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Demir M, Tunakan Dalgic C, Mete Gokmen EN, Savas R, Eroglu S, Ozden G, Orcen C, Pacaci Cetin G, Arslan B, Bilgir F, Bulut G, Akcam NY, Ozgul S, Cerci P, Coskun R, Gode S, Yilmaz I, Sin AZ. The Effectiveness of Biological Agents on Chronic Rhinosinusitis with Nasal Polyposis in Patients with Comorbid Asthma: A Multicenter Real-Life Study from Türkiye. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:448. [PMID: 38541174 PMCID: PMC10972277 DOI: 10.3390/medicina60030448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024]
Abstract
Background and Objectives: Real-life data on the efficacy of biologic agents (BAs) on asthma-comorbid CRSwNP are needed. Our primary goal is to investigate the effects of BAs on CRSwNP symptoms, as well as endoscopic and tomography scores. Our secondary goal is to show a reduction in the frequency of acute sinusitis exacerbations and the need for surgery. Materials and Methods: We conducted a multicenter, retrospective, real-life study. We screened the patients with asthma-comorbid CRSwNP treated with omalizumab or mepolizumab. A total of 69 patients (40 F/29 M; omalizumab n = 55, mepolizumab n = 14) were enrolled. We compared the visual analog scale (VAS), sinonasal outcome test-22 (SNOT-22), nasal congestion score (NCS), Lund-Mackay computed tomography score (LMS), and total endoscopic polyp scores (TPS) before and after BAs. We evaluated the endoscopic sinus surgery (ESS) and acute exacerbations of chronic rhinosinusitis (AECRS) frequencies separately, according to the BAs. Results: The overall median (min-max) age was 43 (21-69) years. The median (min-max) of biologic therapy duration was 35 (4-113) months for omalizumab and 13.5 (6-32) for mepolizumab. Significant improvements were seen in VAS, SNOT-22, and NCS with omalizumab and mepolizumab. A significant decrease was observed in TPS with omalizumab [95% CI: 0-4] (p < 0.001), but not with mepolizumab [95% CI: -0.5-2] (p = 0.335). The frequency of ESS and AECRS were significantly reduced with omalizumab [95% CI: 2-3] (p < 0.001) and [95% CI: 2-5] (p < 0.001); and mepolizumab [95% CI: 0-2] (p = 0.002) and [95% CI: 2-8.5] (p < 0.001), respectively. There was no significant difference in LMS with either of the BAs. Conclusions: Omalizumab and mepolizumab can provide a significant improvement in the sinonasal symptom scores. BAs are promising agents for CRSwNP patients with frequent exacerbations and multiple surgeries.
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Affiliation(s)
- Meryem Demir
- Division of Allergy and Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir 35100, Türkiye; (M.D.); (C.T.D.); (E.N.M.G.)
| | - Ceyda Tunakan Dalgic
- Division of Allergy and Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir 35100, Türkiye; (M.D.); (C.T.D.); (E.N.M.G.)
| | - Emine Nihal Mete Gokmen
- Division of Allergy and Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir 35100, Türkiye; (M.D.); (C.T.D.); (E.N.M.G.)
| | - Recep Savas
- Department of Radiology, Ege University Faculty of Medicine, Izmir 35100, Türkiye;
| | - Suleyman Eroglu
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, Izmir 35100, Türkiye; (S.E.); (S.G.)
| | - Guzin Ozden
- Division of Allergy and Immunology, Department of Internal Medicine, Adana City Hospital, Adana 01230, Türkiye;
| | - Cihan Orcen
- Division of Allergy and Immunology, University of Health Sciences, Derince Training and Research Hospital, Kocaeli 41900, Türkiye;
| | - Gulden Pacaci Cetin
- Division of Allergy and Immunology, Erciyes University Faculty of Medicine, Kayseri 38039, Türkiye; (G.P.C.); (B.A.); (I.Y.)
| | - Bahar Arslan
- Division of Allergy and Immunology, Erciyes University Faculty of Medicine, Kayseri 38039, Türkiye; (G.P.C.); (B.A.); (I.Y.)
| | - Ferda Bilgir
- Department of Allergy and Immunology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir 35360, Türkiye;
| | - Gokten Bulut
- Division of Allergy and Immunology, Ataturk City Hospital, Balikesir 10100, Türkiye;
| | - Nurullah Yekta Akcam
- Division of Allergy and Immunology, Mersin City Hospital, Mersin 33230, Türkiye;
| | - Semiha Ozgul
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir 35100, Türkiye;
| | - Pamir Cerci
- Division of Allergy and Immunology, Eskisehir City Hospital, Eskisehir 26080, Türkiye;
| | - Raif Coskun
- Division of Allergy and Immunology, Cemil Tascioglu City Hospital, Istanbul 34384, Türkiye;
| | - Sercan Gode
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, Izmir 35100, Türkiye; (S.E.); (S.G.)
| | - Insu Yilmaz
- Division of Allergy and Immunology, Erciyes University Faculty of Medicine, Kayseri 38039, Türkiye; (G.P.C.); (B.A.); (I.Y.)
| | - Aytul Zerrin Sin
- Division of Allergy and Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir 35100, Türkiye; (M.D.); (C.T.D.); (E.N.M.G.)
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Houdu J, Jankowski R, Renkes R, Nguyen-Thi PL, Gallet P, Nguyen DT. Minimal clinically important differences on the DyNaChron questionnaire after surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:261-266. [PMID: 37838601 DOI: 10.1016/j.anorl.2023.10.010] [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: 10/16/2023]
Abstract
OBJECTIVES To determine minimal clinically important differences (MCIDs) for the DyNaChron chronic rhinosinusitis quality-of-life questionnaire. INTRODUCTION MCIDs are the smallest changes in a quality-of-life score that are of clinical relevance for the patient. They allow treatment benefit to be estimated. MCIDs have not previously been determined for DyNaChron. MATERIAL AND METHODS A single-center retrospective study analyzed DyNaChron questionnaires filled out between June 2016 and December 2021 by all patients consulting for chronic nasal dysfunction. Five hundred and thirteen of the 2390 patients were operated on for nasal polyposis (NP; n=282) or septo(rhino)plasty+inferior turbinoplasty (SPIT; n=231). Standard error of measurement was used to determine MCIDs. RESULTS MCID for DyNaChron global score was 60 in NP and 58 in SPIT. MCIDs per symptom domain in NP and SPIT respectively were: 15 and 13 for nasal obstruction, 21 and 21 for anterior rhinorrhea, 20 and 19 for posterior rhinorrhea, and 17 and 17 for olfaction. In agreement with global MCID, 257 NPs (91%) and 149 SPITs (65%) showed clinical improvement. CONCLUSION MCID helps assess response to treatment. In the DyNaChron questionnaire, MCIDs enable global and symptom-specific assessment of chronic nasal dysfunction and its impact on quality of life in a single patient or in groups.
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Affiliation(s)
- J Houdu
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - R Jankowski
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - R Renkes
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - P-L Nguyen-Thi
- Unité d'évaluation médicale, unité de méthodologie, data management et statistique - UMDS, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - P Gallet
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - D-T Nguyen
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Campion NJ, Brugger J, Tu A, Stanek V, Brkic FF, Bartosik TJ, Liu DT, Hoehl BS, Gangl K, Eckl-Dorna J, Schneider S. The "real life" efficacy of dupilumab is independent of initial polyp size and concomitant steroids in CRSwNP. J Otolaryngol Head Neck Surg 2023; 52:56. [PMID: 37674253 PMCID: PMC10481502 DOI: 10.1186/s40463-023-00663-4] [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: 12/24/2022] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Dupilumab significantly improves symptom control in chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with large polyps at the initiation of treatment (total polyp score (TPS) ≥ 5) have been the focus in published studies. Patients with significant burden of disease but small polyps (TPS ≤ 4) have not yet been evaluated for clinical response. This study set out to evaluate the benefit of dupilumab treatment on cohorts of small (TPS ≤ 4) compared to large polyps (TPS ≥ 5). Furthermore, benefit of concomitant oral and/or nasal steroid therapy has been evaluated. METHODS 97 patients with CRSwNP, who were begun on dupilumab between January 2020 and October 2021, were included. All patients were followed-up for 6 months. At each visit they underwent nasal endoscopy, smell identification tests and filled out validated patient questionnaires. RESULTS Significant drops in TPS were seen in both patient groups after 6 months of therapy, dropping from a median score of 3 to 0 and from 6 to 2 in patients with small and large polyps respectively. Furthermore, a linear mixed model calculated a drop of 22% and 24% in TPS per month in patients with small and large polyps respectively with no significant difference in rate of decline. Finally the model showed that neither oral nor nasal steroids influenced the rate of response to dupilumab therapy. CONCLUSIONS Polyp size at the initiation of dupilumab therapy and whether patients continue to take steroid therapy does not appear to influence effectiveness of dupilumab treatment.
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Affiliation(s)
- Nicholas J Campion
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Aldine Tu
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Victoria Stanek
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Faris F Brkic
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Tina J Bartosik
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - David T Liu
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bruna S Hoehl
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Gangl
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Eckl-Dorna
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Sven Schneider
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Ding J, Yue C, Wang C, Liu W, Zhang L, Chen B, Shen S, Piao Y, Zhang L. Machine learning method for the cellular phenotyping of nasal polyps from multicentre tissue scans. Expert Rev Clin Immunol 2023; 19:1023-1028. [PMID: 37099717 DOI: 10.1080/1744666x.2023.2207824] [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: 01/04/2023] [Accepted: 04/24/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND This study aimed to establish a convenient and accurate chronic rhinosinusitis evaluation platform CRSAI 1.0 according to four phenotypes of nasal polyps. RESEARCH DESIGN AND METHODS Tissue sections of a training (n = 54) and test cohort (n = 13) were sourced from the Tongren Hospital, and those for a validation cohort (n = 55) from external hospitals. Redundant tissues were automatically removed by the semantic segmentation algorithm of Unet++ with Efficientnet-B4 as backbone. After independent analysis by two pathologists, four types of inflammatory cells were detected and used to train the CRSAI 1.0. Dataset from Tongren Hospital were used for training and testing, and validation tests used the multicentre dataset. RESULTS The mean average precision (mAP) in the training and test cohorts for tissue eosinophil%, neutrophil%, lymphocyte%, and plasma cell% was 0.924, 0.743, 0.854, 0.911 and 0.94, 0.74, 0.839, and 0.881, respectively. The mAP in the validation dataset was consistent with that of the test cohort. The four phenotypes of nasal polyps varied significantly according to the occurrence of asthma or recurrence. CONCLUSIONS CRSAI 1.0 can accurately identify various types of inflammatory cells in CRSwNP from multicentre data, which could enable rapid diagnosis and personalized treatment.
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Affiliation(s)
- Jing Ding
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Head and Neck Molecular Pathological Diagnosis, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Changli Yue
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Head and Neck Molecular Pathological Diagnosis, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Department of Center for Translational Medicine, Keymed Biosciences Inc, Chengdu, Sichuan, China
| | - Libo Zhang
- Department of Center for Translational Medicine, Keymed Biosciences Inc, Chengdu, Sichuan, China
| | - Bo Chen
- Department of Center for Translational Medicine, Keymed Biosciences Inc, Chengdu, Sichuan, China
| | - Shen Shen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yingshi Piao
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Head and Neck Molecular Pathological Diagnosis, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Fokkens WJ, Mullol J, Kennedy D, Philpott C, Seccia V, Kern RC, Coste A, Sousa AR, Howarth PH, Benson VS, Mayer B, Yancey SW, Chan R, Gane SB. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): In-depth sinus surgery analysis. Allergy 2023; 78:812-821. [PMID: 35822924 DOI: 10.1111/all.15434] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) often require repeat sinus surgery. Mepolizumab reduced the need for sinus surgery in the SYNAPSE trial; this analysis sought to provide a more in-depth assessment of surgery endpoints in SYNAPSE. METHODS SYNAPSE was a double-blind Phase III trial (NCT03085797) in adults with recurrent, refractory, severe, CRSwNP eligible for repeat sinus surgery despite standard of care treatments and previous surgery. Patients were randomized (1:1) to mepolizumab 100 mg subcutaneously or placebo, plus standard of care, every 4 weeks for 52 weeks. Time to first inclusion on a waiting list for sinus surgery and time to first actual sinus surgery (both up to week 52) were assessed; the latter endpoint was also analyzed post hoc according to time since last sinus surgery before study screening and baseline blood eosinophil count. RESULTS Among 407 patients (mepolizumab: 206; placebo: 201), mepolizumab versus placebo reduced the risk of being included on a waiting list for sinus surgery (week 52 Kaplan-Meier probability estimate [95% confidence interval]: 13.9% [9.8%, 19.5%] vs. 28.5% [22.7%, 35.4%]). Mepolizumab versus placebo reduced the risk of sinus surgery irrespective of time (<3 vs ≥3 years) since patients' last sinus surgery prior to study screening (hazard ratios [95% confidence intervals] 0.28 [0.09, 0.84] and 0.50 [0.26, 0.98], respectively) and baseline blood eosinophil count. CONCLUSIONS Mepolizumab reduced the risk of further sinus surgery in patients with recurrent, refractory, severe CRSwNP, irrespective of the patient baseline characteristics assessed.
