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Yuan Y, Wu Z, Chen X, Xie B. Rheumatoid Arthritis Exacerbates Eosinophilic Inflammation Contributing to Postoperative Recurrence in Chronic Rhinosinusitis with Nasal Polyps. J Asthma Allergy 2024; 17:901-910. [PMID: 39323972 PMCID: PMC11423822 DOI: 10.2147/jaa.s484402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 09/18/2024] [Indexed: 09/27/2024] Open
Abstract
Objective To assess the impact of rheumatoid arthritis (RA) on histopathological features and the risk of postoperative recurrence in chronic rhinosinusitis with nasal polyps (CRSwNP) patients. Methods A retrospective cohort study of CRSwNP patients who underwent functional endoscopic sinus surgery was performed. Patients were followed up for more than two years, and classified into RA and Non-RA groups, recurrent and non-recurrent groups. The influence of RA on histopathological features and the risk of CRSwNP recurrence was explored. Results A total of 517 CRSwNP patients were finally recruited, including 78 RA patients. The RA group exhibited a higher recurrence rate, tissue eosinophil counts and percentages compared to the non-RA group (P < 0.05). Tissue eosinophil count and percentage, and the prevalence of allergic rhinitis were significantly higher in the recurrent group in compared to the non-recurrent group (P < 0.05). Multivariate logistic regression analysis identified tissue eosinophil count and percentage, RA, and allergic rhinitis as significant predictors of increased recurrence risk (P < 0.05). Both adjusted and unadjusted models affirmed RA as an independent risk factor for CRSwNP postoperative recurrence (P < 0.05). Kaplan-Meier curves further indicated a higher recurrence risk in CRSwNP patients with RA than those without (P < 0.05). Conclusion Our findings suggest that RA significantly exacerbates tissue eosinophilic inflammation and independently heightens the risk of postoperative recurrence in CRSwNP patients. These insights underscore the need for tailored therapeutic strategies addressing the complex interplay between CRSwNP and RA to mitigate recurrence risks and improve clinical outcomes.
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Affiliation(s)
- Yuan Yuan
- Department of Pathology, Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Ze Wu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Xu Chen
- Pathology Center, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of China
| | - Bin Xie
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
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Rodriguez-Van Strahlen C, Arancibia C, Calvo-Henriquez C, Mullol J, Alobid I. Systematic Review of Long Term Sinonasal Outcomes in CRSwNP after Endoscopic Sinus Surgery: A call for Unified and Standardized Criteria and Terms. Curr Allergy Asthma Rep 2024; 24:443-456. [PMID: 38913122 PMCID: PMC11297087 DOI: 10.1007/s11882-024-01154-w] [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] [Accepted: 05/28/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW To present current evidence in long-term (> 5 years) results after endoscopic sinus surgery (ESS) focusing on Patients Reported Outcome Measures (PROMs) and other sinonasal outcomes while assessing the role of ESS in the treatment of CRSwNP, and identifying outcomes which affect the results of ESS and defining recommendations for future studies. RECENT FINDINGS Long-term results of ESS in CRSwNP can be branched in PROMs and other objective measurements. Despite the heterogeneity of reported outcomes make it difficult to perform comparisons and meta-analysis, ESS improves PROMs, including symptoms, QOL and olfaction. Objectives outcomes such as NPS, LMS, type of surgery, or recurrence and revision surgery don't have a clear role in long-term results. Clustering patients suggest asthma, N-ERD, allergy, eosinophil count and IL-5 could have a role in predicting recurrence and severe disease. Long-term studies of CRSwNP treated with ESS are scarce. There is a significant need to standardize the report of results. The use of tools as SNOT-22, NPS, validated smell tests, defined criteria for disease recurrence and control and ESS extension in a unified systematic way could allow better comparisons between treatments in the new era of biologics.
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Affiliation(s)
- Camilo Rodriguez-Van Strahlen
- Rhinology and Skull Base Unit, Department of Oto rhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain.
