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Dąbrowska-Bień J, Skarżyński H, Górski SF, Skarżyński PH. Quality of Life in Patients with Nasal Obstruction after Septoplasty: A Single Institution Prospective Observational Study. Int Arch Otorhinolaryngol 2021; 25:e575-e579. [PMID: 34737830 PMCID: PMC8558945 DOI: 10.1055/s-0040-1722162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/25/2020] [Indexed: 10/27/2022] Open
Abstract
Introduction Nasal obstruction is a common symptom in otorhinolaryngological practice. It can impact significantly on the quality of life of the individual. Objective The primary goal of the present study was to evaluate quality of life after septoplasty in adults with nasal obstruction. A secondary goal was to assess the effectiveness of septoplasty. Methods This was a single institution prospective observational study. Patients had experienced septal deviation and symptomatic nasal obstruction with no benefit from medical treatment. There were 51 patients who completed the Nasal Obstruction Symptom Evaluation (NOSE-POL) scale as well as theVisual Analogue Scale (VAS) before undergoing septoplasty, 3 months later, and finally 7 months after surgery. Patients evaluated changes in their nasal obstruction and changes in their quality of life using the Clinical Global Impression Scale (CGI-S). Results There was a significant improvement in nasal obstruction after septoplasty. Before septoplasty, the mean score on NOSE was 60.3 ± 20.4; 3 months after surgery, it was 32.9 ± 16.8; and 7 months after surgery it was 39.6 ± 33.2. The VAS results also proved a significant enhancement in nasal obstruction after septoplasty. Patients reported an improvement in nasal obstruction as well as a positive change in quality of life, confirming the effectiveness of septoplasty. Conclusions In patients with deformed septum, septoplasty contributes to high satisfaction of the patient and a compelling improvement in disease-specific quality of life. The NOSE-POL questionnaire is a useful tool for measuring the outcomes of this procedure.
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Affiliation(s)
- Justyna Dąbrowska-Bień
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Otorhinolaryngology Surgery Clinic, World Hearing Center, Nadarzyn/Warsaw, Poland
| | - Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Otorhinolaryngology Surgery Clinic, World Hearing Center, Nadarzyn/Warsaw, Poland
| | - Sebastian Filip Górski
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Otorhinolaryngology Surgery Clinic, World Hearing Center, Nadarzyn/Warsaw, Poland
| | - Piotr Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Otorhinolaryngology Surgery Clinic, World Hearing Center, Nadarzyn/Warsaw, Poland.,Department of Heart Failure and Cardiac Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland.,Institute of Sensory Organs, Kajetany/Warsaw, Poland
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Surgery to relieve nasal obstruction: outcome for 366 patients operated on by one senior surgeon. Eur Arch Otorhinolaryngol 2021; 278:3867-3875. [PMID: 33624151 PMCID: PMC8382632 DOI: 10.1007/s00405-021-06696-7] [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] [Received: 11/25/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
Background Studies of patient-rated outcome in septoplasty and turbinoplasty most frequently involve several surgeons with varying surgical skills, techniques and experience. The aim of the present study was to evaluate outcome based on one experienced surgeon. Methods Three hundred and sixty-six consecutive patients referred for nasal obstruction were included. All the patients were examined with nasal endoscopy before and after decongestion, they filled out a nose VAS and rated their overall general health before and three to six months after surgery. The patients underwent septoplasty, septoplasty plus turbinoplasty or turbinoplasty. Results The mean nose VAS for nasal obstruction (0–100) preoperatively was 64.7 for all patients. Patients undergoing septoplasty (n = 159) were younger than patients undergoing septoplasty + turbinoplasty (n = 79) or patients undergoing turbinoplasty alone (n = 128). The nose VAS for nasal obstruction improved significantly in all three groups and 25% had a normal nose VAS after surgery in the septoplasty and septoplasty + turbinoplasty groups compared to only 8% in the turbinoplasty alone group. There was no significant difference in the improvement in nasal obstruction between septoplasty and septoplasty + turbinoplasty, but the septoplasty + turbinoplasty group experienced a significantly greater improvement in general health. Conclusions In 366 patients operated on by one experienced surgeon, septoplasty and septoplasty + turbinoplasty were more effective at relieving nasal obstruction than turbinoplasty alone. Septoplasty + turbinoplasty resulted in a greater improvement in general health than septoplasty alone, despite the same improvement in nasal obstruction, indicating a beneficial effect of additional turbinoplasty in septoplasty.
