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Mohammad I, Stack T, Norris M, Kim S, Lamb M, Thorp BD, Klatt-Cromwell C, Ebert CS, Kimple AJ, Senior BA. The Surprising Effect of Priming on SNOT-22 Results. Am J Rhinol Allergy 2024; 38:153-158. [PMID: 38332587 PMCID: PMC11000435 DOI: 10.1177/19458924241229160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Priming is a psychological phenomenon where subconscious cues in the environment impact our behavioral responses in certain situations. Well studied in the worlds of business, marketing, and even politics, it is unclear how the priming phenomenon impacts patient perception of their own disease state nor how they report that perception using tools like the Sinonasal Outcomes Test (SNOT-22), used to measure that perception in chronic rhinosinusitis. OBJECTIVE To determine the impact of positive or negative priming on self-reported patient perception of their chronic rhinosinusitis disease using the SNOT-22 disease-specific quality of life instrument. METHODS Single-blind, randomized, prospective cohort pilot study of 206 consecutive adult patients with a clinical diagnosis of chronic rhinosinusitis presenting to a university rhinology clinic. Patients were randomized to receive "positive priming" (103) or "negative priming" (103) by reading a passage about the positive or negative aspects of chronic sinusitis and its treatment respectively. Patients were then asked to fill out the SNOT-22 and results between the two groups were compared. RESULTS The negative priming group had a higher median SNOT-22 score of 49 [IQR = 39] compared to the positive priming groups' score of 22 [IQR = 27], p < 0.0001), a difference of nearly three times the minimal clinical impactful difference (MCID). This effect was consistent regardless of age or sex of the patient. Subgroup analysis revealed a greater impact when priming was performed by the senior male attending regardless of patient age or sex (p < 0.001), while priming performed by the younger female research fellow had greater impact on older patients (>59 years, p = 0.001) and female patients (p = 0.003). CONCLUSIONS Priming impacts how patient's perceive their chronic rhinosinusitis as determined by the SNOT-22. It is imperative that the rhinologist understand this when using this instrument in research applications and in clinical decision-making for patients.
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Affiliation(s)
- Ibtisam Mohammad
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
- Department of Otolaryngology— Head & Neck Surgery at Gazi University, Ankara, Turkey
| | - Taylor Stack
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Meghan Norris
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Sulgi Kim
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Meredith Lamb
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Brian D. Thorp
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Christine Klatt-Cromwell
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Charles S. Ebert
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Adam J. Kimple
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Brent A. Senior
- Department of Otolaryngology—Head & Neck Surgery at the University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
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Kim DH, Kim SW, Basurrah MA, Hwang SH. Evaluation of Post-Intervention Outcomes in Patients with Empty Nose Syndrome. Laryngoscope 2024; 134:2005-2011. [PMID: 37750541 DOI: 10.1002/lary.31077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/06/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES To conduct a systematic review and meta-analysis of published articles to assess the impact of inferior turbinate/meatus augmentation in patients diagnosed with empty nose syndrome (ENS). DATA SOURCES PubMed, Cochrane database, Embase, Web of Science, SCOPUS, and Google Scholar. REVIEW METHODS Six databases were searched to December 2022. We retrieved studies evaluating improvements in refractory ENS-related symptoms based on various patient-reported outcome measures after inferior turbinate/meatus augmentation. RESULTS As a result of meta-analysis, Sinonasal Outcome Test, Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), and depression scores were measured at 1 week; 1, 3, and 6 months; and later than 12 months after intervention for patients with ENS. All scores revealed significant symptom improvement. By reference to the minimal clinically important difference of the ENS6Q (6.25), inferior turbinate/meatus augmentation relieved the nasal symptoms of ENS in the long term. Although the improvements in anxiety scores at 1 week (0.4133 [-0.3366; 1.1633], 0.00, I2 = NA) and 1 month (0.4525 [-0.0529; 0.9579], I2 = 0.0%) were not statistically significant, the scores differed significantly at 3 months (0.7351 [0.4143; 1.0559], I2 = 28.4%), 6 months (0.8297 [0.6256; 1.0337], I2 = 37.2%), and longer than 12 months (0.7969 [0.4768; 1.1170], I2 = 0.0%). CONCLUSION These data and analysis suggest that performing inferior turbinate/meatus augmentation on ENS patients may improve not only nasal symptom scores but also accompanying psychological problems such as anxiety and depression. Laryngoscope, 134:2005-2011, 2024.