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Affiliation(s)
- Wytske J Fokkens
- Department of Otolaryngology, University of Amsterdam, Amsterdam, Netherlands
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - David Kennedy
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carl Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Waveney Ear Nose and Throat Service, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Veronica Seccia
- ENT Unit, Department of Neuroscience, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Robert C Kern
- Department of Medicine and Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - André Coste
- Service d'ORL et de Chirurgie Cervico-faciale Centre, Hospitalier Intercommunal de Creteil, et APHP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Universite Paris-Est Creteil, Creteil, France
| | - Ana R Sousa
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Peter H Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK.,Global Respiratory Franchise, GSK House, Brentford, Middlesex, UK
| | - Victoria S Benson
- Epidemiology, Value Evidence and Outcomes, GSK House, Brentford, Middlesex, UK
| | - Bhabita Mayer
- Clinical Statistics, GSK House, Brentford, Middlesex, UK
| | - Steve W Yancey
- Respiratory Medical Franchise, GSK, Research Triangle Park, North Carolina, USA
| | - Robert Chan
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Simon B Gane
- Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Ear Institute, University College London, London, UK
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Mitchell MB, Workman AD, Lee SE. Clinically meaningful changes in efficacy outcomes in chronic rhinosinusitis with nasal polyposis. Curr Opin Allergy Clin Immunol 2023; 23:9-13. [PMID: 36539378 DOI: 10.1097/aci.0000000000000874] [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: 12/24/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis with nasal polyps (CRSwNP) carries a high disease burden, and many studies have been done investigating the efficacy of various medical and surgical therapies. However, outcome metrics have varied across these studies, making it difficult to compare therapeutic efficacy on a large scale. In this article, we discuss various outcome metrics used across prior studies as well as the relationship between these measures. RECENT FINDINGS Outcome metrics in CRSwNP studies include both clinically assessed and patient-reported outcome measures (PROMs). The former includes olfaction testing, scoring systems based on imaging and endoscopic evaluation, and histopathological and immunohistochemical evaluation of sinus tissue, and the latter includes quality-of-life instruments, symptom severity scales, and disease-control instruments. Recent studies evaluating the efficacy of new biologics have used a combination of both types of metrics. SUMMARY Both clinical metrics and patient-reported outcomes provide utility in evaluating disease severity and control in patients with CRSwNP, although there are nuances when comparing therapies in this population as patients with CRSwNP are heterogeneous and may have symptoms across several domains. However, PROMs in conjunction with clinical metrics provide useful information to assess patient symptoms and response to interventions.
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Affiliation(s)
- Margaret B Mitchell
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alan D Workman
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stella E Lee
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Lee SE, Farzal Z, Kimple AJ, Moreno-Luna R, Senior BA, Thorp BD, Ebert CS. Availability of Readable Online Spanish Rhinosinusitis Outcome Measures. J Clin Med 2022; 11:jcm11247364. [PMID: 36555979 PMCID: PMC9782990 DOI: 10.3390/jcm11247364] [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: 10/31/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are useful instruments that give providers insight into patients' experiences with disease by quantifying the symptoms that matter most to patients. Results of these questionnaires can help guide management in chronic rhinosinusitis. However, these tools are often developed for native English speakers, which disadvantages others, who already have a language barrier to care. The aim of this study is to evaluate accessibility and readability of Spanish PROMs used to evaluate rhinosinusitis. METHODS Three Spanish readability measures, Gilliam, Peña & Mountain; SOL; and Fernandez-Huerta were used to evaluate PROMs utilized for rhinosinusitis. PROMs with sixth-grade readability level or easier were considered to meet health literacy recommendations. RESULTS Four Spanish PROMs utilized in assessment of rhinosinusitis were identified and evaluated. Cuestionario Español de Calidad de Vida en Rinitis (ESPRINT-15) was the most readable PROM and met readability recommendations in two of three measures. Nasal Obstruction Symptom Evaluation met suggested levels in one measure. The remainder of readability scores were more difficult than recommended. CONCLUSION PROMs are powerful clinical tools that help patients communicate their symptoms and self-advocate. For providers to gain accurate and useful information, these measures should be written at appropriate readability levels. Most Spanish PROMs used for assessment of rhinosinusitis were above recommended readability. Development of future PROMs should ensure appropriate readability levels to provide good patient-centered care for our primarily Spanish speaking patients.
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Affiliation(s)
- Saangyoung E. Lee
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Zainab Farzal
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Adam J. Kimple
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Ramón Moreno-Luna
- Unidad de Rinología y Base de Cráneo, UGC de Otorrinolaringología, Hospital Universitario Virgen de la Macarena, 41009 Sevilla, Spain
| | - Brent A. Senior
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brian D. Thorp
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Charles S. Ebert
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence:
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Verma P, Rawat DS, Aseri Y, Verma PC, Singh BK. A prospective longitudinal study of clinical outcome and quality of life assessment in patients with chronic rhinosinusitis after functional endoscopic sinus surgery using sino nasal outcome test-22. Indian J Otolaryngol Head Neck Surg 2022; 74:792-799. [PMID: 36452849 PMCID: PMC9702441 DOI: 10.1007/s12070-020-01847-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 03/30/2020] [Indexed: 11/28/2022] Open
Abstract
Chronic rhinosinusitis (CRS) significantly affect the quality of life (QoL) of patients. The study was conducted in CRS patients who were treated with functional endoscopic sinus surgery (FESS) after failure of medical treatment to analyze clinical outcome using prospectively collected data through a symptom-based rhinosinusitis outcome measure, the Sino-nasal Outcome Test-22 (SNOT-22). The aim of the study was to evaluate and compare the QoL in patients of chronic rhinosinusitis pre-operative and after FESS by SNOT-22. The prospective study was conducted on 40 patients of chronic rhinosinusitis with or without nasal polyposis. Demographic, clinical, diagnostic nasal endoscopy and radiological findings were recorded. Visual analogue scoring and SNOT-22 questionnaire scoring were done preoperatively and at 3rd and 6th months post-operatively. These scores were compared and a value of p < 0.01 was considered statistical significant. Nasal obstruction (80%) was the most commonly reported disabling condition followed by rhinorrhea (75%), facial pain-pressure (72.5%), headache and sneezing. The mean preoperative nasal endoscopy score was 8.08 ± 3.65. The mean preoperative Lund Mackay CT scan score was 11.725 ± 3.64. The mean preoperative SNOT-22 score was 46.25 ± 20.44. After FESS, nasal discharge was improved in 86% patients. Average VAS scores showed significant postoperative improvement at 6 months (p < 0.01). The mean postoperative diagnostic nasal endoscopy score improved to 2.80 ± 1.64 at 6 months (p < 0.01). The mean postoperative SNOT-22 scores decreased at postoperative follow up visits at 3 and 6 months to 14.58 ± 4.90 at 3 months and 22.38 ±7.93 at 6 months (p < 0.01). CRS patient refractory to medical treatment showed statistical significant improvement after FESS. The SNOT-22 scoring was easy to use scoring used for QoL assessment showed significant improvement after FESS.
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Affiliation(s)
- Payal Verma
- Department of ENT, JLN Medical College and Hospitals, Ajmer, Rajasthan 305001 India
| | - Digvijay Singh Rawat
- Department of ENT, JLN Medical College and Hospitals, Ajmer, Rajasthan 305001 India
| | - Yogesh Aseri
- Department of ENT, JLN Medical College and Hospitals, Ajmer, Rajasthan 305001 India
| | | | - B. K. Singh
- Department of ENT, JLN Medical College and Hospitals, Ajmer, Rajasthan 305001 India
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Mullol J, Azar A, Buchheit KM, Hopkins C, Bernstein JA. Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1434-1453.e9. [PMID: 35306180 DOI: 10.1016/j.jaip.2022.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Chronic rhinosinusitis (CRS) affects up to 12% of the general population and is traditionally divided into two main phenotypic subsets, based on the presence of nasal polyps (CRSwNP) or their absence. It is well-established that many patients with CRSwNP report poor quality of life (QoL), which is further compromised by comorbidities (eg, asthma, bronchiectasis, aspirin-exacerbated respiratory disease). Chronic rhinosinusitis CRS with nasal polyps is managed with a combination of medical therapy and surgical interventions, and biologics are emerging as a promising new treatment option for patients with inadequate response to the standard of care. A range of patient-reported outcome measures have been used to assess QoL for patients with CRSwNP in clinical trials, including disease-specific questionnaires (eg, Sino-Nasal Outcome Test-22) and generic ones (eg, Short Form-36). Significantly impaired QoL has been identified as a criterion for the indication to use biologics in patients with CRSwNP. This review summarizes clinical evidence (2010-2021) on QoL outcomes with currently available treatments for CRSwNP and assesses the improvement in QoL after biologic treatments, especially for patients with comorbidities reported in interventional studies (randomized controlled trials and real-world experience).
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Affiliation(s)
- Joaquim Mullol
- Clinical and Experimental Respiratory Immunoallergy, Hospital Clinic Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universidad de Barcelona, Centro Investigación Biomédica En Red Enfermedades Respiratorias, Barcelona, Spain.
| | - Antoine Azar
- Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Kathleen M Buchheit
- AERD Center, Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Claire Hopkins
- Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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10
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Janson C, Bjermer L, Lehtimäki L, Kankaanranta H, Karjalainen J, Altraja A, Yasinska V, Aarli B, Rådinger M, Hellgren J, Lofdahl M, Howarth PH, Porsbjerg C. Eosinophilic airway diseases: basic science, clinical manifestations and future challenges. Eur Clin Respir J 2022; 9:2040707. [PMID: 35251534 PMCID: PMC8896196 DOI: 10.1080/20018525.2022.2040707] [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] [Indexed: 11/09/2022] Open
Abstract
Eosinophils have a broad range of functions, both homeostatic and pathological, mediated through an array of cell surface receptors and specific secretory granules that promote interactions with their microenvironment. Eosinophil development, differentiation, activation, survival and recruitment are closely regulated by a number of type 2 cytokines, including interleukin (IL)-5, the key driver of eosinophilopoiesis. Evidence shows that type 2 inflammation, driven mainly by interleukin (IL)-4, IL-5 and IL-13, plays an important role in the pathophysiology of eosinophilic airway diseases, including asthma, chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. Several biologic therapies have been developed to suppress type 2 inflammation, namely mepolizumab, reslizumab, benralizumab, dupilumab, omalizumab and tezepelumab. While these therapies have been associated with clinical benefits in a range of eosinophilic diseases, their development has highlighted several challenges and directions for future research. These include the need for further information on disease progression and identification of treatable traits, including clinical characteristics or biomarkers that will improve the prediction of treatment response. The Nordic countries have a long tradition of collaboration using patient registries and Nordic asthma registries provide unique opportunities to address these research questions. One example of such a registry is the NORdic Dataset for aSThmA Research (NORDSTAR), a longitudinal population-based dataset containing all 3.3 million individuals with asthma from four Nordic countries (Denmark, Finland, Norway and Sweden). Large-scale, real-world registry data such as those from Nordic countries may provide important information regarding the progression of eosinophilic asthma, in addition to clinical characteristics or biomarkers that could allow targeted treatment and ensure optimal patient outcomes.
