest sex-specific and symptom-related lower QOL scores, with minimal histopathology association. Anatomical tumor involvement may be more reflective of QOL than T-staging, as orbital and skull base erosion, PNI, and palate lesions are significantly associated with reduced baseline QOL.
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Affiliation(s)
- Cara M Fleseriu
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Sabrina L Maoz
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Erik P Chan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Nithin D Adappa
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Ian M Humphries
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Christopher H Le
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Eugene H Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael A Kohanski
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jivianne K Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Seyed A Nabavizadeh
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - James N Palmer
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Carlos D Pinheiro-Neto
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam C Resnick
- Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maie A St John
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Jay Storm
- Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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5
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Upreti G, Modi A, Vadher P, Chudasama PK. Sino-nasal Outcome Test (SNOT22) score in adult population with no known sino-nasal disease. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08557-5. [PMID: 38520535 DOI: 10.1007/s00405-024-08557-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/12/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE This cross-sectional study aimed to establish normative values for Sino-Nasal Outcome Test (SNOT-22) score in adult Indian population without known sino-nasal diseases. The purpose was to fill a critical knowledge gap, providing insights into how various host factors influence SNOT-22 scores which seek to serve as reference for clinical studies, facilitating comparisons of symptom severity and aid in patient counselling based on specific score patterns. METHODS One thousand and twelve adults meeting inclusion criteria participated in the study. Participants provided demographic information, occupation details, addiction history, and medical background. They completed SNOT-22 questionnaire, grading their symptoms on Likert scale of 0-5 based on severity experienced in the past 2 weeks. The collected data were analysed to derive meaningful insights. RESULTS Mean SNOT-22 score for the study population was 6.80, with 90% scoring below 15, and 40% within 0-3 range. Females exhibited significantly lower mean scores than males. Residents of rural areas reported higher scores than urban counterparts. Education levels had no significant influence on scores. Occupational exposure to aeroallergens, addiction (especially tobacco), and a history of allergies, bronchial asthma, or atopy were associated with significantly higher SNOT-22 scores. Principal component analysis identified four distinct domains, with the nasal symptom domain consistently emerging as the major contributor to differences in subgroups with significantly different total SNOT-22 scores. CONCLUSION The normative data and subgroup analyses established in this study serve as a foundation for future research, aiding clinicians in predicting symptoms and providing tailored counselling for individuals with sino-nasal pathologies.
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Affiliation(s)
- Garima Upreti
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Rajkot, Gujarat, India.
| | - Anjali Modi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Payal Vadher
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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Beswick DM, Khatiwada A, Miller JE, Humphries SM, Wilson A, Vladar EK, Lynch DA, Taylor-Cousar JL. Impact of highly effective modulator therapy on chronic rhinosinusitis and health status: 2-year follow-up. J Cyst Fibros 2024; 23:214-218. [PMID: 37805356 DOI: 10.1016/j.jcf.2023.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology, Department of Head and Neck Surgery, University of California, 10833 Le Conte Avenue, CHS 62-235, Los Angeles, CA 90095-1624, United States.
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, CO, United States
| | - Jessa E Miller
- Department of Otolaryngology, Department of Head and Neck Surgery, University of California, 10833 Le Conte Avenue, CHS 62-235, Los Angeles, CA 90095-1624, United States
| | | | - Alexandra Wilson
- Clinical Research Services, National Jewish Health, Denver, CO, United States
| | - Eszter K Vladar
- Department of Medicine, Division of Pulmonary Science and Critical Care Medicine, University of Colorado, Aurora, CO, United States; Department of Cell Biology, University of Colorado School of Medicine, Aurora, CO, United States
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, United States
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7
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Grimm DR, Beswick DM, Maoz SL, Wang EW, Choby GW, Kuan EC, Chan EP, Adappa ND, Geltzeiler M, Getz AE, Humphreys IM, Le CH, Abuzeid WM, Chang EH, Jafari A, Kingdom TT, Kohanski MA, Lee JK, Nayak JV, Palmer JN, Patel ZM, Pinheiro-Neto CD, Resnick AC, Sim MS, Smith TL, Snyderman CH, John MA, Storm P, Suh JD, Wang MB, Hwang PH. SNOT-22 subdomain outcomes following treatment for sinonasal malignancy: A prospective, multicenter study. Int Forum Allergy Rhinol 2024. [PMID: 38372441 DOI: 10.1002/alr.23338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Patients with sinonasal malignancy (SNM) present with significant sinonasal quality of life (QOL) impairment. Global sinonasal QOL as measured by the 22-item Sinonasal Outcomes Test (SNOT-22) has been shown to improve with treatment. This study aims to characterize SNOT-22 subdomain outcomes in SNM. METHODS Patients diagnosed with SNM were prospectively enrolled in a multi-center patient registry. SNOT-22 scores were collected at the time of diagnosis and through the post-treatment period for up to 5 years. Multivariable regression analysis was used to identify drivers of variation in SNOT-22 subdomains. RESULTS Note that 234 patients were reviewed, with a mean follow-up of 22 months (3 months-64 months). Rhinologic, psychological, and sleep subdomains significantly improved versus baseline (all p < 0.05). Subanalysis of 40 patients with follow-up at all timepoints showed statistically significant improvement in rhinologic, extra-nasal, psychological, and sleep subdomains, with minimal clinically important difference met between 2 and 5 years in sleep and psychological subdomains. Adjuvant chemoradiation was associated with worse outcomes in rhinologic (adjusted odds ratio (5.22 [1.69-8.66])), extra-nasal (2.21 [0.22-4.17]) and ear/facial (5.53 [2.10-8.91]) subdomains. Pterygopalatine fossa involvement was associated with worse outcomes in rhinologic (3.22 [0.54-5.93]) and ear/facial (2.97 [0.32-5.65]) subdomains. Positive margins (5.74 [2.17-9.29]) and surgical approach-combined versus endoscopic (3.41 [0.78-6.05])-were associated with worse psychological outcomes. Adjuvant radiation (2.28 [0.18-4.40]) was associated with worse sleep outcomes. CONCLUSIONS Sinonasal QOL improvements associated with treatment of SNM are driven by rhinologic, extra-nasal, psychological, and sleep subdomains.
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Affiliation(s)
- David R Grimm
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Daniel M Beswick
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Sabrina L Maoz
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Garret W Choby
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Erik P Chan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Oregon, Portland, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Christopher H Le
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Eugene H Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jivianne K Lee
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Carlos D Pinheiro-Neto
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam C Resnick
- Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Myung S Sim
- Department of Medicine-Statistics Core, University of California Los Angeles, Los Angeles, California, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Oregon, Portland, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maie A John
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Phillip Storm
- Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
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8
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Min HJ, Park JY. Usefulness of nasal cavity evaluation before high-resolution esophageal manometry in high-risk patients. Korean J Intern Med 2024; 39:86-94. [PMID: 38031365 PMCID: PMC10790053 DOI: 10.3904/kjim.2023.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/10/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND/AIMS A catheter is inserted through the nasal cavity during high-resolution esophageal manometry (HRM), which may cause adverse events such as pain or epistaxis. Despite these possible safety considerations, studies on this subject are very limited. We aimed to investigate the usefulness of nasal cavity evaluation before HRM to reduce the risk of adverse events and test failure. METHODS Patients who underwent HRM after consultation with the ear-nose-throat department for nasal evaluation were retrospectively enrolled between December 2021 and May 2022. The included patients had a previous history of sinonasal disease or surgery or had subjective nasal discomfort. All patients answered the Sino-Nasal Outcome Test (SNOT-22) questionnaire, and subjective nasal discomfort was scored using a visual analog scale. Nasal endoscopy and acoustic rhinometry were performed for disease evaluation and volumetric assessment. RESULTS The analysis included 22 patients with a mean age of 58.9 years. The mean SNOT-22 score was 24.2, and 16 patients (72.7%) complained of subjective nasal obstruction. The HRM catheter was successfully inserted in 20 patients (90.9%), without any significant adverse events. The objective measurement outcomes of acoustic rhinometry and sinus endoscopy did not always correspond to subjective symptoms. Narrowed nasal airways unresponsive to decongestants were observed in two patients with failed catheter insertion. CONCLUSION To reduce the risk of adverse events and test failure during HRM, a site-specific questionnaire to evaluate nasal obstruction might be helpful. When nasal obstruction is suspected, objective nasal cavity evaluation could be recommended for the safe and successful performance of HRM.