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hildebrandt ME, Møller PR, Fjældstad AW, Ovesen T. Postinfectious conditions challenge disease-specificity of SNOT-22. Eur Arch Otorhinolaryngol 2024; 281:2395-2402. [PMID: 38177896 DOI: 10.1007/s00405-023-08385-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The Sino-Nasal-Outcome-Test 22 (SNOT-22) questionnaire assesses treatment outcome and health-related quality of life (HRQOL) in patients with chronic rhinosinusitis (CRS). However, given the overlap between CRS and olfaction in terms of nasal function and the definition of CRS, a fundamental question arises: can patients with olfactory dysfunction (OD) stemming from other causes attain SNOT-22 scores similar to those seen in CRS, even in the absence of CRS? Our study aimed to explore whether OD arising from various postinfectious mechanisms challenges the disease-specificity of SNOT-22 for CRS. If so, could focus on scores within specific symptom domains of SNOT-22 prove valuable in distinguishing between different etiologies. METHODS The study adopted an observational, retrospective cohort design based on prospectively registered patients and related variables using the REDCap platform. 460 patients experiencing OD due to either (1) simple or (2) complex post-COVID-19, (3) postinfectious non-COVID-19, and (4) CRS, were included in the analysis. RESULTS The study revealed that the total SNOT-22 score lacks disease-specificity for CRS. This is evident, because complex postinfectious mechanisms resulting from COVID-19 can produce similar symptoms in patients. Notably, elevated total scores were primarily driven by high subdomain scores within the "sleep and cognition" domain. CONCLUSIONS The application of SNOT-22 as a screening tool needs to be approached with caution, as the total score alone does not provide disease-specific insights. A more thorough exploration of the four symptom domains and the identification of distinctive scoring patterns within the clinical context may prove pivotal in effectively differentiating between various underlying causes.
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Affiliation(s)
- Mascha E Hildebrandt
- Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, University Clinic for Balance, Flavour and Sleep, Hospitalsparken 15, 7400, Herning, Denmark.
| | - Patrick R Møller
- Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, University Clinic for Balance, Flavour and Sleep, Hospitalsparken 15, 7400, Herning, Denmark
| | - Alexander W Fjældstad
- Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, University Clinic for Balance, Flavour and Sleep, Hospitalsparken 15, 7400, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen's Boulevard 82, 8200, Aarhus N, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, University Clinic for Balance, Flavour and Sleep, Hospitalsparken 15, 7400, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen's Boulevard 82, 8200, Aarhus N, Denmark
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Misirovs R, Chan R, Lipworth B. 5-Item sino-nasal outcome test and 22-item sino-nasal outcome test relationship with endoscopic and radiologic scores in chronic rhinosinusitis with nasal polyps. Ann Allergy Asthma Immunol 2024; 132:363-367. [PMID: 37984707 DOI: 10.1016/j.anai.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The 22-item sino-nasal outcome test (SNOT-22) is a frequently used patient-recorded outcome measure in patients with chronic rhinosinusitis with nasal polyps (CRSwNPs). Objective findings of nasal polyps and paranasal sinus inflammation are frequently graded using nasal polyp score (NPS) and Lund-Mackay Score (LMS), respectively. OBJECTIVE To evaluate a novel, abbreviated, rhinology-focused, five-domain SNOT-5 questionnaire because we had anecdotally noticed a relative disconnect between SNOT-22 and endoscopy and imaging scores. METHODS We performed a retrospective, cross-sectional, single-center review of patients with CRSwNPs who had filled out a SNOT-22, along with post hoc-derived SNOT-5 scores, which were then assessed in relation to NPS and LMS. RESULTS A total of 129 patients were included in the analysis. SNOT-5 but not SNOT-22 scores significantly correlated vs either NPS (P < .005) and LMS (P < .001), whereas only SNOT-5 differed significantly when comparing the cohort's lowest and highest tertiles for mean LMS: 11.8 vs 16.8 (95% CI, 1.5-8.4; P < .01) and for mean NPS 12.4 vs 15.6 (95% CI, 0.5-5.9; P < .05). CONCLUSION In a retrospective, real-life cohort study of CRSwNP, there was a relative disconnect between the significant association of SNOT-5 but not SNOT-22 in relation to objective endoscopy and imaging measures. We, therefore, propose that further prospective intervention studies are indicated in CRSwNP to evaluate the SNOT-5 score including establishing the minimal clinically important difference.
