Diagnosis and management of acute rhinosinusitis

Patient-reported outcome measures for acute rhinosinusitis in adults and children: a systematic review of the quality of existing instruments

BACKGROUND

Acute rhinosinusitis (ARS) is a self-limiting inflammation of the nose and sinuses caused by viral or bacterial infections that requires primarily symptomatic treatment. Patient-reported outcome measures (PROMs) are suitable tools for the assessment of the effectiveness of remedies for ARS from the patient's perspective in clinical trials and real-world studies. Data regarding the quality of existing PROMs for ARS are limited.

PURPOSE

To conduct a systematic review of the quality of existing disease-specific PROMs for use in adults and children with ARS according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for use of the identified instruments in future clinical studies.

METHODS

We systematically searched PubMed, Web of Science and Embase for studies reporting on the development and/or validation of PROMs for ARS. We assessed the methodological quality of each included study, evaluated the quality of measurement properties per PROM and study, and graded the evidence. Based on the overall evidence, we derived recommendations for use of the instruments.

RESULTS

We identified four studies on three PROMs measuring symptoms of ARS and quality of life in adults (Sinonasal Outcome Test-16, SNOT-16; Measurement of Acute Rhinosinusitis, MARS; Rhinosinusitis Quality-of-Life Assessment, RhinoQoL). For ARS in children, we identified two studies on two PROMs measuring symptoms of ARS (Pediatric Rhinosinusitis Symptom Scale, PRSS; Sinus Symptom Questionnaire, S5). Our assessment of measurement properties indicates that all instruments require further validation before they can be unrestrictedly recommended for use in future research (COSMIN category B). In particular, there were no content validity studies for any of the identified instruments, but also data on other important measurement properties, e.g., structural validity, are lacking.

CONCLUSION

Currently, no PROM for ARS in adults and children can be unrestrictedly recommended based on the evaluation of their quality. Further validation is required for all identified PROMs. Content validation involving patients and experts should be given priority.

SYSTEMATIC REVIEW REGISTRATION

OSF ( https://doi.org/10.17605/OSF.IO/VAP8U ).

Rhinosinusitis Treatment with Cineole: Patient-Reported Quality of Life Improvements from a Non-Interventional, Pharmacy-Based Survey

BACKGROUND

Rhinosinusitis is commonly treated with decongestants, analgesics, and local corticosteroids. Phytotherapeutics are also utilised for symptomatic relief, including cineole, the main component of eucalyptus oil.

METHODS

The current non-interventional, anonymised survey investigated quality of life in participants with rhinosinusitis (with or without additional symptoms of bronchitis) via the German version of a validated quality of life questionnaire (RhinoQol). Overall, 310 subjects administered a cineole preparation (Sinolpan) and 40 subjects applying nasal decongestant were recruited in German pharmacies.

RESULTS

Significant improvements in frequency (64.0%), bothersomeness (52.1%), and impact (53.9%) of rhinosinusitis symptoms were reported upon treatment with cineole over a mean treatment period of seven days (p < 0.001 each). The overall treatment efficacy of cineole was evaluated as good or very good by 90.0% of the participants, and the quality of life during work or leisure time improved upon treatment. Six (non-serious) possibly related side effects were reported in four participants who were administered cineole. The tolerability of the treatment was assessed as good or very good by 93.9% of the participants.

CONCLUSIONS

Cineole can be considered as a safe and well-tolerated rhinosinusitis treatment conferring a clear improvement in quality of life outcomes.

Riniti e rinosinusiti acute dell’adulto

Le riniti e le rinosinusiti acute sono delle patologie frequenti e benigne nella maggior parte dei casi. La loro diagnosi è, prima di tutto, clinica. La difficoltà del loro trattamento è la differenziazione delle forme virali, più frequenti e banali, e delle forme batteriche, rare ma potenzialmente gravi. Le recenti raccomandazioni sono riassunte in questa esposizione. Analizzando le prove scientifiche del momento, esse insistono sui criteri diagnostici clinici, sulle indicazioni degli esami complementari, sull’efficacia dei vari trattamenti e sull’importanza dell’informazione e dell’educazione dei pazienti. I futuri lavori in questo settore dovranno permettere di selezionare in modo più preciso i pazienti che richiedono realmente una terapia antibiotica e di evitare, così, importanti spese sanitarie nonché la comparsa di ceppi batterici resistenti.

Rinitis y rinosinusitis agudas del adulto

Las rinitis y rinosinusitis agudas son afecciones frecuentes y benignas en la mayoría de los casos. Su diagnóstico es esencialmente clínico. La dificultad de su tratamiento consiste en diferenciar las formas víricas, más frecuentes y banales, de las formas bacterianas, que son infrecuentes pero potencialmente graves. En este artículo se resumen las recomendaciones recientes, que se basan en la evidencia actual e insisten en los criterios diagnósticos clínicos, las indicaciones de las pruebas complementarias, la eficacia de los distintos tratamientos, así como la importancia de la información y de la educación de los pacientes. Los futuros trabajos en este ámbito deberán permitir seleccionar con más precisión a los pacientes que requieren realmente una antibioticoterapia y evitar de ese modo unos gastos sanitarios considerables, así como la aparición de cepas bacterianas resistentes.

Actual concepts in rhinosinusitis: a review of clinical presentations, inflammatory pathways, cytokine profiles, remodeling, and management

Rhinosinusitis (RS) is a heterogeneous group of diseases. It is a significant and increasing health problem that affects about 15% of the population in Western countries. It has a substantial impact on patients' health-related quality of life and daily functioning and represents a huge financial burden to society and the health care system as a result of the direct and indirect costs. In addition, RS is not well-understood, and little is known about the etiology and pathophysiology. In the past decade, many papers have been published that have changed our understanding of RS. RS is commonly classified into acute and chronic RS based on symptom duration. In acute RS, an inflammatory reaction initiated by a viral infection characterizes most uncomplicated, mild to moderate cases. Therefore, the first line of treatment for these cases are intranasal steroids and not antibiotics. In severe and complicated cases, antibiotics combined with topical steroids remain the treatment of choice. On the other hand, chronic RS is actually subdivided into two distinct entities (chronic rhinosinusitis with and without polyps), as growing evidence indicates that these entities have specific inflammatory pathways and cytokine profiles. The authors review recent data regarding the clinical presentations, cytokine profiles, tissue remodeling, and modalities of treatment for each form of RS.