Health utility values for patients with recurrent acute rhinosinusitis undergoing endoscopic sinus surgery: a nested case control study

Impact of recurrent acute rhinosinusitis on quality of life

KEY POINTS

Quality of life (QoL) in patients with recurrent acute rhinosinusitis (RARS) is understudied. QoL for RARS patients is similar to chronic rhinosinusitis patients, although objective disease severity is lower. QoL of RARS patients is similarly affected during active and inactive infection.

Endoscopic sinus surgery (ESS) to change quality of life for adults with recurrent rhinosinusitis: study protocol for a randomized controlled trial

BACKGROUND

Endoscopic sinus surgery (ESS) has been used for decades to treat recurrent acute rhinosinusitis episodes (RARS) in adults. RARS results in infectious symptoms, antibiotic courses, sick leaves, and impaired quality of life. Theoretically, the ESS procedure, through improving the drainage of the paranasal sinuses, decreases the symptoms and enhances the quality of life of the RARS patients. Whether this is true has not been reported in a randomized trial yet.

METHODS

We conduct a single-center, non-blinded, randomized, 6-month, parallel group superiority clinical study including 80 adult participants referred to surgical treatment for RARS. The participants will either have ESS or conservative medical treatment (control group). The primary outcome will be the difference between the mean disease-specific Sinonasal Outcome Test 22 (quality of life questionnaire) change scores (from baseline to 6 months) of ESS and control group.

DISCUSSION

This study will add significant new information to the effect and harms of ESS procedure in the treatment of adults with RARS.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04241016 . Registered on 17 January 2020.

Relationship Between Physical Function and Health Utility in Patients Undergoing Surgical Treatment for Malignant Pleural Mesothelioma

PURPOSE

Health utility, which is a measure of patient-reported outcome (PRO), has recently been used in health-related quality of life for patients with various cancers. However, the relationship between health utility and the physical function and of patients undergoing pleurectomy/decortication (P/D) as surgical treatment for malignant pleural mesothelioma (MPM) has not been reported in the perioperative and convalescent phases. This study aimed to evaluate the perioperative and postoperative health utility of patients undergoing P/D for MPM at one year postoperatively and to examine the relationship with physical function.

METHODS

We included patients underwent P/D. Grip strength, knee extension strength, 6-minute walk distance (6MWD), forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) were measured to assess physical function, and the Short-Form Six-Dimension (SF-6D) was completed to assess health utility. These assessments were performed preoperatively, postoperatively, and one year postoperatively. Statistical analysis was performed using one-way analysis of variance for comparison of pre and postoperative and one year mean values.

RESULTS

There were 24 subjects (23 males, 65.5±8.3 year). SF-6D, 6MWD, FVC, and FEV1 values one year operatively improved significantly compared with postoperative. Additionally, SF-6D was correlated with 6MWD.

CONCLUSION

Health utility were also correlated with exercise capacity.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

I.

EXECUTIVE SUMMARY

BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document.

METHODS

ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary.

RESULTS

ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided.

CONCLUSION

This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

Diagnostic Criteria of Recurrent Acute Rhinosinusitis: A Systematic Review

BACKGROUND

RARS is a challenging clinical phenomenon that affects many patients, and diagnostic criteria for this condition are not fully characterized in the literature.

OBJECTIVE

To examine diagnostic criteria for recurrent acute rhinosinusitis (RARS).

STUDY DESIGN

Systematic review.

METHODS

Cochrane, PubMed (MEDLINE), clinicaltrials.gov, EMBASE, Google Scholar, and Web of Science databases were queried for articles related to RARS dating from 1990 to present, according to PRISMA statement guidelines. Full text articles pertinent to the diagnostic criteria of RARS were included in this review. Inclusion criteria included articles specifically addressing RARS; studies with 3 or more patients; and articles in English.

RESULTS

A total of 1022 titles/abstracts potentially related to RARS were identified. Of these, sixty-nine full texts were selected for review, and 22 of these ultimately met inclusion criteria. The level of evidence was generally low. Studies and guidelines have used many different definitions for RARS diagnosis over the years based on symptomatology, physical examination, nasal endoscopy, imaging, and laboratory domains. Clinically important RARS has been defined most commonly as 4 or more discrete episodes of ARS per year, but this frequency is typically based on expert opinion. Additionally, radiologic anatomic associations such as concha bullosa, accessory maxillary os, and narrowed infundibular distance may be associated with RARS. Endoscopic visualization and imaging are sometimes used to confirm the presence of sinus disease during exacerbations of RARS, but there is variability in this practice.

CONCLUSION

The diagnostic definition for RARS has developed over time and is currently based on low level 4 and 5 evidence. Because of the migratory definition of RARS, comparing inter-study results of RARS management remains difficult, and future studies should aim to follow current expert guidelines on diagnostic criteria of RARS.