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Nilsen AH, Helvik AS, Thorstensen WM, Salvesen Ø, Bugten V. General health, vitality, and social function after sinus surgery in chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2019; 4:476-483. [PMID: 31637289 PMCID: PMC6793610 DOI: 10.1002/lio2.299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/15/2019] [Accepted: 07/24/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives Chronic rhinosinusitis (CRS) has an impact on health-related quality of life (HRQOL). The objective of this study was to examine generic and disease-specific HRQOL and symptoms in CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps before and 6 months after sinus surgery, and to identify preoperative patient factors associated with HRQOL outcome in the two groups separately. Methods This prospective, observational study consisted of 220 CRSwNP and 196 CRSsNP patients. Generic and disease-specific HRQOL were measured using the Short-Form-Health-Survey (SF-36) and Sino-Nasal-Outcome-Test (SNOT-20). Symptoms were assessed on a visual analog scale. Results Preoperatively, CRSwNP patients reported worse score in general health (SF-36), rhinologic subset (SNOT-20): nasal obstruction, nasal discharge, and altered sense of smell compared to CRSsNP patients, who reported worse score in physical role, bodily pain, ear/face subset, and facial pain. After surgery, generic and disease-specific HRQOL and symptoms improved in both groups. CRSwNP patients had greater improvement in general health, vitality and social function, nasal obstruction, and altered sense of smell, compared to CRSsNP-patients. In both groups, higher age, daily smoking, and having had sinus surgery previously were associated with less generic HRQOL improvement, in addition to female sex and allergy in CRSsNP patients. Conclusion The greater improvement in general health, vitality, and social function after surgery may indicate a greater potential for generic HRQOL improvement in CRSwNP patients compared to CRSsNP patients. Female sex and allergy was associated with less improvement of generic HRQOL in the CRSsNP group, but not in the CRSwNP group. Level of evidence 2c outcome research.
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Affiliation(s)
- Ann Helen Nilsen
- Department of Otolaryngology - Head and Neck Surgery St Olav's University hospital of Trondheim Trondheim Norway.,Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
| | - Anne-Sofie Helvik
- Department of Otolaryngology - Head and Neck Surgery St Olav's University hospital of Trondheim Trondheim Norway.,Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
| | - Wenche Moe Thorstensen
- Department of Otolaryngology - Head and Neck Surgery St Olav's University hospital of Trondheim Trondheim Norway.,Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
| | - Vegard Bugten
- Department of Otolaryngology - Head and Neck Surgery St Olav's University hospital of Trondheim Trondheim Norway.,Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
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Effect of Nasal Obstructive Disorders on Sinonasal Symptoms in Children with Different Levels of Bronchial Asthma Control. Can Respir J 2018; 2018:4835823. [PMID: 29854029 PMCID: PMC5964596 DOI: 10.1155/2018/4835823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
Abstract
Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p < 0.0001) and ACQ-5 and SNOT-20 (R=0.42, p < 0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP.
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Nilsen AH, Helvik AS, Thorstensen WM, Bugten V. A comparison of symptoms and quality of life before and after nasal septoplasty and radiofrequency therapy of the inferior turbinate. BMC EAR, NOSE, AND THROAT DISORDERS 2018; 18:2. [PMID: 29422774 PMCID: PMC5787231 DOI: 10.1186/s12901-017-0050-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 12/22/2017] [Indexed: 01/22/2023]
Abstract
Background The primary goal of this study is to compare pre- and postoperative symptoms and health related quality of life (HQOL) in 57 patients who underwent septoplasty (group-1), 56 patients who underwent septoplasty combined with radiofrequency therapy of inferior turbinates (RFIT) (group-2) and 58 patients who underwent RFIT alone (group-3). The secondary goal is to investigate if the change in symptoms and HQOL differed between these three patient groups after surgery. Methods All patients reported symptoms on a visual analogue scale (VAS) and HQOL on Sino-Nasal-Outcome-Test-20 (SNOT-20) and Short-Form-Health-Survey-36 (SF-36) before and 6 months after surgery. The pre- and postoperative scores and improvement were compared within and between the three patient groups. Results Preoperatively the three patient groups had a fairly similar symptom burden and HQOL, except for group-1 which reported more symptoms of oral breathing than group-3 (p < 0.01) and group-3 which reported more problems in the ear/facial--subset of SNOT-20 and in the