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Affiliation(s)
- Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Yong Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Maoz SL, Wang EW, Hwang PH, Choby G, Kuan EC, Fleseriu CM, Chan EP, Adappa ND, Geltzeiler M, Getz AE, Humphreys IM, Le CH, Abuzeid WM, Chang EH, Jafari A, Kingdom TT, Kohanski MA, Lee JK, Lazor JW, Nabavizadeh A, Nayak JV, Palmer JN, Patel ZM, Pinheiro-Neto CD, Resnick AC, Smith TL, Snyderman CH, St John MA, Storm PB, Suh JD, Wang MB, Sim MS, Beswick DM. Long-term quality of life after treatment in sinonasal malignancy: A prospective, multicenter study. Int Forum Allergy Rhinol 2023; 13:2030-2042. [PMID: 37082883 DOI: 10.1002/alr.23171] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Quality of life (QOL) for individuals with sinonasal malignancy (SNM) is significantly under-studied, yet it is critical for counseling and may impact treatment. In this study we evaluated how patient, treatment, and disease factors impact sinonasal-specific and generalized QOL using validated metrics in a large cohort over a 5-year posttreatment time frame. METHODS Patients with SNM who underwent definitive treatment with curative intent were enrolled in a prospective, multisite, longitudinal observational study. QOL was assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22) and University of Washington Quality of Life Questionnaire (UWQOL) instruments at pretreatment baseline and multiple follow-ups through 5 years posttreatment. Multivariable modeling was used to determine demographic, disease, and treatment factors associated with disease-specific and generalized physical and social/emotional function QOL. RESULTS One hundred ninety-four patients with SNM were analyzed. All QOL indices were impaired at pretreatment baseline and improved after treatment. SNOT-22 scores improved 3 months and UWQOL scores improved 6 to 9 months posttreatment. Patients who underwent open compared with endoscopic tumor resection had worse generalized QOL (p < 0.001), adjusted for factors including T stage. Pterygopalatine fossa (PPF) involvement was associated with worse QOL (SNOT-22, p < 0.001; UWQOL Physical dimension, p = 0.02). Adjuvant radiation was associated with worse disease-specific QOL (p = 0.03). Neck dissection was associated with worse generalized physical function QOL (p = 0.01). Positive margins were associated with worse generalized social/emotional function QOL (p = 0.01). CONCLUSION Disease-specific and generalized QOL is impaired at baseline in patients with SNM and improves after treatment. Endoscopic resection is associated with better QOL. PPF involvement, adjuvant radiation, neck dissection, and positive margins were associated with worse QOL posttreatment.
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Affiliation(s)
- Sabrina L Maoz
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Cara M Fleseriu
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erik P Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Christopher H Le
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Eugene H Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael A Kohanski
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jivianne K Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Jillian W Lazor
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Nabavizadeh
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - James N Palmer
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Carlos D Pinheiro-Neto
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam C Resnick
- Center for Data Driven Discovery, Children's Hospital of Philadelphia, Pittsburgh, Pennsylvania, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maie A St John
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Phillip B Storm
- Center for Data Driven Discovery, Children's Hospital of Philadelphia, Pittsburgh, Pennsylvania, USA
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Myung S Sim
- Department of Medicine-Statistics Core, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
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Bou-Nassif R, Abou-Mrad Z, El Ahmadieh TY, Tabar V, Cohen MA. Patient-Reported Outcomes in Endoscopic Endonasal Skull Base Surgery. Endocrinol Metab Clin North Am 2022; 51:727-739. [PMID: 36244689 PMCID: PMC11012236 DOI: 10.1016/j.ecl.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The functional outcome, quality of life, and patient feedback related to a chosen treatment approach in skull base surgery have become a subject of interest and focused research in recent years. The current advances in endoscopic optical imaging technology and surgical precision have radically lowered the perioperative morbidity associated with skull base surgery. This has pushed toward a higher focus on patient-reported outcomes (PROs). It is now critical to ensure that the offered treatment plan and approach align with the patient's preferences and expectations, in addition to the surgeon's best clinical judgment and experience. PROs represent a view that reflects the patient's own thoughts and perspective on their condition and the management options, without input or interpretations from the surgeon. Having PRO data enables patients the opportunity to learn from the experiences and perspectives of other patients. This input empowers the patient to become an active participant in the decision-making process at different stages of their care. An in-depth PRO evaluation requires specific validated tools and scoring systems, namely the patient-reported outcomes measures (PROM) tools. In this review, we discuss the currently available skull-base-related PROs, the assessment tools used to capture them, and the future trends of this important topic that is in its infancy.
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Affiliation(s)
- Rabih Bou-Nassif
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Pituitary and Skull Base Tumor Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Zaki Abou-Mrad
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Pituitary and Skull Base Tumor Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Tarek Y El Ahmadieh
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Pituitary and Skull Base Tumor Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Pituitary and Skull Base Tumor Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Marc A Cohen
- Pituitary and Skull Base Tumor Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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11
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Patel PP, Cui J, Cahill KN, Laidlaw TM. Objective validity of patient-reported symptoms in aspirin-exacerbated respiratory disease patients. Clin Exp Allergy 2022; 52:348-351. [PMID: 34820927 PMCID: PMC8810664 DOI: 10.1111/cea.14062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | - Jing Cui
- Department of Medicine, Harvard Medical School,Division of Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Katherine N. Cahill
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tanya M. Laidlaw
- Department of Medicine, Harvard Medical School,Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, Massachusetts
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Kwiatkowska M, Szczygielski K, Chloupek A, Panasiewicz P, Jurkiewicz D. The effect of odontogenic sinusitis with periapical lesions on quality of life. Otolaryngol Pol 2021; 76:13-20. [DOI: 10.5604/01.3001.0015.4539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b> Introduction:</b> Usually the symptoms presented in odontogenic sinusitis do not differ from chronic sinusitis of other origin. However, odontogenic sinusitis is considered as an independent disease which requires specific diagnostic approach and treatment. </br></br> <b>Aim:</b> The aim of the study is to define the main symptoms of odontogenic rhinosinusitis with periapical lesions and its impact on the quality of life. </br></br> <b>Material and methods:</b> The SNOT-22 and OHIP-14 questionnaires were distributed among 26 symptomatic patients suffering from odontogenic sinusitis with periapical lesions in the teeth that remain in close contact with the maxillary sinus floor. Data was collected by means of an interview and standard examination performed by an otolaryngologist and a maxillofacial surgeon. The symptoms were also objectified using nasal endoscopy and radiological studies. The acquired data was statistically analyzed. </br></br> <b>Results:</b> The total OHIP-14 score was 14.7 ± 11.3, whereas the total SNOT-22 score was 44.6 ± 18.8. Women scored significantly higher in the total SNOT-22 score as well as domains concerning nasal symptoms, quality of sleep, and emotional symptoms. The answers given in similar items were comparable between both questionnaires. </br></br> <b>Conclusions:</b> Properly diagnosed odontogenic sinusitis (OS) with periapical lesions (PAL) will improve the quality of health-care and spare the patients inadequate procedures. Standard examination should include a unified and validated question-naire concerning both sinonasal and oral symptoms. Painful aching in the mouth and discomfort during eating might help to identify the OS with PAL during a medical interview and help both ENT (ear-nose-throat) specialists and dentists to establish proper patient-oriented diagnosis and treatment.