- Universitat de Barcelona, Barcelona, Spain.
| | - Claudio Arancibia
- Rhinology and Skull Base Unit, Department of Oto rhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Christian Calvo-Henriquez
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Joaquim Mullol
- Rhinology and Skull Base Unit, Department of Oto rhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Oto rhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
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Ickrath P, Hackenberg S, Müller-Diesing F. [Modern management of chronic rhinosinusitis]. Dtsch Med Wochenschr 2024; 149:757-763. [PMID: 38863144 DOI: 10.1055/a-2161-1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Chronic rhinosinusitis is a common disease. Due to the significant reduction of the quality of life, possible serious complications and economic consequences, a sufficient therapy is essential. With the entry of biologics into the treatment of chronic rhinosinusitis, relevant innovations have emerged in recent years. This article is aimed at providing an up-to-date overview of the conservative and surgical treatment options for chronic rhinosinusitis.
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Tashman K, Adams D, Vickery TW, Holbrook EH, Gray ST, Bleier BS, Scangas G, Metson R. Five-year EuroQol 5-Dimension Outcomes After Endoscopic Sinus Surgery. Laryngoscope 2024; 134:2592-2601. [PMID: 38126531 DOI: 10.1002/lary.31206] [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: 04/27/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The EuroQol 5-Dimension (EQ-5D) is a general health survey that is quick to administer, widely used, and directly convertible to health utility values (HUV). We aim to describe the five-year EQ-5D outcomes among patients who undergo surgical treatment for chronic rhinosinusitis (CRS). STUDY DESIGN Prospective observational cohort study. METHODS Patients with CRS completed the EQ-5D questionnaire preoperatively and annually for five years following endoscopic sinus surgery. Paired t-tests and McNemar's tests were used to compare preoperative and postoperative scores. Mixed-effects modeling was used for multivariate analysis. RESULTS Among 1296 patients enrolled in our study, 812 (74.7%) completed the postoperative survey at one year and 336 (38.9%) completed it at five years. There was a significant and sustained reduction of patients reporting pain/discomfort (74.9% vs. 58.0%, p < 0.001) and anxiety/depression (49.6% vs. 38.1%, p = 0.01) out to five years. Frequency of problems reported in the usual activity domain decreased at one year and was sustained through year four (30.6% vs 19.7%, p = 0.003). After multivariable modeling, female gender (p = 0.02), prior sinus surgery (p = 0.01), tobacco use (p = 0.038), headaches (p = 0.013), allergies (p = 0.001), diabetes (p = 0.022), hypertension (p = 0.036), higher preoperative SNOT-22 score (p < 0.001), and a lower preoperative Lund-Mackay score (p < 0.001) were associated with significantly worse EQ-5D HUV over time. Similarly, a worse EQ-5D Visual Analog Scale (VAS) over time was associated with allergies (p = 0.03), diabetes (p < 0.001), hypertension (p = 0.04), higher preoperative SNOT-22 score (p < 0.001), and prior sinus surgery (p < 0.001). CONCLUSION Patients with chronic rhinosinusitis experience significant sustained improvements in health-related quality of life up to five years after ESS as measured by the EQ-5D instrument. LEVEL OF EVIDENCE Level 2 Laryngoscope, 134:2592-2601, 2024.
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Affiliation(s)
- Katherine Tashman
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Dara Adams
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Thad W Vickery
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eric H Holbrook
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - George Scangas
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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Hackenberg S, Renson A, Röseler SM, Baumann I, Topcuoglu MSY, Hebestreit H. Pädiatrische Rhinologie. Laryngorhinootologie 2024; 103:S188-S213. [PMID: 38697148 DOI: 10.1055/a-2178-2957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The following review article highlights key topics in pediatric rhinology that are currently the focus in research and at conferences as well as in the interdisciplinary discussion between otorhinolaryngologists and pediatricians. In particular, congenital malformations such as choanal atresia or nasal dermoid cysts are discussed, followed by statements on the current procedures for sinogenic orbital complications as well as on the diagnosis and therapy of chronic rhinosinusitis in children. Furthermore, updates on the role of the ENT specialist in the care for children with cystic fibrosis and primary ciliary dyskinesia are provided.