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Affiliation(s)
- Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Valentyna Yasinska
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Sweden
| | - Bernt Aarli
- Department of Clinical Science, University of Bergen and Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Madeleine Rådinger
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Johan Hellgren
- Department of Otorhinolaryngology, University of Gothenburg, Gothenburg, Sweden
| | | | - Peter H Howarth
- Respiratory Medical Franchise, GSK, Brentford, Middlesex, UK
| | - Celeste Porsbjerg
- Department of Respiratory Medicine, Bispebjerg Hospital and Copenhagen University, Copenhagen, Denmark
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11
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Yang X, Shen S, Deng Y, Wang C, Zhang L. Air Pollution Exposure Affects Severity and Cellular Endotype of Chronic Rhinosinusitis With Nasal Polyps. Laryngoscope 2021; 132:2103-2110. [PMID: 34870326 DOI: 10.1002/lary.29974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Air pollution has emerged as an important environmental risk factor for chronic rhinosinusitis (CRS) progression. This study assessed exposure to five types of air pollution (PM2.5/10 , SO2 , NO2 , CO, O3 ) and explored their effects on CRS with nasal polyps (CRSwNP) severity and endotype. STUDY DESIGN Retrospective cohort study. METHODS Air pollution data from monitoring sites in Beijing were obtained to assess individual air pollution exposure. Outcomes of CRSwNP (n = 282) including Lund-Mackay (L-M) score, Lund-Kennedy (L-K) score, visual analogue scale (VAS) score and nasal patency/airflow resistance and so on were measured to analyze correlations with air pollution and compare groups with different exposure types. Multivariable-adjusted binary logistic regression was used to determine potential air pollution risk factors of the endotype of eosinophilic CRSwNP (ECRSwNP). RESULTS Short-term exposures to PM2.5/10 , SO2 , CO, NO2 , and O3 were weak but significantly associated with increased L-M scores. Short-term exposures to PM10 , CO, and NO2 were correlated with increased VAS headache/facial pain scores. The L-M scores of the group of the highest PM2.5 (≥150 μg/m3 ) exposure were significantly higher than those of control group. For each increased unit of the average concentration of PM2.5 , there was a 1.047-fold (95% confidence interval, 1.005-1.091) increased risk of the endotype of ECRSwNP. CONCLUSIONS Air pollution exposure exacerbated CRSwNP severity and PM2.5 could be a risk factor for endotype of ECRSwNP, suggesting the role of air pollution in CRSwNP pathogenesis. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Xiaozhe Yang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shen Shen
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuzhoujia Deng
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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12
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Mullol J, Bachert C, Amin N, Desrosiers M, Hellings PW, Han JK, Jankowski R, Vodicka J, Gevaert P, Daizadeh N, Khan AH, Kamat S, Patel N, Graham NMH, Ruddy M, Staudinger H, Mannent LP. Olfactory Outcomes with Dupilumab in Chronic Rhinosinusitis with Nasal Polyps. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:1086-1095.e5. [PMID: 34628065 DOI: 10.1016/j.jaip.2021.09.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Loss of smell (LoS) is one of the most troublesome and difficult-to-treat symptoms of severe chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE To assess the impact of dupilumab on sense of smell in severe CRSwNP. METHODS In the randomized SINUS-24 and SINUS-52 studies, adults with severe CRSwNP received dupilumab 300 mg subcutaneously or matching placebo every 2 weeks for 24 or 52 weeks, respectively. Smell was assessed using daily patient-reported LoS score (0-3) and University of Pennsylvania Smell Identification Test (UPSIT; 0-40). Data from the 2 studies were pooled through week 24. Relationships between patient phenotypes and smell outcomes were also assessed. RESULTS We randomized 724 patients (286 placebo, 438 dupilumab); mean CRSwNP duration was 11 years; 63% had prior sinonasal surgery. Mean baseline LoS was 2.74. Dupilumab produced rapid improvement in LoS, evident by day 3, which improved progressively throughout the study periods (least squares mean difference vs placebo -0.07 [95% CI -0.12 to -0.02]; nominal P < .05 at day 3, and -1.04 [-1.17 to -0.91]; P < .0001 at week 24). Dupilumab improved mean UPSIT by 10.54 (least squares mean difference vs placebo 10.57 [9.40-11.74]; P < .0001) at week 24 from baseline (score 13.90). Improvements were unaffected by CRSwNP duration, prior sinonasal surgery, or comorbid asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease. Baseline olfaction scores correlated with all measured local and systemic type 2 inflammatory markers except serum total immunoglobulin E. CONCLUSIONS Dupilumab produced rapid and sustained improvement in sense of smell, alleviating a cardinal symptom of severe CRSwNP.
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Affiliation(s)
- Joaquim Mullol
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.
| | - Claus Bachert
- Ghent University, Ghent, Belgium; Karolinska Institutet, Stockholm, Sweden
| | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Martin Desrosiers
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, Quebec, Canada
| | | | | | | | - Jan Vodicka
- Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
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13
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Han JK, Bachert C, Fokkens W, Desrosiers M, Wagenmann M, Lee SE, Smith SG, Martin N, Mayer B, Yancey SW, Sousa AR, Chan R, Hopkins C. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial. THE LANCET RESPIRATORY MEDICINE 2021; 9:1141-1153. [PMID: 33872587 DOI: 10.1016/s2213-2600(21)00097-7] [Citation(s) in RCA: 253] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps affects approximately 2-4% of the general population, and long-term use of systemic corticosteroids is associated with adverse effects. The aim of this study was to assess the efficacy and safety of mepolizumab in adults with recurrent, refractory severe bilateral chronic rhinosinusitis with nasal polyps. METHODS SYNAPSE was a randomised, double-blind, placebo-controlled, parallel-group, phase 3 trial done at 93 centres, mainly hospitals, in 11 countries. Eligible patients were aged 18 years or older with recurrent, refractory, severe, bilateral nasal polyp symptoms (nasal obstruction symptom visual analogue scale [VAS] score of >5), were eligible for repeat nasal surgery (overall symptoms VAS score >7 and endoscopic nasal polyps score of ≥5, with a minimum score of 2 in each nasal cavity) despite standard of care treatment, and had to have at least one nasal surgery in the past 10 years. Patients were randomly assigned (1:1), using permuted block design, to receive either 100 mg mepolizumab subcutaneously or placebo once every 4 weeks, in addition to standard of care (mometasone furoate intranasal spray for at least 8 weeks before screening and during the study, saline nasal irrigations, systemic corticosteroids or antibiotics, or both), as required, for 52 weeks. Site staff, the central study team, and patients were masked to study treatment and absolute blood eosinophil counts. The coprimary endpoints were change from baseline in total endoscopic nasal polyp score at week 52 and in mean nasal obstruction VAS score during weeks 49-52, assessed in the intention-to-treat population (ITT). This study is registered with ClinicalTrials.gov, NCT03085797. FINDINGS From May 25, 2017, to Dec 12, 2018, 854 patients were screened for eligibility. 414 patients were randomly assigned with 407 included in the ITT population; 206 received mepolizumab and 201 received placebo. Total endoscopic nasal polyp score significantly improved at week 52 from baseline with mepolizumab versus placebo (adjusted difference in medians -0·73, 95% CI -1·11 to -0·34; p<0·0001) and nasal obstruction VAS score during weeks 49-52 also significantly improved (-3·14, -4·09 to -2·18; p<0·0001). Adverse events considered related to study treatment were reported in 30 (15%) of 206 patients receiving mepolizumab and 19 (9%) of 201 receiving placebo. On-treatment serious adverse events occurred in 12 (6%) patients receiving mepolizumab and 13 (6%) receiving placebo; none were considered related to treatment in those receiving mepolizumab. One death was reported in the placebo group (myocardial infarction; death occurred 99 days after the last dose) and was considered unrelated to the treatment. INTERPRETATION Mepolizumab treatment improved nasal polyp size and nasal obstruction compared with placebo, with no new safety indications, in patients with recurrent, refractory severe chronic rhinosinusitis with nasal polyps. These findings suggest that mepolizumab provides an effective add-on treatment option to standard of care in this population. FUNDING GlaxoSmithKline.
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Affiliation(s)
- Joseph K Han
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Claus Bachert
- Department of Oto-Rhino-Laryngology, Upper Airways Research Laboratory, Ghent University Hospital, Ghent University, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institutet, University of Stockholm, Stockholm, Sweden
| | - Wytske Fokkens
- Department of Otolaryngology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Martin Desrosiers
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'University de Montreal, Montreal, QC, Canada
| | - Martin Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Stella E Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Steven G Smith
- Respiratory Therapeutic Area Unit, GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | - Steven W Yancey
- Respiratory Therapeutic Area Unit, GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | - Claire Hopkins
- Department of ENT, Guy's Hospital, London, UK; St Thomas' Hospital, King's College London, London, UK
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14
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Trimarchi M, Indelicato P, Vinciguerra A, Bussi M. Clinical efficacy of dupilumab in the treatment of severe chronic rhinosinusitis: The first case outside of a clinical trial. Clin Case Rep 2021; 9:1428-1432. [PMID: 33768860 PMCID: PMC7981721 DOI: 10.1002/ccr3.3792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
Treatment options for severe CRSwNP are limited. Dupilumab is a safe, well-tolerated, and effective alternative in patients with poor control of symptoms, corticosteroid-dependent disease, and high rates of recurrence of nasal polyps after surgery.
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Affiliation(s)
- Matteo Trimarchi
- Otorhinolaryngology UnitDivision of Head and Neck DepartmentIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Pietro Indelicato
- Otorhinolaryngology UnitDivision of Head and Neck DepartmentIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Alessandro Vinciguerra
- Otorhinolaryngology UnitDivision of Head and Neck DepartmentIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Mario Bussi
- Otorhinolaryngology UnitDivision of Head and Neck DepartmentIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
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15
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Lee SE, Farzal Z, Kimple AJ, Senior BA, Thorp BD, Zanation AM, Ebert CS. Readability of patient-reported outcome measures for chronic rhinosinusitis and skull base diseases. Laryngoscope 2020; 130:2305-2310. [PMID: 31603564 DOI: 10.1002/lary.28330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Outcome measures in healthcare that presume a higher level of patient health and overall literacy may inadequately estimate the disease experiences of less-educated patients and further disadvantage them. Patient-Reported Outcome Measures (PROMs) are widely used communication tools for clinical practice and are often used to evaluate and guide management for chronic rhinosinusitis (CRS) and skull base diseases. However, their readability and subsequent incomprehensibility for patients have not been assessed. The aim of this study is to evaluate the readability of commonly used PROMs for these conditions and whether they meet recommended readability levels. METHODS Three readability measures, Gunning Fog, Simple Measure of Gobbledygook (SMOG), and FORCAST were used in the evaluation of commonly used PROMs for CRS and skull base disease. PROMs with sixth-grade readability level or lower were considered to meet health literacy experts' recommendations. RESULTS A total of 11 PROMs were reviewed (8 CRS, 3 skull base). Gunning Fog consistently estimated the easiest readability, whereas FORCAST the most difficult. One hundred percent of CRS and 67% of skull base PROMs were above National Institutes of Health and health literacy experts' recommended reading levels. PROMs developed more recently had easier readability. CONCLUSION PROMs are important clinical tools in otolaryngology that help guide management of disease for improved patient-centered care. Like many other fields of medicine, those used in otolaryngology are beyond recommended reading levels. Development of PROMs in the future should meet recommended readability levels to fully assess the disease experience of our patients. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2305-2310, 2020.