general-mental-health-domain of SF-36 than group-1 (p < 0.01). Postoperatively all patient groups reported improved symptom scores of nasal obstruction, nasal discharge, snoring, oral breathing and reduced general health (p < 0.01), and better HQOL (p < 0.05). Patients in group-2 had less symptoms of nasal obstruction than group-3 (p < 0.05). Postoperative symptom score for nasal obstruction was 29.1 (SD67.6) in group-1, 27.5 (SD22.5) in group-2 and 37.2 (SD24.8) in group-3. Revision cases reported more nasal obstruction postoperatively; 41.3 (SD27) than non revision cases; 28.6 (SD24) (p < 0.01). The HQOL after surgery was about the same in all three patient groups, but we found that patients with comorbidities as sleep apnea and asthma reported worse HQOL than other patients (p < 0.01). Conclusion Surgical treatment of nasal obstruction led to less symptoms and better HQOL for all three patient groups. Comparing the postoperative scores between the patient groups we find that all groups reached the same level of HQOL. Regarding symptoms, the patients who underwent septoplasty combined with RFIT reported postoperatively less nasal obstruction than patients who underwent RFIT alone which may indicate that a combined procedure of septoplasty and RFIT is better than RFIT alone to treat nasal obstruction. Furthermore, revision cases, patients with sleep apnea and asthma patients seem to have poorer outcome after surgery than other patients. Both disease specific and general QOL instruments add valuable information for identifying factors influencing outcome. Electronic supplementary material The online version of this article (10.1186/s12901-017-0050-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann Helen Nilsen
- 1Department of Ear, Nose and Throat, Head and Neck Surgery, St Olavs University Hospital, 7006 Trondheim, Norway
| | - Anne-Sofie Helvik
- 1Department of Ear, Nose and Throat, Head and Neck Surgery, St Olavs University Hospital, 7006 Trondheim, Norway.,2Institute of Public Health and General Practice, Norwegian University of Science and Technology, 7006 Trondheim, Norway
| | - Wenche Moe Thorstensen
- 1Department of Ear, Nose and Throat, Head and Neck Surgery, St Olavs University Hospital, 7006 Trondheim, Norway.,3Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7006 Trondheim, Norway
| | - Vegard Bugten
- 1Department of Ear, Nose and Throat, Head and Neck Surgery, St Olavs University Hospital, 7006 Trondheim, Norway.,3Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7006 Trondheim, Norway
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Bugten V, Nilsen AH, Thorstensen WM, Moxness MHS, Amundsen MF, Nordgård S. Quality of life and symptoms before and after nasal septoplasty compared with healthy individuals. BMC EAR, NOSE, AND THROAT DISORDERS 2016; 16:13. [PMID: 27799847 PMCID: PMC5084441 DOI: 10.1186/s12901-016-0031-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/31/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The goal of this study is to compare quality of life (Qol) and symptoms in 91 patients with a deviated nasal septum preoperatively and postoperatively with a control group of 93 healthy individuals. METHODS All patients reported Qol on Sino-Nasal-Outcome-Test-20 (SNOT-20) and symptoms on visual analogue scale (VAS) preoperatively and 6 months after surgery and the results were compared with the controls. RESULTS Mean SNOT-20 score improved from 1.8(SD0.9) preoperatively to 0.9(SD0.8) postoperatively (p < 0.000) but did not reach the same level as the controls 0.4(SD0.5). Septum surgery leads to a significant symptom improvement for all symptoms investigated (p < 0.000) on VAS. The patients reached the same level as the healthy controls in 6 of 11 symptoms (headache, facial pain, sneezing, trouble with rhinosinusitis, cough and snoring) but the patients group had significantly more trouble with nasal blockage (VAS 29 vs 9), change in sense of smell (VAS 12 vs5), nasal discharge (VAS 22 vs 11), oral breathing (VAS 23 vs 13) and reduced general health (VAS 12 vs 5) also postoperatively (p < 0.01). Sub analyses showed that allergic patients reported a VAS score of 36 (SD30) for nasal blockage and 17 (SD22) for facial pressure postoperatively versus 23(SD22) and 6(SD13) in non-allergic patients (p < 0.03 and p < 0.01). Patients with obstructive sleep apnea syndrome (OSAS) reported more trouble with snoring on VAS postoperatively than other patients, 42(SD28) versus 20(SD23) (p < 0.002). CONCLUSION Septoplasty leads to a highly significant improvement in Qol and symptoms. The patients do not reach the same level of Qol as healthy controls. All symptoms are reported as mild on VAS postoperatively. Allergic patients tend to report more nasal blockage and facial pressure postoperatively than other patients and a focus on medical treatment should be kept also postoperatively. Patients with obstructive sleep apnea report more trouble with snoring postoperatively and alterative treatment options for snoring may be considered in these patients.