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Affiliation(s)
- Stephan Hackenberg
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Würzburg
| | - Ariane Renson
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik RWTH Aachen
| | - Stefani Maria Röseler
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik RWTH Aachen
| | - Ingo Baumann
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum Heidelberg
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Liu Z, Yao Y, Xie H, Zhou A, Fan Y, Liu J, Jiao Q. Visual and bibliometric analysis of chronic rhinosinusitis and nasal polyps. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100211. [PMID: 38419685 PMCID: PMC10899047 DOI: 10.1016/j.jacig.2024.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 03/02/2024]
Abstract
Background Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by persistent sinonasal inflammation and sinus microbiome dysbiosis. Nasal polyps (NPs) are one of the main manifestations that cause diverse clinical symptoms of CRS. Objective We sought to conduct a bibliometric and visual analysis of articles on CRS and NPs published between 2003 and 2022 to provide researchers with the current state of research and potential directions. Methods We searched relevant articles from 2003 to 2022 in the Web of Science database. VOSviewer and the Bibliometrix R package were used to perform the bibliometric analysis. Results A total of 3907 publications were retrieved. The United States made the highest contributions to global research, followed by China. Northwestern University had the most publications. The most published author was C. Bachert, followed by R. P. Schleimer and R. J. Schlosser. The authors with the most co-citations were C. Bachert, W. J. Fokkens, and P. Gevaert. Moreover, the journal with the most publications was the International Forum of Allergy & Rhinology, and the Journal of Allergy and Clinical Immunology was the most cited. "Covid-19," "biologics," and "type 2 inflammation" were the top current research hotspots. Conclusions The United States and Northwestern University were the leading country and institution in researching CRS and NPs. C. Bachert was the most influential expert. The International Forum of Allergy & Rhinology and the Journal of Allergy and Clinical Immunology were leading journals. "Covid-19," "biologics," and "type 2 inflammation" were the trending topics.
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Affiliation(s)
- Zhichen Liu
- Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuxu Yao
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Huanxia Xie
- Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Aina Zhou
- Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhui Fan
- Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jisheng Liu
- Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qingqing Jiao
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Mu A, Ni Z, Ma C. Nasal Irrigation Improves the Nasal Related Quality of Life in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma. Biol Res Nurs 2024; 26:293-302. [PMID: 38079151 DOI: 10.1177/10998004231221548] [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] [Indexed: 03/16/2024]
Abstract
Background: After transsphenoidal pituitary adenoma resection patients have reduced olfactory function and quality of life. This study aimed to evaluate the effects of nasal irrigation on the nasal related quality of life in patients undergoing transsphenoidal pituitary adenoma resection. Methods: Patients undergoing transsphenoidal resection of pituitary adenomas in a tertiary hospital in China were included. The patients were randomly divided into a control group and nasal irrigation group according to the random sequence generated by the SPSS22.0 software. The 22-item sino-nasal outcome test (SNOT-22) was used to evaluate nasal related quality of life; lower SNOT-22 scores indicate a higher quality of life. The Toyota and Takagi (T&T) olfactometer test was used to evaluate the olfactory function of patients. Results: A total of 82 patients were finally included. The SNOT-22 scores of both groups after surgery were significantly higher than those before surgery (p < .05). The total SNOT-22 score of nasal irrigation group at one month (23.45 ± 3.72 vs. 27.48 ± 4.07) and three months (15.83 ± 2.86 vs. 21.82 ± 3.36) after surgery was lower than that in the control group (p < .05). There was no significant difference in olfactory function between the two groups at one month and three months after surgery (p > .05). The nasal mucosal score in the nasal irrigation group was significantly improved compared with the control group at one month and three months after surgery (p < .05). Conclusion: Nasal irrigation is associated with improved quality of life in patients undergoing transsphenoidal pituitary adenoma resection compared with the control group.