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Affiliation(s)
- Saangyoung E Lee
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Zainab Farzal
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Adam J Kimple
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Brent A Senior
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Brian D Thorp
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Charles S Ebert
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
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16
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Brown HJ, Kuhar HN, Plitt MA, Husain I, Batra PS, Tajudeen BA. The Impact of Laryngopharyngeal Reflux on Patient-reported Measures of Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol 2020; 129:886-893. [PMID: 32390460 DOI: 10.1177/0003489420921424] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study explored the impact of laryngopharyngeal reflux (LPR) on quality-of-life outcomes captured by Sino-Nasal Outcome Test (SNOT-22) and Reflux Symptom Index (RSI) in patients with chronic rhinosinusitis (CRS) and patients with symptoms of LPR. METHODS In a retrospective chart review, SNOT-22 and RSI scores were analyzed in patients seen at a tertiary care center with CRS, LPR, or both CRS and LPR. SNOT-22 items were grouped into sleep, nasal, otologic, and emotional symptom subdomains. RESULTS A total of 138 patients (36 with CRS alone, 60 with LPR alone, and 42 with both CRS and LPR) were included. Compared to patients with CRS alone, those with CRS and LPR (CRS+LPR) had higher SNOT-22 total (50.54 ± 19.53 vs 35.31 ± 20.20, P < .001), sleep (19.61 ± 9.31 vs 14.42 ± 10.34, P < .022), nasal (17.38 ± 7.49 vs 11.11 ± 8.52, P < .001), otologic subdomains (9.17 ± 5.07 vs 5.53 ± 5.14, P < .002), and RSI (22.06 ± 9.42 vs 10.75 ± 8.43, P < .003). Patients with LPR alone had higher RSI compared to those with CRS (18.48 ± 9.77 vs 10.75 ± 8.43, P < .037). RSI and SNOT-22 scores were positively correlated irrespective of patient group (R = 0.289, P = .003). CONCLUSION Compared to patients with CRS or LPR alone, those with CRS+LPR demonstrated higher RSI and total and subdomain SNOT-22 scores. Patients with LPR alone had elevated SNOT-22 despite absent endoscopic evidence of sinusitis.
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Affiliation(s)
| | - Hannah N Kuhar
- Department of Otolaryngology, Ohio State University Medical Center, Columbus, OH, USA
| | - Max A Plitt
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, USA
| | - Inna Husain
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, USA
| | - Pete S Batra
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, USA
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17
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Lee SE, Farzal Z, Ebert CS, Zanation AM. Readability of Patient-Reported Outcome Measures for Head and Neck Oncology. Laryngoscope 2020; 130:2839-2842. [PMID: 32078176 DOI: 10.1002/lary.28555] [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: 09/18/2019] [Revised: 11/26/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patient-reported outcome measures (PROMs) are communication tools to help patients convey their disease experience to medical providers and guide management decisions. However, the utility of healthcare outcome measures is dependent on patient literacy and readability of PROMs. If written for a more advanced literacy level, they can misestimate symptoms and add significant barriers to care, especially in the underserved. However, readability of head and neck (H&N) oncology PROMs has not been assessed. The aim of this study was to evaluate the readability of H&N oncology PROMs to assess whether they meet recommended readability levels. STUDY DESIGN Bibliometric review. METHODS Three readability measures: Gunning Fog, Simple Measure of Gobbledygook, and FORCAST were used to evaluate the readability level of commonly used H&N PROMs. PROMs with sixth grade readability level or lower were considered to meet the recommendations of health literacy experts. RESULTS Eight H&N oncology PROMs were reviewed. None of H&N PROMs met health literacy experts' and National Institutes of Health recommended reading levels. Gunning Fog consistently estimated easiest readability and FORCAST the most difficult. CONCLUSIONS PROMs are important clinical tools that drive patient-centric care in H&N oncology. All H&N PROMs are written above recommended reading levels and do not meet suggested standards. Future PROMs should be written with easier readability to accurately convey patients' H&N oncology disease experiences. LEVEL OF EVIDENCE 4 Laryngoscope, 2020.
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Affiliation(s)
- Saangyoung E Lee
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Zainab Farzal
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Charles S Ebert
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
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Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, Mullol J, Greos LS, Bosso JV, Laidlaw TM, Cervin AU, Maspero JF, Hopkins C, Olze H, Canonica GW, Paggiaro P, Cho SH, Fokkens WJ, Fujieda S, Zhang M, Lu X, Fan C, Draikiwicz S, Kamat SA, Khan A, Pirozzi G, Patel N, Graham NMH, Ruddy M, Staudinger H, Weinreich D, Stahl N, Yancopoulos GD, Mannent LP. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet 2019; 394:1638-1650. [PMID: 31543428 DOI: 10.1016/s0140-6736(19)31881-1] [Citation(s) in RCA: 726] [Impact Index Per Article: 145.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) generally have a high symptom burden and poor health-related quality of life, often requiring recurring systemic corticosteroid use and repeated sinus surgery. Dupilumab is a fully human monoclonal antibody that inhibits signalling of interleukin (IL)-4 and IL-13, key drivers of type 2 inflammation, and has been approved for use in atopic dermatitis and asthma. In these two studies, we aimed to assess efficacy and safety of dupilumab in patients with CRSwNP despite previous treatment with systemic corticosteroids, surgery, or both. METHODS LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52 were two multinational, multicentre, randomised, double-blind, placebo-controlled, parallel-group studies assessing dupilumab added to standard of care in adults with severe CRSwNP. SINUS-24 was done in 67 centres in 13 countries, and SINUS-52 was done in 117 centres in 14 countries. Eligible patients were 18 years or older with bilateral CRSwNP and symptoms despite intranasal corticosteroid use, receiving systemic corticosteroids in the preceding 2 years, or having had sinonasal surgery. Patients in SINUS-24 were randomly assigned (1:1) to subcutaneous dupilumab 300 mg or placebo every 2 weeks for 24 weeks. Patients in SINUS-52 were randomly assigned (1:1:1) to dupilumab 300 mg every 2 weeks for 52 weeks, dupilumab every 2 weeks for 24 weeks and then every 4 weeks for the remaining 28 weeks, or placebo every 2 weeks for 52 weeks. All patients were randomly assigned centrally with a permuted block randomisation schedule. Randomisation was stratified by asthma or non-steroidal anti-inflammatory drug-exacerbated respiratory disease status at screening, previous surgery at screening, and country. Patients with or without comorbid asthma were included. Coprimary endpoints were changes from baseline to week 24 in nasal polyp score (NPS), nasal congestion or obstruction, and sinus Lund-Mackay CT scores (a coprimary endpoint in Japan), done in an intention-to-treat population. Safety was assessed in a pooled population of both dupilumab groups in SINUS-52 up to week 24 and the dupilumab group in SINUS-24 and the placebo groups in both studies until week 24. The trials are complete and registered at ClinicalTrials.gov, NCT02912468 and NCT02898454. FINDINGS Between Dec 5, 2016, and Aug 3, 2017, 276 patients were enrolled in SINUS-24, with 143 in the dupilumab group and 133 in the placebo group receiving at least one study drug dose. Between Nov 28, 2016, and Aug 28, 2017, 448 patients were enrolled in SINUS-52, with 150 receiving at least one dose of dupilumab every 2 weeks, 145 receiving at least one dose of dupilumab every 2 weeks for 24 weeks and every 4 weeks until week 52, and 153 receiving at least one dose of placebo. Dupilumab significantly improved the coprimary endpoints in both studies. At 24 weeks, least squares mean difference in NPS of dupilumab treatment versus placebo was -2·06 (95% CI -2·43 to -1·69; p<0·0001) in SINUS-24 and -1·80 (-2·10 to -1·51; p<0·0001) in SINUS-52; difference in nasal congestion or obstruction score was -0·89 (-1·07 to -0·71; p<0·0001) in SINUS-24 and -0·87 (-1·03 to -0·71; p<0·0001) in SINUS-52; and difference in Lund-Mackay CT scores was -7·44 (-8·35 to -6·53; p<0·0001) in SINUS-24 and -5·13 (-5·80 to -4·46; p<0·0001) in SINUS-52. The most common adverse events (nasopharyngitis, worsening of nasal polyps and asthma, headache, epistaxis, and injection-site erythema) were more frequent with placebo. INTERPRETATION In adult patients with severe CRSwNP, dupilumab reduced polyp size, sinus opacification, and severity of symptoms and was well tolerated. These results support the benefits of adding dupilumab to daily standard of care for patients with severe CRSwNP who otherwise have few therapeutic options. FUNDING Sanofi and Regeneron Pharmaceuticals.
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Affiliation(s)
- Claus Bachert
- Faculty of Medicine, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium; CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Joseph K Han
- Division of Allergy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Martin Desrosiers
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Peter W Hellings
- Laboratory of Experimental Immunology, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nikhil Amin
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Stella E Lee
- Department of Otolaryngology-Head and Neck Surgery, Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joaquim Mullol
- Hospital Clínic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - Leon S Greos
- Colorado Allergy and Asthma Centers, Centennial, CO, USA
| | - John V Bosso
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Tanya M Laidlaw
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Anders U Cervin
- Faculty of Medicine, University of Queensland and Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Jorge F Maspero
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
| | - Claire Hopkins
- Department of Ear, Nose, and Throat, Guy's and St Thomas' Hospitals, London, UK
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Walter Canonica
- Personalized Medicine Asthma & Allergy, Humanitas University, Clinical and Research Center, IRCCS, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Seong H Cho
- Division of Allergy-Immunology, University of South Florida, Tampa, FL, USA
| | | | - Shigeharu Fujieda
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | | | - Xin Lu
- Sanofi, Bridgewater, NJ, USA
| | | | | | | | | | | | | | | | | | | | | | - Neil Stahl
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
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Sahlstrand-Johnson P, Holmström M, Ehnhage A. Does the oral steroid treatment of patients with nasal polyposis cause osteopenia or osteoporosis? Clin Otolaryngol 2019; 44:1011-1016. [PMID: 31529761 DOI: 10.1111/coa.13431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/19/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to investigate the bone mineral density (BMD) in a group of Swedish patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) with or without asthma, as well as to evaluate whether the treatment of this patient group is in accordance with the EPOS recommendations. DESIGN, SETTINGS AND PARTICIPANTS Adult patients with a diagnosis of CRSwNP, and a history of at least two courses of oral corticosteroids (OCS) during the last year, were consecutively included in this study at five centres. MAIN OUTCOME MEASURES The BMD of the patients was measured by Dual-energy X-ray absorptiometry (DXA), which is the only technology for classifying BMD according to the criteria established by WHO. RESULTS A total of 51 patients, with an average number of 7 years with OCS treatment, were enrolled. During the last 12 months, the mean number of OCS courses was 2.76, and the total mean intake was 891 mg of Prednisone equivalents. According to the T-scores, 17 patients were measured to have ≤-1 SD T-score lumbar spine, which is considered to be osteopenia, and five patients had <-2.5 SD T-score, considered as osteoporosis. However, when taking age and gender into account and analysing the Z-scores, only 2 patients had a reduced density of the spine and none in the hip, which is no difference compared to a matched Swedish population. CONCLUSIONS This prospective study shows that 2-3 moderate courses of OCS annually may be used without high risk of causing osteopenia/osteoporosis in patients with CRSwNP.
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Affiliation(s)
| | - Mats Holmström
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ehnhage
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Castillo Vizuete JA, Sastre J, del Cuvillo Bernal A, Picado C, Martínez Moragón E, Ignacio García JM, Cisneros Serrano C, Álvarez Gutiérrez FJ, Mullol Miret J. Asthma, Rhinitis, and Nasal Polyp Multimorbidities. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.arbr.2018.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Luparello P, Lazio MS, Voltolini L, Borchi B, Taccetti G, Maggiore G. Outcomes of endoscopic sinus surgery in adult lung transplant patients with cystic fibrosis. Eur Arch Otorhinolaryngol 2019; 276:1341-1347. [PMID: 30689038 DOI: 10.1007/s00405-019-05308-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/18/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Cystic Fibrosis (CF) is the most common autosomal recessive disease in Caucasian population. Due to its pathological mechanism, chronic rhino sinusitis (CRS) associated or not with nasal polyposis usually occurs in adults and affects close to one-half of all CF patients. The goal of our work was to evaluate the impact of Endoscopic Sinus Surgery (ESS) in the quality of life (QoL) of the CF patients and demonstrate an improvement of the functional outcomes in the patients underwent the surgical procedure rather than in the not treated ones, particulary in lung transplant patients. METHODS We studied 54 adult patients affected by CF. Lund-Kennedy, Lund-Mackay scores, and SNOT-22 were analysed. 14 had lung transplant and 9 had both lung tranplant and ESS procedures. RESULTS 22 (40.7%) out of 54 CF patients underwent ESS. This group presented more likely complaints consistent with CRS. Lund-Kennedy and Lund-Mackay scores appeared higher in the ESS group: 10 (range of 6-12) and 15 (range of 12-20), respectively. SNOT-22 showed median values for non-ESS and ESS group of 20 (range of 3-68) and 40 (range of 10-73), respectively. CONCLUSIONS ESS represents the best option to improve clinical QoL of CF patients who do not response to conventional medical therapy, with a stabilization of respiratory function after transplantation.