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Affiliation(s)
- Marta Kwiatkowska
- Department of Otolaryngology, Military Institute of Medicine in Warsaw, Poland
| | - Kornel Szczygielski
- Department of Otolaryngology, Military Institute of Medicine in Warsaw, Poland
| | - Aldona Chloupek
- Department of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine in Warsaw, Poland
| | - Paulina Panasiewicz
- Department of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine in Warsaw, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology, Military Institute of Medicine in Warsaw, Poland
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13
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Predictors of sinonasal disease onset, progression, and severity in pediatric cystic fibrosis patients. Am J Otolaryngol 2021; 42:103016. [PMID: 33836483 DOI: 10.1016/j.amjoto.2021.103016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Pediatric cystic fibrosis (CF) patients have a variable onset, severity, and progression of sinonasal disease. The objective of this study was to identify genotypic and phenotypic factors associated with CF that are predictive of sinonasal disease, recurrent nasal polyposis, and failure to respond to standard treatment. METHODS A retrospective case series was conducted of 30 pediatric patients with CF chronic rhinosinusitis with and without polyps. Patient specific mutations were divided by class and categorized into high risk (Class I-III) and low risk (Class IV-V). Severity of pulmonary and pancreatic manifestations of CF, number of sinus surgeries, nasal polyposis and recurrence, age at presentation to Otolaryngology, and Pediatric Sinonasal Symptom Survey (SN-5)/Sinonasal Outcome Test (SNOT-22) scores were examined. RESULTS 27/30 patients (90%) had high risk mutations (Class I-III). 21/30 (70.0%) patients had nasal polyposis and 10/30 (33.3%) had recurrent nasal polyposis. Dependence on pancreatic enzymes (23/27, 85.2% vs 0/3, 0.0%, p = 0.009) and worse forced expiratory volumes (FEV1%) (mean 79, SD 15 vs mean 105, SD 12, p = 0.009) were more common in patients with high risk mutations. Insulin-dependence was more common in those with recurrent polyposis (5/10, 50% vs 2/20, 10%, p = 0.026). There was no statistical difference in ages at presentation, first polyps, or sinus surgery, or in polyposis presence, recurrence, or extent of sinus surgery based on high risk vs. low risk classification. CONCLUSION CF-related diabetes was associated with nasal polyposis recurrence. Patients with more severe extra-pulmonary manifestations of CF may also be at increased risk of sinonasal disease.
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14
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Impact of CFTR Therapy on Chronic Rhinosinusitis and Health Status: Deep Learning CT Analysis and Patient Reported Outcomes. Ann Am Thorac Soc 2021; 19:12-19. [PMID: 34436985 PMCID: PMC8787790 DOI: 10.1513/annalsats.202101-057oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
RATIONALE Elexacaftor/tezacaftor/ivacaftor (ETI) in triple combination improves pulmonary health for people with cystic fibrosis (PwCF) however its impact on objective measures of sinus disease and health utility is unestablished. OBJECTIVES To evaluate the impact of ETI on chronic rhinosinusitis (CRS) and general health status incorporating computed tomography (CT), quality-of-life (QOL) and productivity loss. METHODS Adult PwCF+CRS with CF transmembrane conductance regulator genotype F508del/F508del or F508del/minimal function who clinically initiated ETI participated in a prospective, observational study. The primary endpoint was change in percent sinus CT opacification (%SO) after 6 months of ETI assessed via deep learning-based methods. Secondary endpoints included changes in sinonasal QOL, health utility value and productivity loss, which were evaluated monthly via validated metrics. RESULTS 30 PwCF provided baseline data; 25 completed the study. At baseline, the cohort had substantial CRS, with mean 22-question SinoNasal Outcome Test (SNOT-22) score 33.1 and mean sinus CT %SO 63.7%. At 6-month follow-up, %SO improved by mean 22.9% (p<0.001). %SO improvement trended toward greater magnitude for those naïve to prior modulator therapy (p=0.09). Mean SNOT-22 scores and health utility improved by 15.3 and 0.068 [6.8%] (all p<0.007). Presenteeism, activity impairment and overall productivity loss improved (all p<0.049). Improvements in SNOT-22 scores and health utility occurred by one month and remained improved over the study. CONCLUSIONS ETI is associated with substantial improvements in sinus CT opacification and productivity loss, and clinically meaningful improvements in sinonasal QOL and health utility. Most improvements were rapid, robust and durable over the study.
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15
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Albrecht T, Beule AG, Hildenbrand T, Gerstacker K, Praetorius M, Rudack C, Baumann I. Cross-cultural adaptation and validation of the 22-item sinonasal outcome test (SNOT-22) in German-speaking patients: a prospective, multicenter cohort study. Eur Arch Otorhinolaryngol 2021; 279:2433-2439. [PMID: 34351466 PMCID: PMC8986669 DOI: 10.1007/s00405-021-07019-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022]
Abstract
Purpose Chronic rhinosinusitis (CRS) is a common condition associated with a significant reduction of the health-related quality of life. One of the most widely used assessment tools in CRS is the disease-specific, health-related questionnaire SNOT-22. The aim of this study was to translate and validate the SNOT-22 into the German language.
Methods The questionnaire was translated using the forward–backward translation technique. After the translation its reliability, validity, and sensitivity were evaluated. For this purpose, the questionnaire was completed by patients diagnosed with CRS before, 3 months and 1 year after endoscopic sinus surgery and by healthy individuals as controls at three university hospitals in Germany. The individual scores of the questionnaire before surgery was correlated with the Lund–Mackay score as well as a global disease-specific question.
Results A total of 139 CRS patients and 31 healthy individuals participated in the study. Internal consistency at all timepoints was very good, with Cronbach’s alpha scores of 0.897, 0.941, and 0.945. The questionnaire was able to discriminate between CRS patients and control subjects (p < 0.0001) and scores improved significantly 3 month and 1 year after sinus surgery (p < 0.0001), indicating a good test–retest reliability, validity, and responsiveness. A significant correlation to the single global disease-specific question could be found (p < 0.0001), but no correlation with the Lund–Mackay score. Conclusion The German Version of the SNOT-22 is a reliable, valid, and sensitive instrument for measuring health-related quality of life in patients with CRS. It can be recommended for clinical practice and outcome research for German-speaking patients.