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Affiliation(s)
- Rasads Misirovs
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom; Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
| | - Rory Chan
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom
| | - Brian Lipworth
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom.
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Yang N, Waytz A, Soler ZM, Overdevest JB, Gudis DA. The effects of priming on rhinologic patient reported outcome measures: a randomized controlled trial. Rhinology 2024; 62:71-81. [PMID: 37805987 DOI: 10.4193/rhin23.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are questionnaires designed to assess a patient's perception of their medical condition. The 22-item Sino-Nasal Outcomes Test (SNOT-22), the Rhinosinusitis Disability Index (RSDI) and the mini-Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) are validated PROMs commonly used to assess rhinologic conditions. The objective of this study is to determine if responses on these PROMs may be influenced by priming respondents with positive or negative health-related questionnaires. METHODS Nine hundred patients were prospectively randomized to one of nine groups. Groups A, D and G were positively primed prior to completing the SNOT-22, the RSDI and MiniRQLQ, respectively. Groups B, E, and H were negatively primed. Groups C, F, and I served as control groups, completing the PROMs without priming. Priming was performed by administering a survey designed to make patients think about their health-related quality of life in a positive or negative way. RESULTS Patients who were primed negatively had statistically significantly worse scores on the SNOT-22, RSDI and MiniRQLQ when compared to patients who were primed positively. When compared to the control group, patients who were primed negatively had statistically worse scores on the SNOT-22 and RSDI. There was no significant difference in scores between the positive priming and the control groups for any PROM. CONCLUSIONS Priming subjects regarding their health-related quality of life impacts their responses on rhinologic PROMs. Further study is required to understand the clinical and research implications of this novel finding and to clarify the optimal manner for administering and interpreting PROMs.
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Affiliation(s)
- N Yang
- Department of Otolaryngology - Head and Neck Surgery, New York Presbyterian Hospital- Columbia University Irving Medical Center, New York, NY, USA
| | - A Waytz
- Department of Management and Organizations, Kellogg School of Management- Northwestern University, Evanston, IL, USA
| | - Z M Soler
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - J B Overdevest
- Department of Otolaryngology - Head and Neck Surgery, New York Presbyterian Hospital- Columbia University Irving Medical Center, New York, NY, USA
| | - D A Gudis
- Department of Otolaryngology - Head and Neck Surgery, New York Presbyterian Hospital- Columbia University Irving Medical Center, New York, NY, USA
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Yu SE, Chiang S, Olonisakin TF, Moore JA, Bergmark RW, Maxfield AZ, Roditi RE, Buchheit KM, Lundberg M, Mitchell MB, Lee SE. Local cytokine levels associate with SNOT-22 and UPSIT scores in chronic rhinosinusitis. Int Forum Allergy Rhinol 2024; 14:114-118. [PMID: 37365846 DOI: 10.1002/alr.23222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/04/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
KEY POINTS Elevated IL-5, IL-13, IL-33, and CCL2 correlate with lower UPSIT scores in CRS and AERD patients. Elevated IL-5, IL-13, TNF-α, CCL2, and CXCL-8 correlate with higher SNOT-22 scores in CRS and AERD patients.
