Psychometric evaluation of the SinoNasal Outcome Test-16 for quality of life in chronic rhinosinusitis with nasal polyps

Surgery for chronic rhinosinusitis with nasal polyps: An update

This update aimed to evaluate surgical indications in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). It was conducted and reported according to the criteria stipulated by the Synthesis Without Meta-analysis (SwiM) guidelines. From the PubMed-National Library of Medicine database, 1098 articles were identified for the period 2006-2021 using the key words "nasal polyps" and "surgery". After screening and analysis, 39 publications were selected. The efficacy of surgery on functional improvement in CRSwNP, measured by the specific quality-of-life score SNOT-22, is established, and improvement in olfactory function is expected in 50% of patients. The rate of surgical revision is at least 10-15% at 4 years, but the disease can be controlled for several years, with the interval between primary surgery and symptomatic recurrence exceeding 10 years in some cases. The criteria for surgery are not clearly defined in the literature. However, several authors consider failure of ≥ 8 weeks' well-conducted local medical treatment and use of more than 2 courses of systemic corticosteroids as a reliable indication. No studies or meta-analyses are currently available to determine the superiority of one surgical technique over another.

Surgical and instrumental options for chronic rhinitis: A systematic review and PRISMA meta-analysis

BACKGROUND

There is no consensus on the role of surgery in the treatment of chronic rhinitis (CR). Should it be considered when nasal symptoms are not controlled by medical treatment? Various targets (turbinates and secretory nerves) and techniques (surgical, laser, cryotherapy, radiofrequency and phototherapy) have been reported, but benefit varies between reports. The aim of this systematic review and meta-analysis was to evaluate results of surgical and instrumental procedures in CR care.

METHODS

Two systematic reviews of the US National Library of Medicine, Cochrane Library, Web of Science and Embase databases were conducted in October 15, 2021 (registration numbers CRD42021284257 and CRD42021295227). A database watch was performed until submission of the manuscript. The review focuses on total nasal symptom score (TNSS) and quality of life (QoL) after treatment. All controlled studies reporting nasal surgery/instrumental procedures in adult patients with CR were included.

RESULTS

The database search yielded a total of 5628 articles; after eligibility screening, 2091 patients were included from 21 studies. QoL results favored surgery/instrumental procedures over medical treatment (SMD -1.27; 95% CI [-2.38; -0.16]; I2=97%), as did TNSS (SMD -1.40; 95% CI [-2.30; -0.50]; I2=98%). The small number of studies and their heterogeneity did not allow meta-regression to be performed.

CONCLUSION

This systematic review supports the use of surgical/instrumental procedures to improve nasal symptom score and QoL of adult patients with CR poorly controlled by medical treatment.

French health insurance data for chronic rhinosinusitis with nasal polyps between 2011 and 2018: A STROBE-compliant analysis

AIMS

The main aim of the present study was to report the annual volume of surgeries performed for chronic rhinosinusitis with nasal polyps (CRSwNP) in France, based on health insurance data. The secondary objectives were to describe the different characteristics of the surgeries and their complications, and to estimate the number of patients eligible for biotherapy.

MATERIAL AND METHODS

This was a descriptive observational retrospective study using data from French national health insurance databases for the period 2011-2018. Inclusion criteria comprised all hospital stays with procedures related to CRSwNP according to the French Common Classification of Medical Acts and consistent with French practices.

RESULTS

Ninety-two thousand one hundred and fourty one patients (92,141) for 92,884 admissions for CRSwNP surgery were analyzed, providing an accurate representation of CRSwNP surgery in France between 2011 and 2018. The revision surgery rate for patients operated on in 2011 was 13.0% (1,457/11,212), corresponding to an average annual rate of 1.86% over 7 years. In the 11,750 sinus surgery admissions in 2018, the complications rate was only 0.65% (77/11,750).

CONCLUSION

Sinus surgery is safe (0.65% complications) and reliable (estimated revision rate, 5.5%: 5,078/92,884). This study provides the first evaluation of the target population for biotherapy in France.