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Affiliation(s)
- Aiping Mu
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhuojun Ni
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chen Ma
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
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Misirovs R, Chan R, Lipworth B. 5-Item sino-nasal outcome test and 22-item sino-nasal outcome test relationship with endoscopic and radiologic scores in chronic rhinosinusitis with nasal polyps. Ann Allergy Asthma Immunol 2024; 132:363-367. [PMID: 37984707 DOI: 10.1016/j.anai.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The 22-item sino-nasal outcome test (SNOT-22) is a frequently used patient-recorded outcome measure in patients with chronic rhinosinusitis with nasal polyps (CRSwNPs). Objective findings of nasal polyps and paranasal sinus inflammation are frequently graded using nasal polyp score (NPS) and Lund-Mackay Score (LMS), respectively. OBJECTIVE To evaluate a novel, abbreviated, rhinology-focused, five-domain SNOT-5 questionnaire because we had anecdotally noticed a relative disconnect between SNOT-22 and endoscopy and imaging scores. METHODS We performed a retrospective, cross-sectional, single-center review of patients with CRSwNPs who had filled out a SNOT-22, along with post hoc-derived SNOT-5 scores, which were then assessed in relation to NPS and LMS. RESULTS A total of 129 patients were included in the analysis. SNOT-5 but not SNOT-22 scores significantly correlated vs either NPS (P < .005) and LMS (P < .001), whereas only SNOT-5 differed significantly when comparing the cohort's lowest and highest tertiles for mean LMS: 11.8 vs 16.8 (95% CI, 1.5-8.4; P < .01) and for mean NPS 12.4 vs 15.6 (95% CI, 0.5-5.9; P < .05). CONCLUSION In a retrospective, real-life cohort study of CRSwNP, there was a relative disconnect between the significant association of SNOT-5 but not SNOT-22 in relation to objective endoscopy and imaging measures. We, therefore, propose that further prospective intervention studies are indicated in CRSwNP to evaluate the SNOT-5 score including establishing the minimal clinically important difference.
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Affiliation(s)
- Rasads Misirovs
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom; Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
| | - Rory Chan
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom
| | - Brian Lipworth
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom.
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Tam B, Collet C, Le J, Badash I, Garcia E, Wrobel B, Rice D, Hur K. Association of ethnicity and time to surgery among patients with chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2023; 8:1442-1448. [PMID: 38130267 PMCID: PMC10731491 DOI: 10.1002/lio2.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/07/2023] [Accepted: 09/18/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Determine factors associated with delayed endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Methods This is a retrospective cohort study conducted at a tertiary care academic center. Patients were included in the study if they were at least 18 years old and underwent surgery for CRS. Electronic medical records were retrospectively reviewed to collect demographic and clinical data. Patients with CRS secondary to another pathology such as malignancy were excluded. Multiple linear regression was performed to determine factors associated with the number of days between a patient's preoperative consultation and the date of surgery. Results A total of 103 patients with a mean age of 46.6 ± 16.8 years were included in the analysis; 51.5% of patients were females, 46.6% identified as White, and 29.1% identified as Hispanic. The majority of patients (67.0%) had preferred provider organization health insurance; 43.7% of patients had nasal polyps, 70.9% had a deviated nasal septum, and the mean preoperative Sinonasal Outcomes Test-22 (SNOT-22) score was 41.0 ± 23.8. The mean time to surgery after the final preoperative visit was 71.7 days ± 65.6 days. Hispanic ethnicity was associated with increased time to surgery (p < .05) when controlling for other variables. No other variables were associated with time to surgery on multivariate analysis. Conclusion Hispanic ethnicity may be an independent predictor of increased time to sinus surgery independent of disease severity and other demographic variables. Level of Evidence 2b.