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Affiliation(s)
- Paolo Luparello
- Department of Surgery and Translational Medicine, Clinic of Otolaryngology, Head and Neck Surgery, Careggi University Hospital, University of Florence, Largo Brambilla, 3-50134, Florence, Italy.
| | - Maria S Lazio
- Department of Surgery and Translational Medicine, Clinic of Otolaryngology, Head and Neck Surgery, Careggi University Hospital, University of Florence, Largo Brambilla, 3-50134, Florence, Italy
| | - Luca Voltolini
- Department of Thoracic Surgery, University Hospital Careggi, Florence, Italy
| | - Beatrice Borchi
- Infectious Disease Department, Careggi University and Hospital, Florence, Italy
| | - Giovanni Taccetti
- Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy
| | - Giandomenico Maggiore
- Department of Surgery and Translational Medicine, Clinic of Otolaryngology, Head and Neck Surgery, Careggi University Hospital, University of Florence, Largo Brambilla, 3-50134, Florence, Italy
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Asthma, rhinitis, and nasal polyp multimorbidities. Arch Bronconeumol 2018; 55:146-155. [PMID: 30449614 DOI: 10.1016/j.arbres.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/22/2022]
Abstract
The aim of this review is to assist pulmonologists in the management of diseases involving both the upper and lower respiratory tract that are linked by a common, interrelated epidemiology, clinical signs and symptoms, and inflammatory mechanism - asthma, in particular. The document discusses the definitions of the various sinonasal phenotypes associated with asthma: allergic and non-allergic rhinitis and chronic rhinosinusitis with or without nasal polyps. Diagnostic criteria and severity levels are also listed. Particular attention has been given to the 2 main syndromes associated with asthma: (i)allergic rhinitis, the most common, and (ii)chronic rhinosinusitis with nasal polyps, the disease most closely associated with severe asthma. To summarize, the upper respiratory tract should always be evaluated in order to achieve a single diagnosis and comprehensive treatment of the "united airway".
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Choukry K, Hasnaoui J, Chafiki Z, Khdim M, Abada R, Mahtar M. Assessment of chronic sinonasal dysfunction and cross-cultural adaptation of the DyNaChron questionnaire. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:307-310. [PMID: 29887212 DOI: 10.1016/j.anorl.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sinonasal pathologies generate six principal symptoms with major organic and psychosocial impact that can be studied on a self-administered questionnaire assessing chronic sinonasal dysfunction independently of etiology. The objective of the present study was to translate, culturally adapt and validate the DyNaChron questionnaire for Arabic-speaking Moroccan patients. METHODS The translation and cross-cultural adaptation of DyNaChron followed international guidelines. 164 patients filled out the questionnaire at day 0 and day 7 (without treatment) and day 60 after treatment. A prospective multicenter study validated the questionnaire for internal consistency, test-retest reliability and sensitivity to change. RESULTS Mean age was 35 years, with male predominance (63%). Nasal obstruction was the most frequent symptom (97.6%). Internal consistency on Cronbach alpha was high (0.97). Reproducibility on intraclass correlation (ICC) was excellent (0.84). Sensitivity to change was excellent for the majority of patients (effect size=0.97-6.69; SRM=2.47-6.74). CONCLUSION This study of a cross-cultural Moroccan adaptation of the DyNaChron questionnaire showed good validity, reproducibility and sensitivity to change, and better representation of all symptoms generated by chronic sinonasal dysfunction. It can be used to evaluate the psychosocial and organic impact of chronic sinonasal dysfunction and to assess treatment.
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Affiliation(s)
- K Choukry
- ENT Department, hôpital du 20 Août 1953, CHU de Ibn Rochd, 6, rue Lahssen Elaarjoun, Casablanca, Morocco.
| | - J Hasnaoui
- ENT Department, hôpital du 20 Août 1953, CHU de Ibn Rochd, 6, rue Lahssen Elaarjoun, Casablanca, Morocco
| | - Z Chafiki
- ENT Department, hôpital du 20 Août 1953, CHU de Ibn Rochd, 6, rue Lahssen Elaarjoun, Casablanca, Morocco
| | - M Khdim
- ENT Department, hôpital du 20 Août 1953, CHU de Ibn Rochd, 6, rue Lahssen Elaarjoun, Casablanca, Morocco
| | - R Abada
- ENT Department, hôpital du 20 Août 1953, CHU de Ibn Rochd, 6, rue Lahssen Elaarjoun, Casablanca, Morocco
| | - M Mahtar
- ENT Department, hôpital du 20 Août 1953, CHU de Ibn Rochd, 6, rue Lahssen Elaarjoun, Casablanca, Morocco
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Youssef AM, Awad OGAN, Taha M. Pulmonary Function of Patients with Chronic Rhinosinusitis and the Impact of Endoscopic Sinus Surgery. OTO Open 2017; 1:2473974X17738759. [PMID: 30480195 PMCID: PMC6239150 DOI: 10.1177/2473974x17738759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/02/2017] [Accepted: 10/04/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare pulmonary function tests (PFTs) among control subjects and patients with chronic rhinosinusitis (CRS) and to investigate the outcomes of endoscopic sinus surgery (ESS) on PFTs among patients with CRS. STUDY DESIGN Prospective study conducted from June 2015 to June 2016. SETTING Tertiary referral hospital. SUBJECTS AND METHODS The study is based on 2 groups: adult control subjects (group 1, n = 25) and adult patients with medically resistant CRS (group 2, n = 25). PFTs were used to compare the lower airway condition between the groups. Another comparison in PFTs was made among patients with CRS at 1 week preoperatively and 1 month postoperatively to evaluate the effectiveness of ESS. RESULTS In group 1, all subjects had an FEV1/FVC ratio ≥80% (forced expiratory volume in 1 second / forced vital capacity) with a mean of 0.84 ± 0.07, as compared with group 2, from 61% to 70% for 5 (20%) patients, 71% to 79% for 10 (40%), and ≥80% for 10 (40%). FEV1/FVC was significantly lower in group 2 than group 1 (P = .04). At 1 month postoperatively, the FEV1/FVC values of group 2 was from 61% to 70% for 2 (8%) patients, 71% to 79% for 13 (52%), and ≥80% for 10 (40%). The mean FEV1/FVC was 0.9 ± 0.50, and these values were significantly higher (P = .02) when compared with preoperative values. CONCLUSION This study provides objective evidence that patients with CRS may have nonmanifest lower airway affection when compared with control subjects and that ESS is efficacious in the improvement of such affection.
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Affiliation(s)
- Ahmed M. Youssef
- Otolaryngology–Head and Neck Department,
Minia University, Minia, Egypt
| | | | - Mohamed Taha
- Chest Department, Minia University,
Minia, Egypt
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Berkiten G, Kumral TL, Saltürk Z, Atar Y, Yildirim G, Uyar Y, Aydoğdu I, Arslanoğlu A. Effect of Deviated Nasal Septum Type on Nasal Mucociliary Clearance, Olfactory Function, Quality of Life, and Efficiency of Nasal Surgery. J Craniofac Surg 2017; 27:1151-5. [PMID: 27300450 DOI: 10.1097/scs.0000000000002696] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the influence of deviated nasal septum (DNS) type on nasal mucociliary clearance, quality of life (QoL), olfactory function, and efficiency of nasal surgery (septoplasty with or without inferior turbinate reduction and partial middle turbinectomy). METHODS Fifty patients (20 females and 30 males) with septal deviation were included in the study and were divided into 6 groups according to deviation type after examination by nasal endoscopy and paranasal computed tomography. The saccharin clearance test to evaluate the nasal mucociliary clearance time, Connecticut Chemosensory Clinical Research Center smell test for olfactory function, and sinonasal outcome test-22 (SNOT-22) for patient satisfaction were applied preoperatively and postoperatively at the sixth week after surgery. RESULT Nasal mucociliary clearance, smell, and SNOT-22 scores were measured before surgery and at the sixth week following surgery. No significant difference was found in olfactory and SNOT-22 scores for any of the DNS types (both convex and concave sides) (P > 0.05). In addition, there was no difference in the saccharin clearance time (SCT) of the concave and convex sides (P > 0.05). According to the DNS type, the mean SCT of the convex sides showed no difference, but that of the concave sides showed a difference in types 3, 4, 5, and 6. These types had a prolonged SCT (P < 0.05). Olfactory scores revealed no difference postoperatively in types 5 and 6 but were decreased significantly in types 1 to 4 (P < 0.05). There was no significant difference in the healing of both the mucociliary clearance (MCC) and olfactory functions. SNOT-22 results showed a significant decrease in type 3. CONCLUSION All DNS types disturb the QoL regarding nasal MCC and olfaction functions. MCC values, olfactory function, and QoL scores are similar among the DNS types. Both sides of the DNS types affect the MCC scores symmetrically. Septal surgery improves olfaction function and QoL at the sixth week following surgery but disturbs nasal MCC; thus, the sixth week is too early to assess nasal MCC.
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Affiliation(s)
- Güler Berkiten
- Okmeydani Training and Research Hospital Ear Nose and Throat Clinic, Şişli, Istanbul, Turkey
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Masterson L, Egro FM, Bewick J, Erskine SE, Clark A, Javer AR, Philpott CM. Quality-of-life outcomes after sinus surgery in allergic fungal rhinosinusitis versus nonfungal chronic rhinosinusitis. Am J Rhinol Allergy 2016; 30:e30-5. [PMID: 26980383 DOI: 10.2500/ajra.2016.30.4280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Given the differences in pathophysiology between allergic fungal rhinosinusitis (AFRS) and other chronic rhinosinusitis (CRS) subgroups, it remains unclear about whether these patients respond differently to a combination of surgical and medical treatments. OBJECTIVE To evaluate differences in quality-of-life (QoL) outcomes for a cohort of patients who underwent endoscopic sinus surgery (ESS) for CRS. METHODS This retrospective review included patients with CRS who underwent ESS between 2010 and 2013. QoL was measured by using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, SNOT-22 scores before ESS and at 1, 3, 6, 9, and 12 months after ESS. Groups tested were CRS with nasal polyposis, CRS without nasal polyposis (CRSsNP), and patients with AFRS. A linear mixed- effects regression model was used to calculate the adjusted mean QoL differences. RESULTS Among the 250 patients included, 61.6% had CRS with nasal polyposis (n = 154), 28.8% had CRSsNP (n = 72), and 9.6% had AFRS (n = 24). Significant differences were seen in SNOT-22 scores between pre- and postoperative visits and between the etiologic subgroups (p < 0.001). Multivariate analysis revealed significantly greater improvement in QoL for patients with AFRS in comparison with those with CRSsNP at the 9-month follow-up (change in SNOT-22 score, 22.6 [95% confidence interval, 1.2-44.1]; p < 0.0) and the 12-month follow-up (change in SNOT-22 score, 20.2 [95% confidence interval, 0.5-39.9]; p < 0.04). CONCLUSIONS Patients with AFRS experienced a more-prolonged QoL benefit from surgical and targeted medical intervention compared with those with CRSsNP, which may reflect the severity of inflammation that they presented with compared with other CRS subtypes.
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Affiliation(s)
- Liam Masterson
- Department of Ear Nose and Throat, James Paget University Hospital, Lowestoft Road, Gorleston-on-Sea, UK
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Sinonasal symptom assessment by the self-reported DyNaChron questionnaire: Before or after consultation? Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:19-22. [PMID: 27726976 DOI: 10.1016/j.anorl.2016.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Assessment of sinonasal symptoms on a self-reported questionnaire is thoroughly subjective, but indispensable for quantifying symptoms. The present study sought to compare responses on the DyNaChron questionnaire just before and just after consultation for chronic sinonasal dysfunction. MATERIALS AND METHODS 78 patients (mean age, 43.1±16.9 years) consulting for chronic sinonasal dysfunction took part in a prospective study, responding to the computerized version of the DyNaChron self-reported questionnaire, in a dedicated room, just before and just after medical interview and physical examination. RESULTS Most patients tended to grade symptoms as less severe after consultation. Significant differences in mean score were found for nasal obstruction (difference of 0.94/10), anterior (0.40) and posterior rhinorrhea (0.26), olfactory disorder (0.65), and facial pain and headache (0.65), but not for chronic cough. CONCLUSION Self-reported scores for chronic sinonasal dysfunction differ slightly from before to after consultation. They are therefore to be interpreted with caution, taking account of possible factors of bias.