Validity and Reliability Study of Bahasa Malaysia Version of Sino-Nasal Outcome Test 22 in Chronic Rhinosinusitis Patient

Background

Chronic rhinosinusitis (CRS) affects 14% of the general population. The Sino-Nasal Outcome Test 22 (SNOT-22) is a reliable instrument assessing the impact of CRS. This study aimed to examine the reliability and construct validity of the translated Bahasa Malaysia version of SNOT-22.

Methods

This cross-sectional study was conducted in the Otorhinolaryngology clinic in Universiti Sains Malaysia (USM). Seventy CRS respondents and 39 healthy participants were included. The Bahasa Malaysia translated SNOT-22 (bmSNOT-22) was produced using rigorous forward and backward translation. Statistical analyses used included feasibility, Cronbach's alpha, intraclass correlation coefficient, Pearson's correlation coefficient and factor analysis.

Results

The feasibility was 97.2% in the initial test and 100% in the retest. The Cronbach's alpha was 0.89 in the initial test. The average intraclass correlation coefficient (ICC) was 0.90, indicating good test-retest reliability. The bmSNOT-22 discriminated between the control group and patients (t = 15.33; P < 0.001).

Conclusion

The bmSNOT-22 is reliable, and validity established therefore recommended for Malaysia's clinicians and researchers as a measurement tool for the outcome in sino-nasal disorders such as rhinosinusitis and nasal polyps.

Rhinoplasty: French validation of the MiRa scale

AIMS

The aim of this study was to translate the MiRa scale into French and validate its use for French-speaking surgeons.

MATERIAL AND METHODS

ISPOR and WHO recommendations were used to carry out the translation process from English to French in five steps. The MiRa scale is a validated analysis scale of nasal dysmorphoses. Few tools are available in French for French-speaking surgeons. ISPOR and WHO recommendations were used to complete the five-step translation process from English into French. To assess the reliability of the MiRa scale-French version, we statistically compared intra-observer repeatability (comparison of scores obtained when one observer assessed each patient twice at a one-month interval) and inter-observer repeatability (comparison of scores obtained when 2 observers assessed the same patient) using the Wilcoxon test and the intraclass correlation coefficient (ICC) (α=5%).

OBJECTIVES

Our goal was to obtain a translation of the idea or concept rather than a literal translation to enable good intra- and inter-observer repeatability.

RESULTS

Each step allowed us to make changes gradually working towards a conceptual translation equivalent to the original version.

CONCLUSION

The MiRa scale is the only aesthetic analysis scale validated in the literature for nasal dysmorphoses. The combined use of two sets of translation recommendations, with a five-step translation-back-translation process, made it possible to obtain a French version perfectly in line with the original. This version is usable by French-speakers.

French validation of the FACE-Q Rhinoplasty module

OBJECTIVES

The aim of this study was to translate the FACE-Q "Rhinoplasty" module into French and validate its use for the French-speaking population.

DESIGN

"Satisfaction with the nose" and "Satisfaction with nostrils" questionnaires were used and translated.

SETTINGS

We were granted permission to use the FACE-Q rhinoplasty module by the development team. These two questionnaires constitute the rhinoplasty module of the FACE-Q questionnaire. ISPOR and WHO recommendations were used to complete the translation process from English into French in six steps.

MAIN OUTCOME MEASUREMENT

Our goal was to obtain, not a literal translation, but rather a translation of the idea or concept.

RESULTS

Each step allowed us to make changes to achieve a conceptual translation equivalent to the original version.

CONCLUSION

The FACE-Q questionnaire is a reference in the field of cosmetic surgery outcome evaluation. The use of two validated translation recommendations, with a six-step translation-back translation process, leads to a French version corresponding to the original. This version is usable in a French-speaking population.

Immune profile modulation of blood and mucosal eosinophils in nasal polyposis with concomitant asthma

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is frequently associated with asthma. Mucosal eosinophil (EO) infiltrate has been found to correlate with asthma and disease severity but not necessarily in every patient. Other multifactorial immune processes are required to determine disease endotypes and response to treatment.

OBJECTIVE

To evaluate EO immunomodulation for migration and survival in accordance with inflammatory protein profiles and asthmatic status in CRSwNP.