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Affiliation(s)
- Tobias Albrecht
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Medical Center-University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Achim Georg Beule
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center-University of Münster, Münster, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Greifswald-University of Greifswald, Greifswald, Germany
| | - Tanja Hildenbrand
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Kathrin Gerstacker
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Mark Praetorius
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center-University of Hamburg, Hamburg, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center-University of Münster, Münster, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Medical Center-University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Abstract
PURPOSE OF REVIEW Although sinus headache has been extensively reviewed and described, misdiagnosis remains common. This paper discusses the myths and truths about sinus headaches. RECENT FINDINGS Sinus headache is used colloquially to attribute facial pain to allergies or a sinus infection; however, most sinus headaches are migraine. Sinus-region pain from sinusitis and migraine share the same origins in the trigeminovascular system, but their causes are very different. After reviewing sinus anatomy and sinogenic pain, we provide information to assist clinicians in correctly diagnosing patients with the additional goal of avoiding unnecessary investigations and treatments. Migraine medications can be used as both a treatment and a diagnostic tool. Other differential diagnoses of facial pain are discussed. Sinus headache is not a diagnosis. All patients with facial pain or pressure with sinus symptoms should be evaluated for migraine because most sinus headache presentations are migraine and require migraine-directed treatment.
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Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Barrow Neurological Institute c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA.
| | - Karissa A Secora
- Department of Neurology, Barrow Neurological Institute c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA
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Tiotiu A, Novakova P, Guillermo G, Correira de Sousa J, Braido F. Management of adult asthma and chronic rhinitis as one airway disease. Expert Rev Respir Med 2021; 15:1135-1147. [PMID: 34030569 DOI: 10.1080/17476348.2021.1932470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Chronic rhinitis is defined as nasal inflammation with the presence of minimum two symptoms such as nasal obstruction, rhinorrhea, sneezing and/or itching one hour daily for a minimum of 12 weeks/year. According their etiology, four groups of rhinitis are described: allergic, infectious, non-allergic non-infectious and mixed.Chronic rhinitis is frequently associated with asthma, shares similar mechanisms of the pathogenesis and has a negative impact of its outcomes sustaining the concept of unified airways disease.Areas covered: The present review summarizes the complex relationship between chronic rhinitis and asthma on the basis of recent epidemiological data, clinical characteristics, diagnosis and therapeutic management. All four groups are discussed with the impact of their specific treatment on asthma outcomes. Some medications are common for chronic rhinitis and asthma while others are more specific but able to treat the associated comorbidity.Expert opinion: The systematic assessment of chronic rhinitis in patients with asthma and its specific treatment improves both disease outcomes. Conversely, several therapies of asthma demonstrated beneficial effects on chronic rhinitis. Treating both diseases at the same time by only one medication is an interesting option to explore in the future in order to limit drugs administration, related costs and side effects.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, France; 9 Rue Du Morvan, Vandoeuvre-lès-Nancy, France.,Development, Adaptation and Disadvantage. Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, - Vandoeuvre-lès-Nancy, France
| | - Plamena Novakova
- ;department of Allergology, Medical University of Sofia, University Hospital "Alexandrovska"; 1, Sofia, Bulgaria
| | - Guidos Guillermo
- Department of Immunology, School of Medicine, Instituto Politecnico Nacional, Gustavo A. Madero, Ciudad De México, CDMX, Mexico
| | - Jaime Correira de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Campus De, Braga, Portugal
| | - Fulvio Braido
- Allergy and Respiratory Diseases Department, University of Genoa, Genova GE, Italy
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18
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Quality of Life and Morbidity after Endoscopic Endonasal Skull Base Surgeries Using the Sinonasal Outcomes Test (SNOT): A Tertiary Hospital Experience. Int J Otolaryngol 2021; 2021:6659221. [PMID: 34104196 PMCID: PMC8159648 DOI: 10.1155/2021/6659221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/28/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Endoscopic endonasal skull base surgery (EESBS) has been associated with a minimally invasive and effective approach for pathology of the anterior skull base and associated with less overall morbidity compared with open approaches. However, it is associated with its own potential morbidity related to surgical manipulation or resection of normal and noninflamed intranasal structures to gain adequate access. The assessment of sinonasal QOL (quality of life) postsurgery is therefore a vital aspect in follow-up of these patients. Objectives To assess quality of life and morbidity after endoscopic endonasal skull base surgery using the Sinonasal Outcomes Test (SNOT-22). Methodology. A single-center retrospective cross-sectional review with a sample of 80-100 patients undergoing endoscopic endonasal transsphenoidal surgery was conducted at the ENT and Neurosurgery departments of King Fahad Specialist Hospital-Dammam (KFSH-D) for a period of 10 years from March 2010 to March 2020. Data were collected through hospital records and database, as well as from patients through phone call interviews. Records were reviewed for diagnosis, demographic features, and 22-item Sinonasal Outcomes Test (SNOT-22) scores noted at three points in time: prior to procedure and after, at 3 months and 6 months. Results Within the study cohort comprising 96 patients, the mean age of the participants was 39.5 ± 12.1 years, and diagnostic typing before and after histopathological investigations revealed maximum pituitary adenomas (46.9%) closely followed by CSF-related ailments (41.7%). The changes in the mean and standard deviation of the total SNOT-22 scores postoperatively at the 3rd month (9.5 ± 5.4) and the 6th month (8.8 ± 5.2) were statistically significant (p < 0.001) when compared to the preoperative score (10.8 ± 5.1). Conclusion Although there was a predicted passivity of symptoms in the post-EESBS period, several significant positive outcomes were seen. The increase in discomfort in the sleep domains postsurgery is an issue to pursue and reason out. The overall SNOT-22 scores noted preoperatively and 3 and 6 months postoperatively showed statistically significant improvements in QOL with no long-term effects.
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19
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Tiotiu A, Novakova P, Baiardini I, Bikov A, Chong-Neto H, de-Sousa JC, Emelyanov A, Heffler E, Fogelbach GG, Kowal K, Labor M, Mihaicuta S, Nedeva D, Novakova S, Steiropoulos P, Ansotegui IJ, Bernstein JA, Boulet LP, Canonica GW, Dubuske L, Nunes C, Ivancevich JC, Santus P, Rosario N, Perazzo T, Braido F. Manifesto on united airways diseases (UAD): an Interasma (global asthma association - GAA) document. J Asthma 2021; 59:639-654. [PMID: 33492196 DOI: 10.1080/02770903.2021.1879130] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The large amount of evidence and the renewed interest in upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). METHODS Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members. RESULTS The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change. UAD refers to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient's health status and requiring an integrated diagnostic and therapeutic plan. The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient's quality of life. CONCLUSIONS Patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and home based continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD. Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, Nancy, France.,EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andras Bikov
- Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Herberto Chong-Neto
- Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil
| | - Jaime Correia- de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University named after I.I.Mechnikov, St-Petersburg, Russia
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Guillermo Guidos Fogelbach
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria.,Instituto Politécnico Nacional, Escuela Nacional de Medicina y Homeopatía, Laboratorio de Bioquímica Estructural, Ciudad de México, México
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | | | - Stefan Mihaicuta
- Pulmonology Department, Cardio Prevent Foundation, University of Medicine and Pharmacy "Dr Victor Babes", Timisoara, Romania
| | - Denislava Nedeva
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Sylvia Novakova
- Allergy Unit of Internal Consulting Department, University Hospital "St. George", Plovdiv, Bulgaria
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section University of Cincinnati, Cincinnati, OH, USA
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Lawrence Dubuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Carlos Nunes
- Centro de ImmunoAlergologia de Algarve, Porto, Portugal
| | - Juan Carlos Ivancevich
- Immunology Department, Faculty of Medicine, del Salvador University, Buenos Aires, Argentina
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences, University of Milan, Division of Respiratory Diseases "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Tommaso Perazzo
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Fulvio Braido
- Department of Internal Medicine, University of Genoa, Genova, Italy.,Respiratory Unit for Continuity of Care IRCCS, Ospedale Policlinico San Martino, Genova, Italy
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20
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Fried J, Yuen E, Li A, Zhang K, Nguyen SA, Gudis DA, Rowan NR, Schlosser RJ. Rhinologic disease and its impact on sleep: a systematic review. Int Forum Allergy Rhinol 2020; 11:1074-1086. [PMID: 33275331 DOI: 10.1002/alr.22740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Rhinologic disease can be responsible for systemic symptoms affecting mood, cognition, and sleep. It is unclear whether sleep disturbance in specific rhinologic disorders (chronic rhinosinusitis [CRS], rhinitis, and nasal septal deviation [NSD]) is an obstructive phenomenon or due to other mechanisms. In this review we examine the impact of CRS, rhinitis, and NSD on objective and subjective sleep outcome metrics and draw comparisons to normal controls and patients with known obstructive sleep apnea (OSA). METHODS A systematic review of 4 databases (PubMed, Scopus, Cochrane Library, and Web of Science) was performed. Studies reporting on objective (apnea-hypopnea index [AHI], respiratory disturbance index [RDI], oxygen nadir) and subjective (Epworth Sleepiness Scale [EpSS], Pittsburgh Sleep Quality Index [PSQI], Fatigue Severity Scale [FSS]) sleep parameters and disease-specific patient-reported outcome measures (PROMs; 22-item Sino-Nasal Outcome Test [SNOT-22], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], Nasal Obstruction Symptom Evaluation [NOSE]) were included. RESULTS The database search yielded 1414 unique articles, of which 103 were included for analysis. Baseline PROMs were at the high end of normal to abnormal for all 3 conditions: EpSS: CRS (9.8 ± 4.0), rhinitis (9.7 ± 4.3), and NSD (8.9 ± 4.6); and PSQI: CRS (11.0 ± 4.5), rhinitis (6.1 ± 3.7), and NSD (8.6 ± 3.5). Objective measures demonstrated a mild to moderate OSA in the studied diseases: AHI: CRS (10.4 ± 11.5), rhinitis (8.6 ± 8.8), and NSD (13.0 ± 6.9). There were significant differences when compared with reported norms in all measured outcomes (p < 0.001). CONCLUSION Sleep quality is impacted by rhinologic (CRS, rhinitis, NSD) disease. There is likely a mild obstructive component contributing to poor sleep, but other contributing factors may be involved.