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Affiliation(s)
- Benjamin Tam
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Casey Collet
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jessica Le
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Ido Badash
- Caruso Department of Otolaryngology–Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Erick Garcia
- Caruso Department of Otolaryngology–Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Bozena Wrobel
- Caruso Department of Otolaryngology–Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Dale Rice
- Caruso Department of Otolaryngology–Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kevin Hur
- Caruso Department of Otolaryngology–Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
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Adams DR, Xu LJ, Vickery TW, Scangas GA, Bleier BS, Gray ST, Metson R. The Impact of Gender on Long-Term Quality of Life After Sinus Surgery for Chronic Rhinosinusitis. Laryngoscope 2023; 133:3319-3326. [PMID: 37114661 DOI: 10.1002/lary.30719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To identify the impact of gender on the clinical outcomes of endoscopic sinus surgery (ESS) through the comparison of quality of life measures in female and male patients who undergo surgical treatment for chronic rhinosinusitis (CRS). STUDY DESIGN Prospective observational cohort study. METHODS Patients with CRS completed the 22-item Sino-Nasal Outcome Test (SNOT-22) and EuroQol 5-Dimension Survey (EQ-5D) preoperatively and annually for 5 years following ESS. Health utility values (HUV) were calculated from EQ-5D scores. Comparisons of cohort characteristics were performed with chi-square and t-tests. A multivariable linear mixed effects model evaluated changes in SNOT-22 and HUV over time by gender. RESULTS Among the 1268 patients (54% female) enrolled, 789 and 343 completed postoperative surveys at one and 5 years, respectively. Preoperatively, females experienced more severe symptoms: mean SNOT-22 score (51.1 ± 20.9 female vs. 44.7 ± 20.0 male, p < 0.001) and HUV (0.80 ± 0.14 female vs. 0.84 ± 0.11 male, p < 0.001). These gender differences were resolved by year one postoperatively (SNOT-22: p = 0.083; HUV: p = 0.465). Two years after surgery, however, females reported more severe symptoms (SNOT-22: 25.6 ± 20.7 female vs. 21.5 ± 17.4 male, p = 0.005; HUV: 0.88 ± 0.12 female vs. 0.90 ± 0.11 male, p = 0.018), a difference that persisted at year five. These gender-related differences remained after adjusting for age, race, ethnicity, nasal polyps, history of prior ESS, and smoking status (p < 0.001). Within-subject improvement was comparable between genders (SNOT-22: p = 0.869; HUV: p = 0.611). CONCLUSION Females with CRS reported more severe symptoms both before and 5 years after surgery compared to their male counterparts. Understanding the mechanism behind these gender-related differences is important for optimizing CRS treatment. LEVEL OF EVIDENCE 2 Laryngoscope, 133:3319-3326, 2023.
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Affiliation(s)
- Dara R Adams
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lucy J Xu
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Thad W Vickery
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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Fu Y, Liu D, Huang W, Wang Z, Zhang Y. A Systematic Review and Meta-analysis of SNOT-22 Outcomes After Sinus Surgery. EAR, NOSE & THROAT JOURNAL 2023:1455613231187761. [PMID: 37606061 DOI: 10.1177/01455613231187761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Background: All stakeholders in the healthcare system have prioritized and will continue to prioritize enhancing care quality. The measurement of sinus-specific quality of life (QOL) is potentially the most commonly used QOL parameter for chronic rhinosinusitis (CRS). Objective: A systematic review and meta-analysis were used in this study to determine the mean change in patients' scores on the 22-item Sino-Nasal Outcome Test (SNOT-22) before and after endoscopic sinus surgery (ESS) for CRS. Methods: PubMed, Google Scholar, and ScienceDirect were searched for articles that compared SNOT-22 scores before and after ESS in adult patients with CRS and were published between January 2000 and March 2023. The mean post-op change, 95% confidence interval (CI), forest plot, and inverse variance weighting were all generated using a random effects model. A mixed-effects meta-regression was used to analyze the effect of patient-specific characteristics across studies. Results: Fifteen prospective patient cohorts published from 2009 to 2023 were included in this meta-analysis. At an average follow-up of 25.5 months, all studies demonstrated a statistically significant difference in mean SNOT-22 scores between baseline and post-op time periods (P < .05), ranging from 5.1 to 55.4. Across all studies, the mean SNOT-22 changed significantly by 26.02 (95% CI: 12.83-38.60). According to a stepwise multivariate analysis, studies with higher mean age and mean pre-op SNOT-22 scores had greater changes in SNOT-22 scores following ESS, whereas trials with longer mean follow-up duration had smaller changes in SNOT-22 scores. Conclusion: Research utilizing the SNOT-22 instrument has demonstrated that endoscopic sinus surgery (ESS) leads to enhanced quality of life (QOL) outcomes. The literature reports that improvement is influenced by the initial SNOT-22 score, the mean age of the patients, and the duration of the follow-up period.