METHODS

Ninety-three patients (47 with asthma) with CRSwNP were included. Each patient was staged clinically according to symptom severity and polyp size. Nasal secretions were collected to establish a cytokine profile. The EOs were purified from blood samples and nasal polyps to delineate specific immunophenotypes by flow cytometry and determine in vitro EO survival in relation to asthmatic status.

RESULTS

The CRSwNP in patients with asthma was characterized by eosinophilia and a high level of interleukin (IL)-5 in nasal secretions. Although EOs exhibited activation profiles after mucosal migration, there was relative down-expression of IL-5 receptor-α (IL-5Rα) on nasal EOs in patients with asthma. The EO culture with IL-5 and IL-9 showed an antiapoptotic effect in patients with asthma through IL-5Rα modulation.

CONCLUSION

Mucosal eosinophilia seems to be induced by EO nasal trapping through modulation of adhesion receptors. In patients with asthma, EO involvement is enhanced by the antiapoptotic synergistic action of T-helper cell type 2 cytokines on IL-5Rα expression. This study shows for the first time that IL-9 is involved in EO homeostasis in CRSwNP and could explain the low benefit of anti-IL-5 therapy for some patients with asthma and nasal polyposis.

Chronic rhinosinusitis assessment using the Adelaide Disease Severity Score

AIM

This study aimed to validate the use of the Adelaide Disease Severity Score for the assessment of chronic rhinosinusitis.

STUDY DESIGN

A prospective cohort study supplying level 2b evidence.

METHODS

Forty-eight patients, scheduled for endoscopic sinus surgery for failed management of chronic rhinosinusitis, completed the Sino-Nasal Outcome Test 22 and the Adelaide Disease Severity Score tool (the latter assessing symptoms (i.e. nasal obstruction, rhinorrhoea, post-nasal drip, headache or facial pain, and olfaction) and quality of life). Lund-Mackay computed tomography scores and Lund-Kennedy endoscopic scores were also recorded. The Adelaide Disease Severity Score results were then compared with those of the other three tools to assess correlation.

RESULTS

Mean scores (95 per cent confidence intervals) were 22.31 (21.47-24.15) for the Adelaide Disease Severity Score and 30.6 (27.15-34.05) for the Sino-Nasal Outcome Test 22; there was a statistically significant correlation (Spearman coefficient = 0.45; p = 0.0015). A statistically significant correlation was also noted with the Lund-Mackay score (p = 0.04) and with the Lund-Kennedy score (p = 0.03).

CONCLUSION

The Adelaide Disease Severity Score is a simple, valid tool for clinical assessment of chronic rhinosinusitis, which correlates well with the Sino-Nasal Outcome Test 22, Lund-Mackay and Lund-Kennedy tools.

French Validation of the NOSE and RhinoQOL Questionnaires in the Management of Nasal Obstruction

Objective. Until now, there has been no validated and specific questionnaire in French allowing the assessment of nasal obstruction and its consequences on quality of life. The aim of this study was to validate the French translation and sociocultural adaptation of the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinosinusitis Quality of Life Survey (RhinoQOL) self-questionnaires.

Study Design. Prospective instrument validation study.

Setting. French tertiary referral center.

Subjects and Methods. The questionnaires were translated into French and then translated back into English. The final version was administered twice to an asymptomatic control population (n = 50) and once to a population with symptomatic septal deviation (n = 50). The psychometric properties (reliability, reproducibility, validity, responsiveness) were assessed by test-retest procedure, internal consistency, correlation intra- and interscores, and response sensitivity between both populations.

Results. There was no statistical difference in both responses obtained from the control population after the test-retest procedure. Internal consistency was 0.86 for the NOSE and 0.57, 0.67, and 0.83 for the scores of the RhinoQOL (frequency, bothersomeness, and impact, respectively). There was always a strong correlation between all NOSE variables and RhinoQOL scores ( r > 0.40; P < 10−3). Effect size showed a high sensitivity to change.

Conclusion. The French versions of both questionnaires appear to be as reliable, valid, and sensitive to change as the English versions. Their association was strong, allowing assessment of nasal obstruction in all its dimensions.