Health Utility Score in Thai Patients with Chronic Rhinosinusitis: Pre- and Postoperative Analyses

BACKGROUND

Endoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients with chronic rhinosinusitis (CRS) who require the surgery. HUS varies depending on the geographical or living environment. HUS in CRS has never been evaluated in Thailand. The objective of this study was to evaluate the HUS of Thai patients with CRS before and after ESS through multiple approaches.

METHODS

Thai patients (age ≥ 18) with CRS scheduled for ESS were enrolled in this prospective study. The preoperative (baseline) demographics, 22-items sinonasal outcome test, endoscopic score, and CT score were recorded. The HUS was evaluated using four methods: the EuroQoL-5 Dimension-5 level (EQ-5D-5L), Visual Analog Scale (VAS), Standard gamble (SG), and Time trade-off (TTO); at baseline, three months and six months post-operation.

RESULTS

Data from 60 patients were analyzed. The mean baseline HUS scores by EQ-5D-5L, VAS, SG, and TTO were 0.75, 0.65, 0.79, and 0.85, respectively. The postoperative HUS significantly improved to 0.96, 0.91, 0.96, 0.97 at three months, and 0.97, 0.92, 0.97, and 0.98 at six months, respectively. ESS raised the HUS by 0.12-0.27 points. Among the four methods, VAS showed the lowest HUS at all time points.

CONCLUSION

The preoperative HUS in Thai patients with CRS generally increased to near-perfect values after the ESS. The increase in HUS reflecting the improved general quality of life, was demonstrated at three and up to six months after ESS.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:2070-2076, 2024.

Evaluating health utility score through direct and indirect methods in patients with chronic rhinosinusitis

INTRODUCTION

EuroQol-5-dimensions-5-levels (EQ-5D-5L), visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) are used for the assessment of Health Utility Scores (HUS) of chronic rhinosinusitis (CRS). This study aimed to determine the overall HUS of CRS, the factors which influence the HUS, and the preferable method.

METHODS

A cross-sectional study was conducted. Patients with primary CRS were recruited. Clinical and socioeconomic data together with HUS were assessed. Four HUS scores determined from the four different methods were compared.

RESULTS

A total of 335 patients were enrolled. The overall HUS, as measured by EQ-5D-5L, VAS, TTO, and SG, was 0.88 ± 0.14, 0.79 ± 0.17, 0.89 ± 0.15, and 0.86 ± 0.16, respectively. The multivariable linear regression revealed that each increasing 22-item sinonasal outcome test (SNOT-22) score predicted a reduction of 0.002 to 0.003 in HUS (all methods, p < 0.01). Patients who scheduled for endoscopic sinus surgery had 0.06 to 0.11 HUS lower than other groups in EQ-5D-5L and VAS (all p < 0.05). Higher endoscopy score, age, presence of comorbid airway diseases, and lower education correlated with lower HUS (p < 0.05). Given the HUS results and regression models, the EQ-5D-5L is likely the preferable choice.

CONCLUSION

The overall HUS of CRS was approximately 0.79-0.89. High SNOT-22 score and those who failed medications, presence of comorbid AR/asthma, increased age, high endoscopy score, and low education negatively impacted HUS. Our data suggest that EQ-5D-5L is a preferable method for measuring HUS in patients with CRS.

A rare case of multifocal chordoma involving the lower clivus and multiple spine levels: illustrative case

BACKGROUND

Chordomas are rare bone tumors originating from notochord remnants with a predilection for the median axis of the body, primarily in the sacrococcygeal spine, skull base, and cervical spine. This paper presents the first reported case of simultaneous multilevel chordomas with various enhancements.

OBSERVATIONS

A 40-year-old woman presented with right-sided otalgia, headache, nasal obstruction, and facial pressure. The patient's head and spinal magnetic resonance imaging (MRI) demonstrated a midline lesion in the clivus, C2, and T1-5 spinal levels. All lesions were T1 isointense and T2 hyperintense, consistent with chordoma. Interestingly, the clivus lesion was enhancing, whereas the C2 lesion was only slightly enhancing, and the rest of the lesions showed no enhancement. The patient underwent endoscopic endonasal transclival approach surgery for the clival lesion, followed by radiation to the surgical bed and the C2 lesion. The remaining lesions were monitored. Follow-up imaging showed stable disease in the C2 lesion and other lower lesions. The patient's severe pain in the posterior cervical spine was managed with cervical fusion, pain management, and physical therapy.

LESSONS

This case underscores the importance of comprehensive spinal MRI in patients with chordomas, as multiple concurrent primaries may be present. The article summarizes the fundamental distinctions between ecchordosis physaliphora and chordoma and casts doubt on the capacity to always differentiate them.

Spontaneous rhinorrhea: a possible concealing initial symptom of ecchordosis physaliphora. Illustrative case

BACKGROUND

Spontaneous rhinorrhea may be the initial manifestation of ecchordosis physaliphora (EP). There are currently 47 published cases of symptomatic EP, with spontaneous rhinorrhea being one of the most prevalent symptoms. The authors report 1 case as a cause of cerebrospinal fluid (CSF) fistula.

OBSERVATIONS

A 46-year-old woman presented to the authors' clinic with meningitis secondary to nasal CSF leakage. The computed tomography (CT) scan indicated an imperceptibly thin/dehiscent focus along the posterior wall of the sphenoid air cell's midline. A tumor was identified during endoscopic endonasal CSF repair surgery. EP was diagnosed in the frozen and final pathology.

LESSONS

EP should be considered as a potential cause of spontaneous rhinorrhea. This initial clinical manifestation accounts for 35% of symptomatic EP cases. The prepontine and posterior sphenoid sinus wall appear to be the locations with the highest susceptibility. Surgical therapy of the fistula without excision of the lesion may result in insufficient issue resolution and recurrence.

Endoscopic Multiport Approach for Exenteration of the Infratemporal Fossa

OBJECTIVE

To demonstrate anatomic relationships pertinent to the endoscopic multiport approach to the infratemporal fossa (ITF). Discuss advantages and limitations of each individual approach.

STUDY DESIGN

Cadaveric study.

METHODS

Endoscopic and endoscopic-assisted endonasal transpterygoid, sublabial transmaxillary, endoscopic transorbital, and endoscopic transoral approaches to accessing the ITF were completed in five silicone-injected fresh cadaveric specimens (10 sides) with the assistance of 0, 30, and 45⁰ rods-lens endoscopes. Image guidance was used to confirm and document the anatomical relationships encountered in each approach.

RESULTS

The endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure to median structures. Endoscopic-assisted sublabial transmaxillary approach enhances the field of exposure, angle of attack, and ease of instrumentation to the lateral part of the ITF. Endoscopic-assisted transorbital approach via the inferior orbital fissure provided cephalic and anterior access. Endoscopic-assisted transoral approach complements the access to lesions extending inferior to the hard palate or far lateral to the mandibular condyle.

CONCLUSIONS

A combination of minimal access infratemporal approaches can provide adequate exposure of the entire ITF while avoiding some of the morbidity associated with open approaches.

LEVEL OF EVIDENCE

NA Laryngoscope, 2023.