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Affiliation(s)
- Jacob Fried
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Erick Yuen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Andraia Li
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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21
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Epperson MV, McCann AC, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Unbiased Measure of General Quality of Life in Chronic Rhinosinusitis Reveals Disease Modifiers. Laryngoscope 2020; 131:1206-1211. [PMID: 33006402 DOI: 10.1002/lary.29139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/22/2020] [Accepted: 09/13/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) is associated with a significant decrease in general health-related quality of life (QOL). The EuroQol 5-dimensional questionnaire measures general health-related quality of life through a health utility value (EQ-5D HUV)-based on five domains reflecting mobility, self-care, activities of daily life, pain/discomfort, and anxiety/depression-and an unbiased visual analog scale (EQ-5D VAS). We sought to identify characteristics of CRS patients with a high EQ-5D HUV but low EQ-5D VAS score. MATERIALS AND METHODS Retrospective cross-sectional study of 300 CRS patients with EQ-5D HUV equal to 1.0 (reflecting perfect health). All patients completed a 22-item Sinonasal Outcome Test (SNOT-22)-from which nasal, sleep, ear/facial discomfort, and emotional subdomain scores were calculated, as well as the EQ-5D. Low EQ-5D VAS was defined as a score less than 80. RESULTS On multivariate analysis, low EQ-5D VAS was associated with only the SNOT-22 sleep subdomain score (odds ratio [OR] = 1.07, 95%CI: 1.02-1.12, P = .003). Comorbid asthma was also associated with lower EQ-5D VAS (OR = 2.16, 95%CI: 1.02-4.59, P = .045). In contrast, polyps were negatively associated with having a lower EQ-5D VAS (OR = 0.34, 95%CI: 0.17-0.69, P = .003). CONCLUSION There are patients with perfect general health-related QOL according to a health utility value-based methodology (like the EQ-5D HUV) who report low general health-related QOL on an unbiased measure like the EQ-5D VAS. In CRS patients with perfect EQ-5D HUV, poor sleep and asthma were associated with low QOL on the EQ-5D VAS, while polyps were negatively associated with low QOL. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1206-1211, 2021.
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Affiliation(s)
- Madison V Epperson
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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22
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Stapleton AL, Shaffer AD, Morris A, Li K, Fitch A, Methé BA. The microbiome of pediatric patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 11:31-39. [PMID: 32348024 DOI: 10.1002/alr.22597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to compare the microbiota of pediatric patients with chronic rhinosinusitis (CRS) who are undergoing adenoidectomy to treat their disease with that of healthy control patients. METHODS Patients undergoing adenoidectomy-only for obstructive sleep apnea (n = 50) and CRS (n = 37) were recruited. Preoperative 22-item Sino-Nasal Outcome Test (SNOT-22) or Sinus and Nasal Quality of Life Survey (SN-5) were collected. Each patient had samples collected from their nasopharynx (adenoid bed) and nasal cavity (sinus) at the onset of surgery. 16S ribosomal ribonucleic acid (rRNA) gene sequencing was subsequently performed to obtain per sample taxonomic abundances. Statistical analyses included permutational multivariate analysis of variance (PERMANOVA), alpha (within sample) diversity measures, and changes in taxonomic abundance. RESULTS Moraxella was the most abundant organism. Nasopharyngeal swabs demonstrated higher alpha diversity compared to the nasal cavity. The diversity was not different based on CRS vs obstructive history. There was an increase in diversity with increasing age, and eczema contributed to a greater difference in diversity between the nasopharynx and nasal cavity. Diversity was not affected by adenoid size; however, use of nasal steroids, inhaled steroids, and antihistamines influenced diversity in both the nasopharynx and nasal cavity. Nasopharyngeal samples were higher in relative abundance for Fusobacterium, Prevotella, Porphyromonas, and Campylobacter compared to the nasal cavity. CONCLUSION The nasopharynx and nasal cavity differed in both microbiota composition and diversity. In contrast, no significant difference in composition or diversity were found in CRS vs control patients. Ecological changes in the nasopharyngeal and sinus site may contribute to the etiology for adenoid hypertrophy in both healthy controls and CRS patients.