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Orb Q, Mace JC, DeConde AS, Steele TO, Cox ST, Smith TL, Alt JA. Patients electing medical vs surgical treatment: emotional domain of the Rhinosinusitis Disability Index associates with treatment selection. Int Forum Allergy Rhinol 2015; 6:315-21. [PMID: 26536520 DOI: 10.1002/alr.21656] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/10/2015] [Accepted: 08/28/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Rhinosinusitis Disability Index (RSDI) consists of multiple subdomains shown to be useful in studying chronic rhinosinusitis (CRS). The objective of this study was to determine if RSDI subdomain scores are associated with selection of treatment modality (endoscopic sinus surgery [ESS] or continued medical management [CMM]) in subjects with CRS. METHODS Patients with CRS were prospectively enrolled into a multi-institutional cohort study. Following an initial period of medical management, patients elected to undergo treatment with either ESS or CMM. Baseline RSDI total and subdomain scores were compared between patients electing different treatment modalities. RESULTS A total of 684 subjects were enrolled with 122 (17.8%) electing CMM and 562 (82.2%) electing ESS. When compared to patients undergoing CMM, patients electing ESS exhibited significantly higher mean baseline RSDI total scores (mean ± standard deviation [SD]: 48.1 ± 24.9 vs 40.1 ± 24.1; p = 0.001) and subdomain scores (emotional: 13.2 ± 9.1 vs 10.4 ± 8.3; p = 0.001; functional: 15.3 ± 8.9 vs 12.6 ± 8.4; p = 0.002; and physical: 19.6 ± 9.3 vs 17.1 ± 9.6; p = 0.007). Emotional subdomain scores were found to be the most associated with choice of treatment modality. CONCLUSION Patients with CRS electing ESS had worse baseline RSDI total and subdomain scores compared to those electing CMM. Although both rhinologic and nonrhinologic symptoms contributed to the selection of treatment modality, emotional symptoms appeared to exhibit the greatest influence on patient-centered treatment decisions.
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Affiliation(s)
- Quinn Orb
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, UT
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health Science Center, Portland, OR
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
| | - Steve T Cox
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee, Memphis, TN
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health Science Center, Portland, OR
| | - Jeremiah A Alt
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, UT
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Symptom-Based Clustering in Chronic Rhinosinusitis Relates to History of Aspirin Sensitivity and Postsurgical Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015. [PMID: 26216252 DOI: 10.1016/j.jaip.2015.06.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Symptoms burden in chronic rhinosinusitis (CRS) may be assessed by interviews or by means of validated tools such as the 22-item SinoNasal Outcome Test (SNOT-22). However, when only the total SNOT-22 scores are used, the pattern of symptom distribution and heterogeneity in patient symptoms is lost. OBJECTIVES To use a standardized symptom assessment tool (SNOT-22) on preoperative symptoms to understand symptom heterogeneity in CRS and to aid in characterization of distinguishing clinical features between subgroups. METHODS This was a retrospective review of 97 surgical patients with CRS. Symptom-based clusters were derived on the basis of presurgical SNOT-22 scores using unsupervised analysis and network graphs. Comparison between clusters was performed for clinical and demographic parameters, postsurgical symptom scores, and presence or absence of a history of aspirin sensitivity. RESULTS Unsupervised analysis reveals coclustering of specific symptoms in the SNOT-22 tool. Using symptom-based clustering, patients with CRS were stratified into severe overall (mean total score, 90.8), severe sinonasal (score, 62), moderate sinonasal (score, 40), moderate nonsinonasal (score, 37) and mild sinonasal (score, 16) clusters. The last 2 clusters were associated with lack of history of aspirin sensitivity. The first cluster had a rapid relapse in symptoms postoperatively, and the last cluster demonstrated minimal symptomatic improvement after surgery. CONCLUSION Symptom-based clusters in CRS reveal a distinct grouping of symptom burden that may relate to aspirin sensitivity and treatment outcomes.
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Fu QL, Ma JX, Ou CQ, Guo C, Shen SQ, Xu G, Shi J. Influence of self-reported chronic rhinosinusitis on health-related quality of life: a population-based survey. PLoS One 2015; 10:e0126881. [PMID: 25978550 PMCID: PMC4433264 DOI: 10.1371/journal.pone.0126881] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/08/2015] [Indexed: 11/26/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is a frequently occurring chronic respiratory disease. There is evidence that effective treatment of CRS can improve patients’ quality of life, but the data regarding the extent to which CRS impairs patients’ quality of life (QoL) is sparse. This study aimed to evaluate the effect of self-reported CRS on health-related QoL and to determine whether the influence was associated with gender, age and socio-economic status. A four-stage random sampling method was used to select the participants from the general population in Guangzhou, China. All participants were interviewed face-to-face at their homes using a standardized questionnaire. The health-related QoL of each participant was assessed using the SF-36 Health Survey. The scores of the SF-36 after adjusting for gender, age, socioeconomic conditions, smoking and some important comorbid conditions were compared between the CRS group and the non-CRS group using analysis of covariance. A multiple linear regression model with interaction terms was established to determine whether CRS affected QoL to the same degree across the different subpopulations. Among a total of 1,411 participants aged at least 15 years, 118 persons (8.4%) had self-reported CRS. Subjects with CRS had an increased prevalence of allergic rhinitis, chronic obstructive pulmonary disease and gout than subjects without CRS. The CRS group had lower scores in all eight domains and the physical and mental component summary than those without CRS (P<0.05), and the greatest differences were in role emotional function (RE), general health (GH) and role physical function (RP). The impairments of the CRS participants in RE and RP were greater among the females than the males. Moreover, physical domains were affected to greater degrees among the elderly and those with high-level education. In conclusion, CRS is a common chronic disorder. Persons with self-reported CRS perceived themselves as having impaired QoL in both the physical and mental domains. These findings shed new light on the health burden of CRS and should be taken into account by clinicians involved in the care of CRS patients.
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Affiliation(s)
- Qing-Ling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, 510080, China
| | - Jin-Xiang Ma
- Department of Applied Statistics, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, 511436, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
- * E-mail: (CQO); (JS)
| | - Cui Guo
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Shuang-Quan Shen
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Geng Xu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, 510080, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, 510080, China
- * E-mail: (CQO); (JS)
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The optimal evaluation and management of patients with a gradual onset of olfactory loss. Curr Opin Otolaryngol Head Neck Surg 2014; 22:34-41. [PMID: 24370953 DOI: 10.1097/moo.0000000000000013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of the causes of olfactory dysfunction, their evaluation and management, with a main focus on the gradual/progressive loss of smell. RECENT FINDINGS As the sense of smell gives us essential information about our environment, its loss can cause nutritional and social problems while threatening an individual's safety. Recent surveys have shown quite a substantial prevalence of hyposmia (one out of four people) and anosmia (one out of 200 people) in a variety of populations. SUMMARY Nasal inflammatory diseases such as allergic rhinitis and predominantly chronic rhinosinusitis account for the major and common causes of gradual/progressive loss of smell. However, they are also among the most successfully treated forms of olfactory dysfunction. The management of gradual/progressive smell deficit must always address its etiological causes. In most cases, a detailed medical history and nasal examination, smell testing, and imaging will help to establish an appropriate diagnosis. In addition to anti-inflammatory therapy, mainly nasal and systemic corticosteroids, recent investigations on smell training suggest that the controlled exposure to selected odors may increase olfactory performance. VIDEO ABSTRACT AVAILABLE See the Video Supplementary Digital Content 1 (http://links.lww.com/COOH/A8).
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Zhang Z, Adappa ND, Doghramji LJ, Chiu AG, Lautenbach E, Cohen NA, Palmer JN. Quality of life improvement from sinus surgery in chronic rhinosinusitis patients with asthma and nasal polyps. Int Forum Allergy Rhinol 2014; 4:885-92. [PMID: 25256422 DOI: 10.1002/alr.21406] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/29/2014] [Accepted: 07/10/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND It is unclear whether chronic rhinosinusitis (CRS) patients with both nasal polyps and asthma have different quality of life (QOL) improvement after functional endoscopic sinus surgery (FESS). We aimed to determine whether CRS patients with asthma and nasal polyps had a greater QOL improvement after FESS compared to patients without asthma or polyps. METHODS This retrospective analysis included adult CRS patients who underwent FESS between 2007 and 2011. QOL was measured using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, clinical factors, SNOT-22 scores before FESS, and 1 month, 3 months, and 6 months post-FESS. Groups tested were asthma alone, polyps alone, asthma and polyps, and no asthma or polyps. Linear mixed-effects regression model was performed to calculate β-coefficients, which represent the adjusted mean QOL differences. RESULTS Among the 376 patients included, 40.16% had both asthma and polyps (n = 151), 14.36% had asthma alone (n = 54), 19.45% had polyps alone (n = 75), and 25.53% had no asthma or polyps (n = 96). After adjusting for all factors, there were significantly more QOL improvements in patients with both asthma and nasal polyps from baseline to 1-month (β-coefficient = -10.05; 95% CI, -15.86 to -4.23; p = 0.001) and 3-month follow-up (β-coefficient = -8.27; 95% CI, -14.98 to -1.56; p = 0.016), and patients with asthma alone from baseline to 6-month follow-up (β-coefficient = -8.78; 95% CI, -17.45 to -0.11; p = 0.047), when compared to patients without asthma or nasal polyps. CONCLUSION CRS patients with both asthma and nasal polyps or asthma alone experience a larger QOL benefit from FESS immediately after FESS compared to CRS patients without asthma or polyps.
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Affiliation(s)
- Zi Zhang
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, U.S.A
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Nguyen DT, Guillemin F, Arous F, Jankowski R. Assessment of quality-of-life outcomes after surgery for nasal polyposis with the DyNaChron questionnaire. Eur Arch Otorhinolaryngol 2014; 272:367-75. [PMID: 24899410 DOI: 10.1007/s00405-014-3109-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/19/2014] [Indexed: 01/11/2023]
Abstract
This prospective study assesses outcomes at 6 weeks and 7 months after radical ethmoid surgery in 65 patients with nasal polyposis using a new and detailed instrument, the DyNaChron questionnaire, which was filled in the day prior to surgery and at 6 weeks and 7 months after surgery at follow-up visits. Before surgery, the leading bothersome symptoms were olfactory disturbances (7.74 ± 2.81) and nasal obstruction (6.66 ± 2.28). After surgery (6th week and 7th month), there was a clear improvement of all symptoms including nasal obstruction, olfactory disturbances, anterior rhinorrhea, postnasal discharge, facial pain/headache and cough in comparison to baseline (p < 0.0001). Nasal obstruction was the most improved symptom (effect size of 2.24). At 7th post-operative month, the sense of smell continued to improve slightly. By contrast, the postnasal discharge score that was significantly improved at 6th post-operative week tended to worsen at 7 months (p = 0.0045). Before surgery, strong psychosocial impacts were observed in association with nasal obstruction and anterior rhinorrhea. The physical impacts of each symptom were proportionally correlated to the symptom score before and after surgery. The quality of life (QOL) related to each symptom was clearly better at 6 weeks and remained steady at 7 months after surgery. In conclusion, olfactory disorders and postnasal rhinorrhea were the main remaining symptoms after sinus surgery despite a global improvement of symptoms and quality of life. The earlier time point to stabilize QOL outcomes of endoscopic sinus surgery could be suggested at 6 weeks after surgery.