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Affiliation(s)
- Yangyang Fu
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
| | - Delong Liu
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
| | - Weipeng Huang
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
| | - Zhengying Wang
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
| | - Yue Zhang
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
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Abdul Latiff AH, Husain S, Abdullah B, Suppiah P, Tan V, Ing Ping T, Woo K, Yap YY, Bachert C, J Schunemann H, Bedbrook A, Czarlewski W, Bousquet J. ARIA Care Pathways 2019: Next-Generation Allergic Rhinitis Care and Allergen Immunotherapy in Malaysia. J Pers Med 2023; 13:jpm13050835. [PMID: 37241005 DOI: 10.3390/jpm13050835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
An increase in the prevalence of allergic rhinitis (AR) worldwide presents a significant burden to the health care system. An initiative was started in Europe designated as Allergic Rhinitis and Its Impact on Asthma (ARIA) to develop internationally applicable guidelines by utilising an evidence-based approach to address this crucial issue. The efforts are directed at empowerment of patients for self-management, the use of digital mobile technology to complement and personalise treatment, and establishment of real-life integrated care pathways (ICPs). This guideline includes aspects of patients' and health care providers' management and covers the main areas of treatment for AR. The model provides better real-life health care than the previous traditional models. This review summarises the ARIA next-generation guideline in the context of the Malaysian health care system.
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Affiliation(s)
- Amir Hamzah Abdul Latiff
- Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Jalan Bukit Pantai, Taman Bukit Pantai, Kuala Lumpur 59100, Malaysia
| | - Salina Husain
- Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Palaniappan Suppiah
- Otorhinolaryngology, Gleneagles Hospital Penang, 1, Jalan Pangkor, George Town 10050, Malaysia
| | - Vincent Tan
- Otorhinolaryngology, KPJ Klang Specialist Hospital, Persiaran Rajawali, Bandar Baru Klang, Klang 41150, Malaysia
| | - Tang Ing Ping
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine & Health Sciences, University Malaysia Sarawak, Kota Samarahan 94300, Malaysia
| | - Kent Woo
- Allergy & Immunology Clinic, Gleneagles Hospital Kuala Lumpur, Jalan Ampang, Kampung Berembang, Kuala Lumpur 50450, Malaysia
| | - Yoke-Yeow Yap
- Otorhinolaryngology, KPJ Johor Specialist Hospital, 39B Jalan Abdul Samad, Johor Bahru 80100, Malaysia
| | - Claus Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Münster, 48149 Münster, Germany
- International Airway Research Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
- Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, 9000 Ghent, Belgium
| | - Holger J Schunemann
- Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | | | - Wienczyslawa Czarlewski
- ARIA & MASK-air, 34090 Montpellier, France
- Medical Consulting Czarlewski, 92300 Levallois, France
| | - Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, 12203 Berlin, Germany
- University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
- Inserm Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
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Walters ZA, Phillips KM, Previtera MJ, Gray ST, Sedaghat AR. Minimal Radiographic Mucosal Thickness or Opacification Criterion for Sinus-Specific Endoscopic Sinus Surgery for Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2023. [PMID: 36807128 DOI: 10.1002/ohn.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Primary chronic rhinosinusitis (CRS) is typically a diffuse process and the extent of endoscopic sinus surgery (ESS) performed for medically recalcitrant CRS is impacted by many factors. However, some third-party payors have implemented policies to authorize coverage for ESS in a sinus-by-sinus manner based on a minimal measurement of millimeters of mucosal thickening or sinus opacification in the corresponding sinus that is being surgically addressed. Our objective was to determine whether such policies are based on scientific evidence that in patients with medically recalcitrant CRS, a minimum measurement of mucosal thickening or sinus opacification is a predictor of CRS in that sinus or improved outcomes after ESS on a sinus-by-sinus basis. DATA SOURCES Medline, Embase, Scopus, and Web of Science databases, from inception through May 2022. REVIEW METHODS A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS We identified 6070 abstracts which were screened and from which 112 studies ultimately underwent a full-text review. From these studies, we found that none investigated (or provided evidence of) whether any minimal degree of radiographic mucosal thickening or sinus opacification predicted CRS or better outcomes after ESS in a sinus-specific manner. CONCLUSION We were unable to find evidence supporting a minimum millimeter measurement of mucosal thickening or sinus opacification as predictors of CRS or better post-ESS outcomes in a sinus-specific manner in patients with medically recalcitrant CRS. The extent of ESS for CRS should be determined through personalized medical decision-making that considers all patient-specific factors.