Management strategies for recurrent acute rhinosinusitis

Background

Management of patients with recurrent acute rhinosinusitis (RARS) is often challenging, and robust data in the literature is scant. The aim of this study is to better characterize the current treatment strategies for RARS used by otolaryngologists.

Methods

An online survey sent to all members of the American Rhinologic Society in a 1 month period evaluated demographics, practice characteristics, and management strategies for patients with RARS, subdivided into those with (RARSwD) and without (RARSsD) septal deviation. Eighty-eight practicing members responded, of whom 41% were fellowship-trained rhinologists.

Results

For most cases of RARSsD, 61% of otolaryngologists would primarily use medical management. Most would wait until patients had experienced 4-5 episodes to perform balloon sinuplasty (80%) or formal sinus surgery (79%). The sinus surgery procedure of choice was limited sinus surgery (62%). For RARSwD, 52% primarily chose medical management. Most would wait until patients had experienced 4-5 episodes to perform balloon sinuplasty (80%) or formal sinus surgery (78%). Nearly all fellowship-trained rhinologists (97%) would perform limited sinus surgery with septoplasty for RARSwD, compared to only 70% of other otolaryngologists who would do so and 24% who would perform complete sinus surgery with septoplasty. While 89% of practitioners in private practice would wait to perform balloon sinuplasty until patients had experienced 4-5 episodes, only 68% of those in academia would wait this long and 23% would do so after only 1-3 episodes.

Conclusions

Treatment of patients with RARS is complex, and the differences in strategies employed between groups of otolaryngologists may reflect their training backgrounds and different patient populations.

Level of Evidence

V.

Quality of Life Gain After Septorhinoplasty: An Analysis of Health Utility and Cost Utility Values Associated with Septorhinoplasty

PURPOSE

Septorhinoplasty is a common procedure performed in rhinology and facial plastic surgery. Despite this, the health benefits associated with the procedure remain controversial. In this study, a health utility assessment of patients undergoing septorhinoplasty was performed. Health gains associated with the procedure, and the cost at which they were acquired, were also determined.

METHODS

Sixty-seven patients undergoing septorhinoplasty at a German tertiary-level hospital were included in the study. Study participants completed the Short Form 36 (SF-36) and satisfaction questionnaires before and 12 months after septorhinoplasty. The Short Form six-dimensional (SF-6D) instrument was used to acquire quality-adjusted life year (QALY) values from SF-36 responses, thus allowing estimation of pre- and post-operative health utilities. Health utility gains after septorhinoplasty were determined and combined with cost data to estimate cost per QALY gained.

RESULTS

Patients undergoing septorhinoplasty reported mean pre-operative health utility values of 0.70 pre-operatively and 0.74 post-operatively resulting in health gains of 0.04 QALYs. Patients satisfied with their procedures had significant health utility gains, while dissatisfied patients did not experience any significant gains. The cost of septorhinoplasty to statutory health insurance was €3487.69. When compared to the baseline, the incremental utility ratio for septorhinoplasty was €94,797.30 per QALY gained.

CONCLUSIONS

This study successfully estimated the health utilities and gains associated with septorhinoplasty. The findings indicate that the procedure has associated health gains but at a high cost-utility ratio. These values provide a reference point for further much-needed economic evaluations.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Appropriateness Criteria for Surgery in the Management of Adult Recurrent Acute Rhinosinusitis

OBJECTIVES/HYPOTHESIS

Endoscopic sinus surgery (ESS) is frequently performed for recurrent acute rhinosinusitis (RARS). Appropriate indications for surgery among patients with RARS have not yet been rigorously determined. The objective of this study was to define appropriateness criteria for ESS in the management of adult RARS.

STUDY DESIGN

Application of RAND-UCLA appropriateness methodology.

METHODS

A panel of nine multidisciplinary experts in RARS was formed to evaluate RARS scenarios generated from current evidence. The panel completed two rounds of a modified Delphi-ranking process and a teleconference.

RESULTS

A total of 32 clinical scenarios were ranked in each round. For adult patients with RARS, ESS can appropriately be offered as a treatment option when patients experience ≥ four annual episodes, and there is confirmation of at least one episode via computed tomography or nasal endoscopy, and the patient and clinician jointly participate in shared decision making, and the patient has either failed a trial of topical nasal steroids or experienced RARS-related productivity loss.

CONCLUSIONS

This study has defined appropriateness criteria for ESS as a management option for adult patients with RARS. These criteria are intended to represent a minimum threshold for which ESS should be considered in the treatment of RARS and do not suggest that all patients who meet these criteria should undergo surgery. These criteria may serve as a baseline set of indications for ESS in patients with RARS.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:37-44, 2019.