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Affiliation(s)
- Vegard Bugten
- Department of Neuroscience, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7006 Trondheim, Norway ; Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Ann Helen Nilsen
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Wenche Moe Thorstensen
- Department of Neuroscience, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7006 Trondheim, Norway ; Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Mads Henrik Strand Moxness
- Department of Neuroscience, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7006 Trondheim, Norway
| | - Marit Furre Amundsen
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Ståle Nordgård
- Department of Neuroscience, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7006 Trondheim, Norway ; Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Trondheim, Norway
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Langdon C, Mullol J. Nasal polyps in patients with asthma: prevalence, impact, and management challenges. J Asthma Allergy 2016; 9:45-53. [PMID: 27042129 PMCID: PMC4798207 DOI: 10.2147/jaa.s86251] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have coexisting asthma under the concept of “United Airway Disease”, being the combination of both diseases, which is one of the most challenging phenotypes to treat. Although clinicians have recognized this difficult-to-treat phenotype for many years, it remained poorly characterized. There is increasing epidemiological evidence linking chronic rhinosinusitis and asthma, but a good understanding of the pathophysiology and the combined management is still lacking. Bronchial asthma is more prevalent in patients who suffer chronic rhinosinusitis, while asthmatic patients have a greater prevalence of CRSwNP than patients without asthma. The effect of CRSwNP treatment, whether medical or surgical, in asthma is today less controversial after some studies have shown improvement of asthma after medical and/or surgical treatment of CRSwNP. However, direct comparisons between surgical and medical treatments are limited. Further randomized clinical trials are, however, still needed to better understand the management when both asthma and CRSwNP occur together. This review aims at summarizing the prevalence, impact, and management challenges regarding both asthma and CRSwNP.
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Affiliation(s)
- Cristobal Langdon
- Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic, Barcelona, Catalonia, Spain; Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic, Barcelona, Catalonia, Spain; Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centre for Biomedical Research in Respiratory Diseases (CIBERES), Barcelona, Catalonia, Spain
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
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- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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Yatera K, Yamasaki K, Noguchi S, Nishida C, Oda K, Akata K, Kido T, Ishimoto H, Mukae H. Prevalence of sinusitis and efficacy of intranasal corticosteroid treatment on asthmatic symptoms in asthmatic patients with rhinosinusitis: a pilot study. Int Forum Allergy Rhinol 2015; 6:398-406. [PMID: 26625349 DOI: 10.1002/alr.21672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/14/2015] [Accepted: 10/02/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prevalence of sinusitis on sinus computed tomography (CT) in asthmatic patients and efficacy of intranasal corticosteroid treatment on asthmatic symptoms in asthmatic patients with rhinosinusitis on sinus CT is unclear. METHODS Sinus CT of asthmatic patients were evaluated using the Lund-Mackay system (LMS). Intranasal corticosteroid treatment (mometasone furoate) was newly added to symptomatic asthmatic patients with rhinosinusitis treated without intranasal corticosteroids, and the findings of the Asthma Control Test (ACT), Asthma Control Questionnaire in 5 items (ACQ5), spirometry, and sinus CT were evaluated before and 3 months after additional intranasal corticosteroid treatment. RESULTS In a total of 160 asthmatic patients, rhinosinusitis and maxillary, ethmoidal, sphenoidal, and frontal sinusitis were observed in 75.0%, 70.0%, 53.1%, 33.1%, and 28.8%, respectively. Nasal symptoms and rhinophonia were observed in 81.9% and 72.5%, respectively, and patients with nasal symptoms and those with rhinophonia both showed significantly higher LMS scores in each sinus. Chronic rhinosinusitis (CRS) was observed in 66.9%, and these patients had significantly more severe asthma than the patients without CRS. In patients with CRS, patients with rhinophonia showed significantly higher LMS scores than those without rhinophonia. ACT, ACQ5, and the value of the forced expiratory volume in 1 second (FEV1) all significantly improved 3 months after the additive intranasal corticosteroid treatment in 24 patients, despite the fact that their LMS scores remained unchanged. CONCLUSION Additive intranasal corticosteroid treatment may be an effective treatment option for symptomatic asthmatic patients with rhinosinusitis.