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Affiliation(s)
- Amanda L Stapleton
- Department of Otolaryngology, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Amber D Shaffer
- Department of Otolaryngology, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Alison Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA
| | - Kelvin Li
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA
| | - Adam Fitch
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA
| | - Barbara A Methé
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA
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23
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Quality of Life Outcomes and Approach-Specific Morbidities in Endoscopic Endonasal Skull Base Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00286-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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24
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Beswick DM, Ayoub NF, Mace JC, Mowery A, Hwang PH, Smith TL. Acute Exacerbations in Recurrent Acute Rhinosinusitis: Differences in Quality of Life and Endoscopy. Laryngoscope 2019; 130:E736-E741. [PMID: 31837149 DOI: 10.1002/lary.28460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Research surrounding outcome differences for patients with recurrent acute rhinosinusitis (RARS) is scarce. This investigation explored quality of life (QOL) and sinonasal attributes in patients during acute episodes (AEs) and in-between AEs of RARS. STUDY DESIGN Retrospective outcomes research. METHODS Data from patients with RARS were collected from two academic institutions between 2009 and 2017 using prospective and retrospective methodology. During clinical presentation, subjects were classified as with or without an AEs using guideline definitions of acute bacterial rhinosinusitis (ABRS). Between-group differences in 22-item Sino-Nasal Outcome Test (SNOT-22) survey and Lund-Kennedy (LK) endoscopy scores were assessed. RESULTS Four hundred twenty-three clinical visits from 202 patients were included. Visits during an AE (168/423, 40%) were associated with significantly worse SNOT-22 total scores compared to between AEs (255/423, 60%; median = 53.0 [interquartile range (IQR) = 24.0] vs. 34.0 [IQR = 29.5]) and all SNOT-22 subdomain scores (all P < .001). LK scores were available for 167 visits, with 56 (34%) completed during an AE. Compared to visits without an AE, endoscopy findings associated with an AE were less frequently normal (LK score = 0, 45% vs. 62%, P = .031) with worse median LK scores (2.0 [IQR = 4.0] vs. 0.0 [IQR = 2.0], P = .005). CONCLUSIONS AEs are associated with significantly worse QOL and mildly worse endoscopic findings. Almost half of visits during AEs had negative endoscopy, identifying a disparity between patient symptoms and objective findings and calling into question alternative or concomitant diagnoses. Diagnostic criteria for ABRS or AEs in RARS do not require objective confirmation of inflammation, presenting a conundrum for clinicians. The potential for overdiagnosis of ABRS and AEs should be considered when determining the risk/benefit ratio of treatments for RARS. LEVEL OF EVIDENCE 2c Laryngoscope, 2019.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology, University of Colorado, Aurora, Colorado
| | - Noel F Ayoub
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Alia Mowery
- School of Medicine, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
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25
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Rawl JW, McQuitty RA, Khan MH, Reichert LK, Kuo YF, Chaaban MR. Comparison of steroid-releasing stents vs nonabsorbable packing as middle meatal spacers. Int Forum Allergy Rhinol 2019; 10:328-333. [PMID: 31742932 DOI: 10.1002/alr.22492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND A randomized controlled trial was held to compare nonabsorbable packs to steroid-eluting absorbable stents as middle meatal spacers after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). METHODS CRS patients were randomly assigned to receive either nonabsorbable Merocel packs wrapped in non-latex glove material (packing type A) or Propel steroid eluting stents (packing type B). Twenty-two-item Sino-Nasal Outcome Test (SNOT-22) scores were collected preoperatively and postoperatively during the initial 4 debridements up to 3 months. Recording of the nasal endoscopy was also collected during all postoperative visits. In addition, Lund-Kennedy scores and middle turbinate lateralization scores, using a new visual analogue scale, were compared between the 2 types of packing. RESULTS Forty CRS patients were prospectively enrolled in this institutional review board (IRB)-approved study. Patients with packing type A had significantly lower middle turbinate lateralization scores at their first (∼10 days) postoperative visit (p = 0.02 and p = 0.04, for left and right sides, respectively). This difference disappeared by later postoperative visits (from 20 days to 3 months). Overall, patients receiving packing type A had significant lower SNOT-22 scores at 20 days postsurgery (p = 0.05). This difference also disappeared at 1 and 3 months postoperation. There were no statistically significant differences in Lund-Kennedy scores. CONCLUSION In this study, nonabsorbable packing materials showed significant superior middle meatal spacing capacities as evidenced by greater middle turbinate medialization capability at the first postoperative visit. Additionally, patients with this type of packing saw improvements in their SNOT-22 scores at the 20-day postoperative visit. This study showed that there was no significant improvement in postoperative outcomes with drug-eluting stents when compared to nonabsorbable packing.
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Affiliation(s)
- Jordan W Rawl
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX
| | - Robert A McQuitty
- University of Texas Medical Branch School of Medicine, Galveston, TX
| | - Mashfee H Khan
- University of Texas Medical Branch School of Medicine, Galveston, TX
| | - Lara K Reichert
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Mohamad R Chaaban
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX
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26
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Yancey KL, Lowery AS, Chandra RK, Chowdhury NI, Turner JH. Advanced age adversely affects chronic rhinosinusitis surgical outcomes. Int Forum Allergy Rhinol 2019; 9:1125-1134. [PMID: 31454179 PMCID: PMC6773466 DOI: 10.1002/alr.22404] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient-specific and disease-specific factors shape the course of chronic rhinosinusitis (CRS) and its response to treatment, with optimal management involving interventions tailored to these factors. Recent evidence suggests CRS inflammatory signatures depend on age. The objective of this study was to determine whether age also influences quality-of-life (QOL) and postoperative outcomes. METHODS Retrospective analysis of prospectively collected QOL data from 403 adults with medically refractory CRS who underwent functional endoscopic sinus surgery (FESS) at a tertiary care medical center between 2014 and 2018 was undertaken. Total and subdomain scores from the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Short Form 8 Health Survey (SF-8) measure of general health completed at preoperative and postoperative visits were reviewed. RESULTS Patients were divided into young (18 to 39 years, n = 100), middle-aged (40 to 59 years, n = 172), and elderly (≥60 years, n = 131) groups. Baseline total SNOT-22 scores differed between groups (p = 0.01), with middle-aged patients having the highest symptom burden and elderly patients having the lowest. Similar patterns were observed for SNOT-22 subdomains. Elderly patients reported smaller improvements and were less likely to achieve a minimally important clinical difference. CRS patients had worse SF-8 scores compared to the general population, and elderly patients were the least likely to match population norms following surgery. Age was an independent predictor of QOL outcomes after FESS. CONCLUSION Age may play a significant role in CRS pathophysiology, symptom burden, and surgical outcomes. Elderly patients report smaller improvements in disease-specific and general health QOL after surgery. CRS management in the elderly population should incorporate age-dependent differences in symptom burden and expectations into treatment algorithms.
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Affiliation(s)
- Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Anne S Lowery
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
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27
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Lauriello M, Di Rubbo V, Sinatti G, Pasqua M, Tucci C, di Marco GP, Necozione S, Eibenstein A. Correlation Between SNOT-22, Nasal Cytology, and Mood Disorders in Patients With Allergic Rhinitis Treated With a Liposomal Nasal Spray. ALLERGY & RHINOLOGY 2019; 10:2152656719866809. [PMID: 31413887 PMCID: PMC6676260 DOI: 10.1177/2152656719866809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with allergic rhinitis (AR) can suffer from mood disorders. The aim of this study was to investigate the clinical effect of a liposomal nasal spray (LN) containing vitamins A and E on the nasal mucosa in patients suffering from AR who had refused any type of anti-allergic treatment. For this purpose, the results of nasal cytology, Visual Analog Scale (VAS), Sino-Nasal Outcome Test-22 (SNOT-22), and Hospital Anxiety and Depression Scale (HADS) test were analyzed. Moreover, we evaluated the relationship between SNOT-22 and nasal cytology and between nasal symptoms and HADS scores. Statistical analysis revealed a significant decrease of scores at T1 in the LN treatment group as concerns VAS, SNOT-22, HADS-Anxiety test and a remarkable reduction of inflammatory cells detected with nasal cytology. Our study showed that higher levels of SNOT-22 corresponded to a higher level of HADS-Anxiety. The mechanisms underlying this relationship in AR patients are currently unknown, but we can suppose that improving mucosal trophism may contribute to the decrease of nasal symptoms and anxiety scores. The improvement of nasal symptoms, as measured by SNOT-22, was significantly correlated with the objective results of nasal cytology. These relationships between SNOT-22 and nasal cytology and between anxiety and cytology were investigated for the first time in our research.