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Affiliation(s)
- Zoe A Walters
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Melissa J Previtera
- Health Sciences Library, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Musleh A, Al-Zomia AS, Shahrani IM, Alshehri A, Alwadie A, Alqhtani F, Deajim M, Aljohani S. Olfactory Change Pattern After Endoscopic Sinus Surgery in Chronic Rhinosinusitis Patients. Cureus 2022; 14:e24597. [PMID: 35651459 PMCID: PMC9138177 DOI: 10.7759/cureus.24597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Chronic rhinosinusitis (CRS) is a chronic inflammation of the sinonasal mucosa that is clinically associated with sinus pressure, nasal congestion, rhinorrhea, and a decreased sense of smell that lasts more than 12 weeks. Endoscopic sinus surgery (ESS) for medically refractory CRS is mainly undergone to improve sinus function and access to topical medicinal treatments. However, olfactory changes after ESS can be unpredictable. Aim The current study aimed to assess olfactory change patterns after endoscopic sinus surgery in patients with chronic rhinosinusitis. Methods A record-based retrospective study was conducted in Aseer Central Hospital (ACH) ear, nose, and throat outpatient (ENT OPD) department and Khamis Mushayt General Hospital from August 15, 2021, to December 15, 2021. Data were collected using pre-structured data extraction sheet to avoid errors. Data extracted and collected included patients' biodemographic data, CRS-associated symptoms, and endoscopic surgery-related data, including duration since surgery, presurgical medications, and duration of surgery. Also, postsurgical complications were extracted, especially olfactory complications. Results A total of 168 patients with chronic rhinosinusitis (CRS) and who had undergone endoscopic sinus surgery in the Aseer region were included. Patient ages ranged from 10 to 61 years, with a mean age of 39.8 ± 12.4 years old. Regarding the associated symptoms and complaints of the study patients, 110 (65.5%) complained of sinusitis, and 86 (51.2%) had allergic RS. The postsurgical complications of patients with CRS who had undergone endoscopic sinus surgery were olfactory dysfunction (OD) in 32 (19%), no complications in 115 (68.55%), and other nonspecific complications, such as headache, drowsiness, nose dryness, and bleeding, in 21 (12.55%). Also, 71 (42.3%) reported that they hardly perceive the fragrance in perfumeries. Conclusion In conclusion, olfactory impairment is a frequent clinical presentation in patients with CRS. In this study, olfactory dysfunction was improved, except among nearly one out of each five patients after ESS. Olfactory dysfunction was more among patients who had undergone recent surgery and those with chronic rhinosinusitis with nasal polyps (CRSwNP). Also, among patients who reported no complications, olfactory function did not return to normal in most patients as they hardly perceive fragrance.
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Affiliation(s)
- Abdullah Musleh
- Otolaryngology - Head and Neck Surgery, King Khalid University Hospital, Khamis Mushait, SAU
| | | | | | | | - Awad Alwadie
- Medicine and Surgery, King Khalid University, Abha, SAU
| | | | - Mosab Deajim
- Medicine and Surgery, King Khalid University, Abha, SAU
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