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Affiliation(s)
- Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Kei Yamasaki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Shingo Noguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Chinatsu Nishida
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Keishi Oda
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Kentarou Akata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Takashi Kido
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
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Hansen AG, Helvik AS, Thorstensen WM, Nordgård S, Langhammer A, Bugten V, Stovner LJ, Eggesbø HB. Paranasal sinus opacification at MRI in lower airway disease (the HUNT study-MRI). Eur Arch Otorhinolaryngol 2015; 273:1761-8. [PMID: 26499376 DOI: 10.1007/s00405-015-3790-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/24/2015] [Indexed: 11/26/2022]
Abstract
The study builds on the concept of united airways, which describes the link between the upper and lower airways. Explorations of this concept have mainly related to asthma and less to chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate paranasal sinus opacification at magnetic resonance imaging (MRI) in COPD, self-reported asthma and respiratory symptoms. In this cross-sectional study, 880 randomly selected participants in the Nord-Trøndelag health survey (HUNT) (mean age 57.7 years, range 50-66 years, 463 women) were investigated using MRI of the paranasal sinuses. Participants were allocated to four mutually exclusive groups: (1) COPD (n = 20), (2) asthma (n = 89), (3) respiratory symptoms (n = 199), and (4) reference group (n = 572). Paranasal sinus opacifications were categorised as mucosal thickening, polyps and retention cysts, and fluid. In each participant, measurements ≥1 mm from all sinuses were summed to give a total for each category of opacities. The sums for these three categories were further added together, and referred to as the total sum. Using the 75th percentile cut-off values, the likelihood of having paranasal sinus opacifications was more than six times higher in participants with COPD and twice as high in participants with asthma than among the reference group. Respiratory symptoms were only associated with mucosal thickening. The present study shows that paranasal sinus opacification is associated not only with asthma, but also with COPD and respiratory symptoms. This is in accordance with the united airways hypothesis, and should be kept in mind when handling patients with these conditions.
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Affiliation(s)
- Aleksander Grande Hansen
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway.
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anne-Sofie Helvik
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Moe Thorstensen
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ståle Nordgård
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnulf Langhammer
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Vegard Bugten
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Beate Eggesbø
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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MESOS: considerations in designing a mechanistic study for a biologic used to treat asthma. ACTA ACUST UNITED AC 2015. [DOI: 10.4155/cli.15.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Management of chronic rhinosinusitis in asthma patients: is there still a debate? Curr Allergy Asthma Rep 2014; 14:440. [PMID: 24682772 DOI: 10.1007/s11882-014-0440-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The united airway concept in which upper and lower respiratory conditions are present in one patient requires special consideration. There is some evidence linking chronic rhinosinusitis and asthma, but a good understanding of the pathophysiology and combined management is still lacking, a fact that leads to discussion. Bronchial asthma is more prevalent in patients who suffer chronic rhinosinusitis. On the other hand, patients with asthma have a greater prevalence of rhinosinusitis than patients without asthma. The effect of chronic rhinosinusitis in patients with or without nasal polyps on asthma treatment, whether medical or surgical, is controversial. Some studies show worsening, other trials improvement, and others no effect. Direct comparisons between surgical and medical treatments are few. Most of the current literature available about this intriguing combination does not provide a good level of evidence. Thus, randomized clinical trials should be performed to better understand the management when asthma and CRS occur together. This review aims to summarize the current state of this association regarding the effects of different types of treatment.
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Thorstensen WM, Sue-Chu M, Bugten V, Steinsvåg SK. Nasal flow, volumes, and minimal cross sectional areas in asthmatics. Respir Med 2013; 107:1515-20. [PMID: 23953957 DOI: 10.1016/j.rmed.2013.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/18/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Unified Airways hypothesis suggests an involvement of the upper airways in asthma. Critical parameters of the nasal airway can be quantified objectively with acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF). OBJECTIVE We aimed to investigate nasal airway patency in asthmatics compared to non-asthmatic controls. Nasal volume, cross sectional area and flow were measured using acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) in 87 asthmatics and 93 non-asthmatic controls before and after decongestion with xylometazoline. Nasal congestion index (NCI) was calculated, and allergy status was assessed by skin prick test or specific IgE. RESULTS We found significantly smaller minimum cross sectional area and nasal cavity volume in asthmatics than controls, and the cross sectional area is at its minimum at 2-3 cm from the nasal orifice in both groups. AR and PNIF measurements are not different in allergic and non allergic subjects in either group. The effect of xylometazoline is not significantly different between the 2 groups with regard to AR, but there is a significant improvement in PNIF for the asthmatics when assessed by the NCI. CONCLUSION The present study demonstrates a significantly smaller nasal airway when assessed by minimum cross sectional area and nasal cavity volume in asthmatics than controls, and these findings apply to asthmatics and controls irrespective of allergy status.
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Affiliation(s)
- Wenche Moe Thorstensen
- Dept of Otolaryngology, Head and Neck Surgery, St Olavs Hospital, University Hospital of Trondheim, 7006 Trondheim, Norway; Institute of Neuroscience, Norwegian University of Science and Technology, 7006 Trondheim, Norway.
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