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Affiliation(s)
- Maria Lauriello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Vittoria Di Rubbo
- Specialty School of ENT, University of Rome Tor Vergata, Rome, Italy
| | - Gaia Sinatti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marina Pasqua
- Specialty School of ENT, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Tucci
- Specialty School of ENT, University of Rome Tor Vergata, Rome, Italy
| | | | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Eibenstein
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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28
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Bhenswala PN, Schlosser RJ, Nguyen SA, Munawar S, Rowan NR. Sinonasal quality-of-life outcomes after endoscopic endonasal skull base surgery. Int Forum Allergy Rhinol 2019; 9:1105-1118. [PMID: 31356005 DOI: 10.1002/alr.22398] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND There are substantial gaps in our understanding of the influence of the endoscopic endonasal approach (EEA) for endoscopic skull base surgery on sinonasal-specific quality of life (QOL) as well as the instruments available for assessment. Our primary objective in this study was to characterize postoperative changes in sinonasal QOL, specifically using the 22-item Sino-Nasal Outcome Test (SNOT-22), with a secondary objective of delineating weaknesses in our current understanding of patient symptomatology after EEA for skull base surgery. METHODS A comprehensive literature review was conducted using PubMed, CINAHL, Cochrane Library, and SCOPUS for studies reporting SNOT-22 data pre- and postoperatively in patients who underwent EEA for skull base pathologies. Studies were limited to patients ≥18 years of age and excluded patients diagnosed with chronic rhinosinusitis (CRS). RESULTS Nineteen unique studies with 27 separate data sets and a total of 1025 patients were used in this meta-analysis. Overall SNOT-22 scores statistically improved at the 6-month (p = 0.0009) and 1-year (p = 0.002) time-points. Patients with preoperative SNOT-22 scores ≥20 achieved postoperative improvements at 12-week (p < 0.00001), 6-month (p < 0.0001), 1-year (p < 0.00001), and long-term follow-up (p < 0.0001). Patients with preoperative SNOT-22 scores <20 remained stable and did not worsen postoperatively. CONCLUSION Patients undergoing EEA for skull base pathologies who have impaired sinonasal QOL preoperatively demonstrated significant postoperative QOL improvements. Those patients with relatively normal preoperative sinonasal QOL remained asymptomatic postoperatively. This study supports the need for development of a contemporary disease- and approach-specific, validated QOL instrument for skull base pathologies.
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Affiliation(s)
- Prashant N Bhenswala
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Suqrat Munawar
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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29
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Williams R, Patel V, Chen YF, Tangbumrungtham N, Thamboo A, Most SP, Nayak JV, Liu SYC. The Upper Airway Nasal Complex: Structural Contribution to Persistent Nasal Obstruction. Otolaryngol Head Neck Surg 2019; 161:171-177. [PMID: 30909809 DOI: 10.1177/0194599819838262] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the contribution of the nasal floor and hard palate morphology to nasal obstruction for nonresponders to prior intranasal surgery. STUDY DESIGN Retrospective case-control study. SETTING Tertiary academic center. METHODS Institutional review board-approved, retrospective institutional database analysis was obtained of a cohort of 575 patients who presented with nasal obstruction over a 21-year period. Of the patients, 89 met inclusion criteria: 52 were placed into the experimental group, defined as having persistent nasal obstruction following endoscopic sinus surgery (ESS), septoplasty, nasal valve repair, and/or turbinoplasty using validated subjective questionnaires, and 37 were placed into the control group, defined as having resolution of subjective nasal obstruction. Computed tomography imaging was presented to 3 blinded experts, who measured numerous nasal airway and hard palate morphology parameters, including anterior nasal floor width, anterior maxillary angle, maxilla width, anterior nasal floor width, and palatal vault height. Standard demographic information, comorbidities, perioperative 22-item Sinonasal Outcome Test (SNOT-22), and follow-up time were also assessed. Wilcox rank sum analysis or t test was performed where appropriate. RESULTS Follow-up ranged from 2 to 36 months following surgical intervention. Several skeletal characteristics within the upper airway were significantly associated with persistent nasal obstruction, including acute maxillary angle (P = .035), narrow maxillary width (P = .006), and high arched palate (P = .004). CONCLUSION Persistent nasal obstruction may be seen in patients with narrow, high arched hard palate despite prior nasal surgical intervention and may benefit from additional skeletal remodeling procedures such as maxillary expansion.
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Affiliation(s)
- Ryan Williams
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Vishal Patel
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,2 Department of Head & Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Yu-Feng Chen
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,3 Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Navarat Tangbumrungtham
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,4 Department of Otorhinolaryngology, Ramathibodi Hospital, Bangkok, Thailand
| | - Andrew Thamboo
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,5 Division of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Sam P Most
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jayakar V Nayak
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Stanley Y C Liu
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Fiorita A, Scarano E, Mastrapasqua R, Picciotti PM, Loperfido A, Rizzotto G, Paludetti G. Moderate OSAS and turbinate decongestion: surgical efficacy in improving the quality of life and compliance of CPAP using Epworth score and SNOT-20 score. ACTA ACUST UNITED AC 2019; 38:214-221. [PMID: 29984797 DOI: 10.14639/0392-100x-1935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/24/2018] [Indexed: 11/23/2022]
Abstract
SUMMARY Drug-induced sleep endoscopy (DISE) is an important procedure in diagnostic pathway of patients affected by moderate OSAS. However, the Italian National Health System does not provide any compatible Diagnosis-related-group (DRG) code codification for DISE, which makes it impossible to obtain regional reimbursement. In order to overcome this problem, DISE is usually associated with other codified surgical procedures. The aim of our study is to assess the association of turbinate decongestion (TD) and DISE in order to combine in a single operating session diagnostic and therapeutic procedures. The objective of our work is to assess the role of nasal surgery on symptoms of moderate OSA. Recent studies have confirmed that isolated nasal surgery improves quality of life (QOL), but not the apnoea hypopnoea index (AHI) during polygraph registration. We enrolled 30 patients, aged between 29 and 64 years (mean 50.53 ± 9.20), 26 males and 4 females, with a mean BMI of 26.07 ± 2.81 kg/m2, who were affected by moderate OSAS. All patients underwent otolaryngologycal pre-operative evaluation, home respiratory polygraph and subjective evaluation through Sino-Nasal-Outcome Test (SNOT-20) and Epworth Sleepiness Scale (ESS). During the same surgery session, they underwent DISE and TD. Patients were re-evaluated six months later using the same questionnaires. We observed a significant improvement (p #x003C; 0.05) in both the mean ESS index (6.03 ± 2.75 vs 4.16 ± 4.63) and total SNOT score (22.53 ± 12.16 vs 13.23 ± 10.82). Significant differences (p #x003C; 0.05) were also identified for partial SNOT questions 1-11 (9.1 ± 5.11 vs 6.13 ± 4.12) and 11-20 (13.36 ± 10.20 vs 7.13 ± 9.644). The results of the present study confirm that TD alone can improve sleepiness, QOL and nasal symptoms. Thus, in absence of a National Health System recognition for DISE, the association of this procedure with TD can be useful for diagnostic and therapeutic management of OSAS, improving CPAP compliance and adherence, reducing sleepiness, ameliorating nasal symptoms and therefore QOL.