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Affiliation(s)
- Duc Trung Nguyen
- Departments of ENT, Head and Neck Surgery, Nancy University Hospital - Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29, Av. du Maréchal de Lattre de Tassigny, 54000, Nancy, France,
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Abstract
Olfactory disorders are common and affect about one-fifth of the general population. The main causes of olfactory loss are post viral upper respiratory infection, nasal/sinus disease, and head trauma and are therefore very frequent among patients in ear, nose, and throat clinics. We have systematically reviewed the impact of quantitative, qualitative, and congenital olfactory disorders on daily life domains as well as on general quality of life and depression. From the extensive body of literature, it can be concluded that loss of the sense of smell leads to disturbances in important areas, mainly in food enjoyment, detecting harmful food and smoke, and to some extent in social situations and working life. Most patients seem to deal well and manage those restrictions. However, a smaller proportion has considerable problems and expresses a noticeable reduction in general quality of life and enhanced depression. The impact of coping strategies is discussed.
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Affiliation(s)
- Ilona Croy
- Occupational and Environmental Medicine, Medicinaregatan 16, University of Gothenburg, Box 414, 40530 Göteborg, Sweden.
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Katotomichelakis M, Simopoulos E, Zhang N, Tripsianis G, Danielides G, Livaditis M, Bachert C, Danielides V. Olfactory dysfunction and asthma as risk factors for poor quality of life in upper airway diseases. Am J Rhinol Allergy 2013; 27:293-8. [PMID: 23883811 DOI: 10.2500/ajra.2013.27.3903] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The study of olfaction/quality of life (QoL) interaction has not been adequately discussed and remains to be further explored. Determination of clinical predictors for poor QoL may support consultation of respective patients. This study explores QoL of patients with olfactory dysfunction and evaluates associated clinical risk factors for QoL prediction. METHODS One hundred eight patients suffering from chronic rhinosinusitis (CRS) and allergic rhinitis (AR) and 30 healthy subjects were studied. Olfactory function was evaluated using objective olfactory test. All patients completed six validated questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits [QOD]) and for assessing psychological state (Zung Anxiety Scale [ZAS], State-Trait Anxiety Inventory, Zung Depression Scale, and Beck Depression Inventory [BDI]) or a generic one (Short Form 36). RESULTS Significantly poorer QoL and more severe anxiety and depression symptoms were observed in anosmic (all p < 0.001) and hyposmic patients compared with controls. Anosmic patients presented significantly worse results compared with hyposmic and normosmic patients. However, higher scores were observed in hyposmic compared with normosmic patients only in the QOD, ZAS, and BDI scale. Patients with CRS presented significantly poorer QoL than patients with AR only. The presence of nasal polyps or concomitant AR in patients with CRS did not show any differentiation in the results. Asthma was associated with significantly worse scores in all the psychometric questionnaires. CONCLUSION Olfactory dysfunction was found to decrease QoL among patients. Anosmia, CRS disease, and asthma as clinical predictors were proved to be independently correlated with QoL, anxiety, and depression levels.
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Affiliation(s)
- Michael Katotomichelakis
- Otorhinolaryngology and Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Nordin S, Olsson P, Hedén Blomqvist E, Stjärne P, Ehnhage A. Effects of FESS and additional fluticasone propionate nasal drops on psychological well-being in nasal polyposis with asthma. Acta Otolaryngol 2013; 133:939-43. [PMID: 23944945 DOI: 10.3109/00016489.2013.783715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION A combined therapy of fluticasone propionate nasal drops (FPND) and functional endoscopic sinus surgery (FESS) can improve quality of life (QoL). When compared with prior data, the results imply that a generic measure of psychological aspects of QoL may be better than measures of respiratory symptoms and clinical parameters to capture a patient's perception of the disease and its treatment. OBJECTIVE To better understand effects of FPND and FESS on generic QoL. METHODS Sixty nasal polyposis patients with concomitant asthma completed participation in a randomized, double-blind, placebo-controlled, 14-week study in which they responded to the General Well-Being Schedule (GWBS). RESULTS GWBS scores (i) increased significantly after administration of FPND, independent of FESS (from lower than normal to normal), (ii) increased after FESS independent of FPND (from lower than normal to normal), and (iii) increased additively after FPND and FESS.
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37
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Jalessi M, Farhadi M, Kamrava SK, Amintehran E, Asghari A, Rezaei Hemami M, Mobasseri A, Masroorchehr M. The reliability and validity of the persian version of sinonasal outcome test 22 (snot 22) questionnaires. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:404-8. [PMID: 24349728 PMCID: PMC3838650 DOI: 10.5812/ircmj.7937] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/22/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The quality of life (QOL) is an important indicator for disease-severity classification and outcome measurement in obtaining treatment sinonasal diseases. The sinonasal outcome test 22 (SNOT 22) questionnaire has been introduced as the best specific sinonasal instrument for QOL measurement. OBJECTIVES To prepare a valid and reliable Persian language version of SNOT 22 questionnaire. PATIENTS AND METHODS After forward and backward translation of the original version of SNOT 22 questionnaire from English to Persian, a group of patients with nasal septal deviation who need septal surgery and another group of healthy volunteers answered the Persian version of the questionnaire. The responsiveness rate, validity (Pearson correlations and differential validity) and reliability (internal consistency and test-retest reliability) of the 22 items of the questionnaire was calculated. P value < 0.05 was considered significant. RESULTS Thirty adults with nasal septal deviation need surgical correction and 30 healthy volunteers were included (mean age 30.4 ± 7.1 vs. 33 ± 6.7, P value = 0.148). The questionnaire was introduced to subjects two times with a two-week-period gap. Total responsiveness rate for 22 items was more than 97%. The total Cronbach's Alfa coefficient was 0.898 (ranging 0.890-0.903). The Pearson correlations were 0.85 and 0.96 for patients and healthy volunteers, respectively. The mean total score were 25.6 ± 13.3 (range 6-52) and 7.6 ± 9.1 (range 0-45) in patients and healthy volunteers, respectively (P < 0.0001). The subscales scores were also significantly different between two groups. CONCLUSIONS The Persian version of SNOT 22 questionnaire is a valid and reliable instrument for accessing sinonasal diseases in Persian-speaking people.
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Affiliation(s)
- Maryam Jalessi
- ENT-Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Farhadi
- ENT-Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyyed Kamran Kamrava
- ENT-Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ebrahim Amintehran
- ENT-Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Alimohammad Asghari
- ENT-Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Alimohammad Asghari, ENT-Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166504294, Fax: +98-2166504294, E-mail:
| | - Mohsen Rezaei Hemami
- ENT-Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Alireza Mobasseri
- ENT-Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammadreza Masroorchehr
- Department of Iranian Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Alobid I, Mullol J. Role of medical therapy in the management of nasal polyps. Curr Allergy Asthma Rep 2013; 12:144-53. [PMID: 22274542 DOI: 10.1007/s11882-012-0247-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nasal and paranasal sinus mucosa that, despite differing hypotheses regarding its cause, remains poorly understood. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, postnasal drip, and facial pain or pressure. Among the objectives of CRSwNP management are to eradicate nasal polyps from nasal and sinusal cavities, eliminate symptoms, and prevent recurrences. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating CRSwNP. Other potential treatments are nasal saline irrigation and antihistamines (in allergic conditions). Endoscopic sinus surgery is recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.
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Affiliation(s)
- Isam Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic i Universitari, IDIBAPS, Barcelona, Catalunya, Spain
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Mullol J, Picado C. Rhinosinusitis and nasal polyps in aspirin-exacerbated respiratory disease. Immunol Allergy Clin North Am 2012; 33:163-76. [PMID: 23639706 DOI: 10.1016/j.iac.2012.11.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The presence of aspirin-exacerbated respiratory disease (AERD) in a patient with chronic rhinosinusitis with nasal polyps and asthma is associated with severe eosinophilic upper and lower airway disease. This article deals with the inflammatory disease of the respiratory tract as it relates to the sinuses. Involvement of the sinuses in AERD is almost universal, depending on the stage of onset of the disease and evaluation by computed tomography. This article explores the clinical aspects, physiopathology, and treatment of rhinosinusitis as it relates to AERD.
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Affiliation(s)
- Joaquim Mullol
- Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, University of Barcelona, Barcelona, Catalonia, Spain.
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The impact of mental health on chronic rhinosinusitis symptom scores. Eur Arch Otorhinolaryngol 2012; 270:1361-4. [PMID: 23095946 DOI: 10.1007/s00405-012-2230-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
We aimed to assess whether anxiety and depression influence a patient's subjective symptom scores in chronic rhinosinusitis (CRS). Fifty-seven consecutive patients referred with CRS were asked to complete Sinonasal Outcome Test-22 (SNOT22) and Hospital Anxiety and Depression Score (HADS) questionnaires. Spearman's rank correlation was used to test association between SNOT22 and HADS. Linear regression was used to simultaneously analyse SNOT, HADS, patient age and gender. Mean anxiety score was 7.9 (range 0-19) with 32 % scoring over 11 (A score of ≥ 11 for either anxiety or depression is suggestive). Mean depression score was 5.0 (range 0-17), with 11 % scoring over 11. Five patients scored over 11 for both domains in the HADS questionnaire. Total SNOT22 and both anxiety (Spearman's ρ = 0.48, p = 0.0002) and depression scores (ρ = 0.44, p = 0.0007) revealed a strong association. We also identified a very strong association between psychological symptoms (questions 11-20) in SNOT22 and anxiety (ρ = 0.60, p = 0.0001) and depression scores (ρ = 0.341, p = 0.002). However, there was no association between nose-specific symptoms in SNOT22 and anxiety score in HADS (ρ = 0.18, p = 0.1775), but there was a strong association between nose-specific symptoms of SNOT22 and depression score in HADS (ρ = 0.32, p = 0.02). There is a strong association between total SNOT 22 and HADS score, but this appears to be due to the impact on generic quality of life items rather than disease-specific symptoms. This supports inclusion of global items in the SNOT22, but also use of two separate subscales when interpreting data.
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Jiang RS, Wu SH, Tsai CC, Li YH, Liang KL. Efficacy of Chinese Herbal Medicine Compared with a Macrolide in the Treatment of Chronic Rhinosinusitis without Nasal Polyps. Am J Rhinol Allergy 2012; 26:293-7. [DOI: 10.2500/ajra.2012.26.3778] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background This study was designed to examine the efficacy of Chinese herbal medicine (CHM) in the treatment of chronic rhinosinusitis (CRS) without nasal polyps. Methods Patients with CRS without nasal polyps were enrolled in the study. Before treatment, they were evaluated by the Taiwanese version of the 20-item Sino-Nasal Outcome Test (TWSNOT-20), nasal endoscopy, saccharin test, and bacterial culture. Then, they were randomized to take CHM (Tsang-Erh-San extract granules and Houttuynia extract powder) or erythromycin for 8 weeks. After treatment, they were evaluated again by the TWSNOT-20, nasal endoscopy, saccharin test, and bacterial culture. Results Fifty-three patients completed the study with 26 in the CHM group and 27 in the erythromycin group. In both the CHM and the erythromycin groups, TWSNOT-20 scores significantly decreased after treatment, but the decrease was not significantly different between the two groups. However, the saccharin transit times were shortened in more patients in the CHM group than in patients in the erythromycin group. Conclusion Our results showed CHM had an efficacy similar to that of macrolides in the treatment of CRS without nasal polyps. However, a placebo effect remained possible in both treatment groups.
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Affiliation(s)
- Rong-San Jiang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine Chung Shan Medical University, Taichung, Taiwan
| | - Shang-Heng Wu
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Chen Tsai
- Department of Chinese Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ya-Hsin Li
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
| | - Kai-Li Liang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, National Yang-Ming Medical University, Taipei, Taiwan
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Quintanilla-Dieck L, Litvack JR, Mace JC, Smith TL. Comparison of disease-specific quality-of-life instruments in the assessment of chronic rhinosinusitis. Int Forum Allergy Rhinol 2012; 2:437-43. [PMID: 22696495 DOI: 10.1002/alr.21057] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/04/2012] [Accepted: 04/24/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many disease-specific, quality-of-life (QOL) instruments exist for chronic rhinosinusitis (CRS), resulting in confusion about the best application and use of each instrument. We hypothesized that the most prevalently utilized instruments do not strongly correlate in all domains, but rather act in complementary fashion for QOL assessment. METHODS A systematic literature review (MEDLINE) was performed to identify the type and frequency of available CRS-specific QOL instruments. Univariate analyses of the 3 most common instruments (Rhinosinusitis Disability Index [RSDI], Chronic Sinusitis Survey [CSS] and 22-item Sinonasal Outcomes Test [SNOT-22]) were performed using a multi-institutional prospective cohort of sinusitis patients. RESULTS Systematic literature review found that the SNOT-20 (and its derivatives), RSDI, and CSS are the most commonly utilized CRS-specific QOL instruments. The majority of RSDI domains were weakly or not correlated with the CSS domains (r = 0.097-0.501; p < 0.001). In contrast, the RSDI was highly correlated with the SNOT-22 (r ≥ 0.666; p < 0.001). Patients with asthma and/or allergies reported significantly worse CSS scores (p < 0.001). Comorbidities had no significant impact on RSDI or SNOT-22 responses. CONCLUSION Different disease-specific CRS QOL instruments measure different aspects of the patient's experience. The RSDI and SNOT-22 are more sensitive to measuring the emotional impact of CRS, whereas the CSS examines medication use and symptoms. These instruments play complementary roles in the evaluation of CRS treatment outcomes.