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Affiliation(s)
- A Fiorita
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
| | - E Scarano
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
| | - R Mastrapasqua
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
| | - P M Picciotti
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
| | - A Loperfido
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
| | - G Rizzotto
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
| | - G Paludetti
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
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Rowan NR, Schlosser RJ, Storck KA, Ganjaei KG, Soler ZM. The impact of medical therapy on cognitive dysfunction in chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:738-745. [DOI: 10.1002/alr.22323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/09/2019] [Accepted: 02/01/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Nicholas R. Rowan
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore MD
| | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
- Department of Surgery; Ralph H. Johnson VA Medical Center; Charleston SC
| | - Kristina A. Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
| | - Kimia G. Ganjaei
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
- Rutgers Robert Wood Johnson Medical School; Piscataway NJ
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
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Wu V, Cusimano MD, Lee JM. Extent of Surgery in Endoscopic Transsphenoidal Skull Base Approaches and the Effects on Sinonasal Morbidity. Am J Rhinol Allergy 2018; 32:52-56. [DOI: 10.2500/ajra.2018.32.4499] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Endoscopic transsphenoidal skull base surgery (ETSS) is now considered the criterion standard approach for resection of pituitary adenomas and other midline anterior skull base lesions. Normal sinonasal structures are resected during ETSS, which raises concerns for nasal morbidity and patient-based outcome. Objective To perform a surgical outcome assessment by examining whether the extent of ETSS approaches affected patient-specific sinonasal quality of life as measured by the 22-item Sino-Nasal Outcome Test (SNOT-22). Methods A single-center prospective cohort study of patients operated on by the same skull base team between 2012 and 2016. Patients with completed pre- and postoperative SNOT-22 were included. The primary outcome was SNOT-22 scores at preoperative, 0–1 month, 2–4 months, >5 months follow-up. Age, sex, tumor pathology, surgical procedure, and intraoperative cerebral spinal fluid leak repair were also obtained. Results Of the 249 ETSS performed, 148 patients (59%) had at least one completed SNOT-22; 45 (18%) met the inclusion criteria. Sinonasal quality of life based on SNOT-22 at the 0–1-month follow-up was significantly worse than the presurgical levels (p < 0.05). However, there was a return of SNOT-22 scores to preoperative levels at 2–4 months (p > 0.05), which was sustained at >5 months (p > 0.05). Factors such as the extent of ETSS, a previous nasal surgery, repair of an intraoperative cerebral spinal fluid leak, and the tumor pathology did not affect SNOT-22 scores at any follow-up intervals (p > 0.05). Conclusion Sinonasal quality of life worsened after ETSS at 0–1 month follow-up but returned to preoperative levels at 2–4 months and remained at postoperative levels >5 months. Analysis of these data will allow us to educate our patients that the anticipated nasal morbidity after ETSS is usually only transient and should be expected to recover to preoperative levels.
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Affiliation(s)
- Vincent Wu
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Michael D. Cusimano
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John M. Lee
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Otolaryngology—Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Ayoub N, Walgama E, Thamboo A, Nayak JV, Hwang PH. Efficacy of endoscopic sinus surgery for chronic rhinosinusitis following primary radiotherapy and concurrent chemotherapy for nasopharyngeal carcinoma. Int Forum Allergy Rhinol 2017; 7:1045-1051. [DOI: 10.1002/alr.22002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/22/2017] [Accepted: 07/26/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Noel Ayoub
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Evan Walgama
- Division of Otolaryngology, Department of General Surgery; Cedars Sinai Medical Center; Los Angeles CA
| | - Andrew Thamboo
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Jayakar V. Nayak
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Peter H. Hwang
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
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Sinonasal quality of life outcomes following laser treatment of epistaxis related to hereditary hemorrhagic telangiectasia. Lasers Med Sci 2017; 32:527-531. [DOI: 10.1007/s10103-017-2144-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
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Levy JM, Mace JC, Rudmik L, Soler ZM, Smith TL. Low 22-item sinonasal outcome test scores in chronic rhinosinusitis: Why do patients seek treatment? Laryngoscope 2016; 127:22-28. [PMID: 27377575 DOI: 10.1002/lary.26157] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/23/2016] [Accepted: 06/01/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patients with chronic rhinosinusitis (CRS) who experience minimal reductions in quality of life (QoL) may present for treatment despite QoL scores comparable to controls without CRS. This study seeks to identify cofactors influencing patients with CRS and low 22-item Sinonasal Outcome Test (SNOT-22) scores to seek care. STUDY DESIGN Prospective, multicenter, observational cohort. METHODS Patients with CRS were enrolled between April 2011 and September 2015. Patients with sinonasal mucocele or unilateral sinus opacification were excluded. Control subjects without CRS were enrolled for comparison. Low-SNOT CRS was defined as a SNOT-22 score < 20. RESULTS A total of 774 subjects (low-SNOT CRS, n = 38; high-SNOT CRS, SNOT-22 ≥ 20, n = 641; controls without CRS, n = 95) were enrolled. Low SNOT scores were identified in 6% of subjects with CRS. After adjustment, low-SNOT CRS and control groups without CRS reported similar baseline average SNOT-22 total scores (P = .879). Unexpectedly, compared to controls, low-SNOT CRS patients had significantly better average psychological (2.1 ± 2.3 vs. 5.8 ± 6.0; P = .030) and sleep dysfunction (2.7 ± 3.4 vs. 6.0 ± 5.2; P = .016) scores. Fourteen of 38 (37%) low-SNOT patients elected to undergo endoscopic sinus surgery (ESS), with a significantly lower likelihood of reporting a minimal clinically important difference (MCID) when compared to high-SNOT patients (43% vs. 82%; P < .001) after a mean follow-up of ∼15 months. CONCLUSIONS Low-SNOT CRS patients represent an outlier population for which measures of QoL fail to identify factors influencing the decision to seek treatment. Low-SNOT CRS patients electing ESS have a decreased likelihood of reporting MCIDs following ESS. Further study is required to identify novel factors associated with treatment-seeking behavior in this population. LEVEL OF EVIDENCE 3B Laryngoscope, 127:22-28, 2017.
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Affiliation(s)
- Joshua M Levy
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
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Erskine S, Hopkins C, Clark A, Anari S, Kumar N, Robertson A, Sunkaraneni S, Wilson J, Carrie S, Kara N, Ray J, Smith R, Philpott C. SNOT-22 in a control population. Clin Otolaryngol 2016; 42:81-85. [DOI: 10.1111/coa.12667] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/27/2022]
Affiliation(s)
- S.E. Erskine
- Norwich Medical School; University of East Anglia; Norwich UK
- ENT Department; James Paget University Hospital NHS Foundation Trust; Great Yarmouth UK
| | - C. Hopkins
- ENT Department; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - A. Clark
- Norwich Medical School; University of East Anglia; Norwich UK
| | - S. Anari
- ENT Department; Heart of England NHS Foundation Trust; Birmingham UK
| | - N. Kumar
- Otolaryngology, Head & Neck Surg; ENT Department; Writington, Wigan and Lee NHS Foundation Trust; Wigan UK
| | - A. Robertson
- ENT Department; Southern General Hospital; Glasgow UK
| | - S. Sunkaraneni
- ENT Department; Royal Surrey County Hospital; Guildford UK
| | - J.A. Wilson
- Otolaryngology, Head & Neck Surgery; Institute of Health & Society; Newcastle University; Newcastle upon Tyne UK
| | - S. Carrie
- ENT Department; Freeman Hospital; Newcastle upon Tyne UK
| | - N. Kara
- ENT Department; Royal Hallamshire Hospital; Sheffield UK
| | - J. Ray
- ENT Department; Darlington Memorial Hospitals NHS Foundation Trust; Darlington UK
| | - R. Smith
- Norwich Medical School; UEA; Norwich UK
| | - C.M. Philpott
- Norwich Medical School; University of East Anglia; Norwich UK
- ENT Department; James Paget University Hospital NHS Foundation Trust; Great Yarmouth UK
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