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Affiliation(s)
- Lourdes Quintanilla-Dieck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA
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Simopoulos E, Katotomichelakis M, Gouveris H, Tripsianis G, Livaditis M, Danielides V. Olfaction-associated quality of life in chronic rhinosinusitis: adaptation and validation of an olfaction-specific questionnaire. Laryngoscope 2012; 122:1450-4. [PMID: 22566102 DOI: 10.1002/lary.23349] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/03/2012] [Accepted: 03/15/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To detect validity and reliability of the Questionnaire of Olfactory Disorders (QOD) compared to other quality-of-life (QoL) questionnaires, to explore its ability to reflect olfaction-related QoL changes, and to investigate age- and gender-related effects of olfactory changes on QOD results. STUDY DESIGN Prospective clinical study. METHODS One hundred two patients (56 males, 46 females; mean age, 41.15 ± 16.31 years), suffering from chronic rhinosinusitis, whose olfactory function was measured using Sniffin' Sticks test were studied. All patients completed three validated general health-related QoL questionnaires (Short Form-36 Health Survey [SF-36], Beck Depression Inventory [BDI], and Zung anxiety scale), and the olfaction-related QOD. RESULTS Internal consistency and test-retest reliability for the QOD was high. Convergent validity assessment showed statistically significant negative correlations of the QOD and the QOD-negative statements (NS) with overall SF-36 score (P < .05 for all groups) and positive correlations of the same scores with BDI and Zung (P < .001). The QOD-positive statements (PS) was positively correlated to SF-36. Discriminative validity demonstrated statistically significant differences of the QOD and QOD-NS scores between all groups of patients (normosmics, hyposmics, anosmics; all pairwise comparisons, P < .001). The QOD-PS score was significantly higher in normosmics and hyposmics compared to anosmics. Patients' age was negatively correlated with the QOD-PS, whereas it was positively correlated with BDI (P < .001) and Zung (P = .007). Females presented significantly higher scores in the QOD, QOD-NS, BDI, and Zung (all P < .001) compared to males. CONCLUSIONS The QOD proved to be a valid, reliable, and easy-to-use method of assessment of olfaction-related QoL with high specificity and sensitivity.
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Affiliation(s)
- Efthimios Simopoulos
- Department of Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Ehnhage A, Olsson P, Kölbeck KG, Skedinger M, Stjärne P. One year after endoscopic sinus surgery in polyposis: asthma, olfaction, and quality-of-life outcomes. Otolaryngol Head Neck Surg 2012; 146:834-41. [PMID: 22287580 DOI: 10.1177/0194599811435638] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Nasal polyposis is a disease known to be associated with asthma. The long-term effects of surgical treatment on lower airways have not been sufficiently studied. STUDY DESIGN One-year follow-up of a double-blind, randomized, placebo-controlled study. SETTING The study was conducted at the Karolinska University Hospital, Stockholm, Sweden. SUBJECTS AND METHODS Fifty-one patients, age 18 years or older, with nasal polyposis and asthma were evaluated 1 year after endoscopic sinus surgery (ESS). Outcomes included dyspnea/cough scores, mean daily peak expiratory flow rate, spirometry, butanol test, olfaction scores, peak nasal inspiratory flow, polyp scores, and health-related quality of life (SF-36). RESULTS The short-term postsurgery improvements in asthma symptom scores, daily peak expiratory flow rate, all nasal parameters including olfaction, and quality-of-life scores were generally maintained 1 year after ESS. CONCLUSION Endoscopic sinus surgery had beneficial long-term effects on asthma, olfaction, and quality of life in patients with nasal polyposis. This is the first study to show long-term benefits of ESS on butanol tests in patients with nasal polyposis.
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Affiliation(s)
- Anders Ehnhage
- Department of Clinical Science, Intervention and Technology, Division of Otorhinolaryngology, Karolinska Institutet, Stockholm, Sweden.
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Videler WJ, Badia L, Harvey RJ, Gane S, Georgalas C, van der Meulen FW, Menger DJ, Lehtonen MT, Toppila-Salmi SK, Vento SI, Hytönen M, Hellings PW, Kalogjera L, Lund VJ, Scadding G, Mullol J, Fokkens WJ. Lack of efficacy of long-term, low-dose azithromycin in chronic rhinosinusitis: a randomized controlled trial. Allergy 2011; 66:1457-68. [PMID: 21884529 DOI: 10.1111/j.1398-9995.2011.02693.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In persistent chronic rhinosinusitis (CRS), conventional treatment is often insufficient. Long-term, low-dose administration of macrolides has been suggested as a treatment option. The MACS (Macrolides in chronic rhinosinusitis) study is a randomized placebo-controlled trial evaluating the efficacy of azithromycin (AZM) in CRS. METHODS We describe a group of patients with recalcitrant CRS with and without nasal polyps unresponsive to optimal medical and (in 92% also) surgical treatment. Patients were treated with AZM or placebo. AZM was given for 3 days at 500 mg during the first week, followed by 500 mg per week for the next 11 weeks. Patients were monitored until 3 months post-therapy. The assessments included Sino-Nasal Outcome Test-22 (SNOT-22), a Patient Response Rating Scale, Visual Analogue Scale (VAS), Short Form-36 (SF-36), rigid nasal endoscopy, peak nasal inspiratory flow (PNIF), Sniffin' Sticks smell tests and endoscopically guided middle meatus cultures. RESULTS Sixty patients with a median age of 49 years were included. Fifty per cent had asthma and 58% had undergone revision sinus surgery. In the SNOT-22, Patient Response Rating Scale, VAS scores and SF-36, no significant difference between the AZM and the placebo groups was demonstrated. Nasal endoscopic findings, PNIF results, smell tests and microbiology showed no relevant significant differences between the groups either. CONCLUSION At the investigated dose of AZM over 3 months, no significant benefit was found over placebo. Possible reasons could be disease severity in the investigated group, under-dosage of AZM and under-powering of the study. Therefore, more research is urgently required.
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Affiliation(s)
- W J Videler
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, the Netherlands
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Nordin S, Blomqvist EH, Olsson P, Stjärne P, Ehnhage A. Effects of smell loss on daily life and adopted coping strategies in patients with nasal polyposis with asthma. Acta Otolaryngol 2011; 131:826-32. [PMID: 21595508 DOI: 10.3109/00016489.2010.539625] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Results from prior studies of quality of life (QoL) in heterogeneous patient groups (regarding disorder type and etiology) with olfactory disorders may be useful also for understanding QoL in homogeneous patient groups. Diagnosis and treatment of smell loss should be given high priority in polyposis with asthma, and coping strategies can be suggested to these patients. OBJECTIVES To investigate the effects of smell loss on daily life and coping strategies in patients with smell loss without dysosmia and with nasal polyposis with asthma as the only primary etiology, and to compare these results with those from a prior study of a patient group with heterogeneous olfactory disorders and etiology. METHODS Fifty patients with smell loss and with nasal polyposis and asthma responded to questions about consequences of smell loss, QoL, psychological well-being and distress, and coping strategies. RESULTS Negative consequences of smell loss, associated risks, and diminished food enjoyment were commonly reported, and various aspects of QoL were rated as being deteriorated. Psychological well-being was found to be poorer than normal, and use of both problem- and emotion-focused strategies was common. The results from this homogeneous patient group are very similar to those previously obtained from a heterogeneous group.
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Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden.
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Development and validity of the DyNaChron questionnaire for chronic nasal dysfunction. Eur Arch Otorhinolaryngol 2011; 269:143-53. [PMID: 21739093 DOI: 10.1007/s00405-011-1690-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 06/21/2011] [Indexed: 10/18/2022]
Abstract
Nasal symptoms are the main elements that lead to a therapeutic decision and allow for evaluating treatment effects or natural evolution. Despite availability of several questionnaires with good measurement qualities, no systematic assessment takes into account the specific physical and psychosocial consequences of each of the six main nasal symptoms, independently of the disease. We proposed to measure these symptoms with the use of a self-reporting questionnaire and to test the validity of the questionnaire in a large representative sample of patients attending outpatient rhinologic clinics. The study was conducted in two parts: (1) expert-based development and testing of the face validity of a questionnaire in French; and (2) validity testing, including construct validity by factor analysis, reproducibility by intraclass correlation coefficient (ICC) and Bland and Altman plots, and sensitivity to change by standardized response means, on a large sample of patients in a prospective multicenter study. DyNaChron, a questionnaire with 78 items divided into six domains and exploring both the physical and psychosocial repercussions of CND, was developed. In total, 759 patients completed the questionnaire at a first visit to a clinic, and 539 again 19.5 days later, on average. The questionnaire structure was confirmed to be composed of six domains (6 factors explaining 68.7% of the variance), with two dimensions in each domain. The questionnaire's convergent validity was confirmed; the Cronbach alpha coefficient for domains was high (0.93-0.96), the ICC ranged from 0.8 to 0.92, and the questionnaire's sensitivity to change was greater for patients with improved health status than for those with worsened status. DyNaChron is a well-structured questionnaire with a high degree of internal consistency and all properties needed to be used in research. It should now be compared with other questionnaires and objective measures to assess whether or not DyNaChron better measures disease severity and its changes. Further work will involve shortening the instrument for use in clinical practice and create a "patient symptomatology score".
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Liang KL, Su YC, Tsai CC, Lin JS, Jiang RS, Su MC. Postoperative Care with Chinese Herbal Medicine or Amoxicillin after Functional Endoscopic Sinus Surgery: A Randomized, Double-blind, Placebo-controlled Study. Am J Rhinol Allergy 2011; 25:170-5. [DOI: 10.2500/ajra.2011.25.3610] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background A number of herbal preparations have been reported being used as adjunctive treatment of patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS). This study was designed to examine the efficacy of Chinese herbal medicine (CHM) in the postoperative care of post-FESS patients. Methods Patients with CRS who underwent FESS were prospectively enrolled in the study. Before surgery, they were evaluated by various methods, including the Chinese version of the Rhinosinusitis Outcome Measure (CRSOM-31), nasal endoscopy, acoustic rhinometry, and computed tomography (CT). After surgery, they were randomized to take CHM (Tsang-Erh-San extract granules and Houttuynia extract powder) for 8 weeks, amoxicillin for 4 weeks, or placebo. They were revaluated by CRSOM-31, nasal endoscopy, and acoustic rhinometry at 8 weeks and by CT at 12 weeks after surgery. Results Ninety-seven patients (33 in the CHM group, 34 in the amoxicillin group, and 30 in the placebo group) completed the study. In the CHM group, CRSOM-31 and endoscopic scores significantly decreased, and the second minimal cross-sectional area of the nasal cavity measured by acoustic rhinometry significantly increased after treatment. In the amoxicillin and placebo groups, CRSOM-31, endoscopic, and CT scores significantly decreased after treatment. However, there were no significant differences in subjective and objective treatment outcomes among three groups of patients. Conclusion Our results showed there was no significant benefit of using CHMs (Tsang-Erh-San extract granules and Houttuynia extract powder) or oral amoxicillin in post-FESS care of CRS patients. Additional investigation is necessary for post-FESS care.
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Affiliation(s)
- Kai-Li Liang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, National Yang-Ming Medical University, Taipei, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Yi-Chang Su
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chen-Chen Tsai
- Department of Chinese Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jui-Shan Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Rong-San Jiang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Mao-Chang Su
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Department of Otolaryngology, Chung-Shan Medical University Hospital, Taichung, Taiwan
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