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Affiliation(s)
- Sophie E Yu
- Division of Otolaryngology - Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Simon Chiang
- Division of Otolaryngology - Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tolani F Olonisakin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - John A Moore
- Department of Otolaryngology-Head & Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Regan W Bergmark
- Division of Otolaryngology - Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alice Z Maxfield
- Division of Otolaryngology - Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel E Roditi
- Division of Otolaryngology - Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marie Lundberg
- Department of Otolaryngology - Head & Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Margaret B Mitchell
- Division of Otolaryngology - Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stella E Lee
- Division of Otolaryngology - Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Plath M, Sand M, Cavaliere C, Plinkert PK, Baumann I, Zaoui K. Normative data for interpreting the SNOT-22. Acta Otorhinolaryngol Ital 2023; 43:390-399. [PMID: 37814974 PMCID: PMC10773542 DOI: 10.14639/0392-100x-n2279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/05/2023] [Indexed: 10/11/2023]
Abstract
Objectives The Sino-Nasal Outcome Test 22 (SNOT-22) is a validated patient-reported outcome instrument to evaluate the health-related quality of life (HRQoL) in patients with chronic rhinosinusitis (CRS). There are no published normative SNOT-22 scores, limiting its interpretation. Methods Symptom scores from 1,000 SNOT-22 questionnaires were analysed by principal component analysis (PCA) and exploratory factor analyses. Data were derived from a survey with 1,000 healthy Europeans (reference cohort) who were recruited using the Respondi panel for market and social science research. This subsample was quoted to the population distribution of the German Microcensus and selected from a non-probability panel. Results The overall normative SNOT-22 score can be detected to be 20.2 ± 19.44. Male (18.49 ± 19.15) and older (> 50 years old; 18.3 ± 17.49) participants had overall lower SNOT-22 mean results than females (21.8 ± 19.6) and younger (21.4 ± 20.55) participants, indicating higher levels of satisfaction. PCA proposed two SNOT-22 domains ("physiological well-being" and "psychological well-being"), which explained 65% of the variance. Conclusions These are the first published (German) normative scores for the SNOT-22 and provide a clinical reference point for the interpretation of data.
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Affiliation(s)
- Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Sand
- GESIS-Leibniz-Institute for the Social Sciences, Mannheim, Germany
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Peter K. Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Karim Zaoui
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Zhou AS, Prince AA, Maxfield AZ, Corrales CE, Shin JJ. The Impact of Sinonasal Symptoms in Relation to Potentially Life-Threatening Comorbidities. Otolaryngol Head Neck Surg 2023; 169:1462-1471. [PMID: 37313804 DOI: 10.1002/ohn.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE While general health may be influenced by sinonasal symptoms, their effects may be overshadowed by comorbid states which may be more serious. To assess the validity of this postulate, we measured the extent to which sinonasal symptoms and concurrent conditions influenced general health. STUDY DESIGN Observational outcomes study. SETTING Academic medical center, community care sites. METHODS Adults with sinonasal symptoms completed the 22-item Sinonasal Outcome Test, along with the Patient-Reported Outcomes Measurement Information System global health short form. Comorbidities were categorized with the Deyo modification of the Charlson comorbidity index. Multivariate regression analyses were utilized to determine the relative impact of sinonasal symptoms and concurrent comorbid conditions on general health. RESULTS Data from 219 consecutive patients demonstrated that sinonasal symptoms were associated with significantly diminished general physical (β = -1.431, p < .001), mental (β = -1.000, p < .001), overall (β = -1.026, p < .001), and social health (β = -0.872, p = .003), regardless of the presence of potentially life-threatening comorbid conditions. Comorbid conditions included cardiovascular disease, chronic obstructive pulmonary disease, connective tissue disease, peptic ulcer, diabetes mellitus, and hepatic disease. The effect of sinonasal symptoms was neither subsumed nor overshadowed by the effects of comorbid states. Nasal, ear, sleep, and psychological domain scores were also associated with general physical, mental, and global health while adjusting for the impact of comorbidities. CONCLUSION Sinonasal symptoms have a substantial effect on general health which is not subsumed by the presence of potentially life-threatening concurrent comorbidities. These data may help support the importance of funding and resource allocation for conditions causing sinonasal symptoms.
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Affiliation(s)
- Allen S Zhou
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony A Prince
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Z Maxfield
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Carleton Eduardo Corrales
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Al Sharhan SS, Al Bar MH, Al Saied AS, Al Somali MI, Abdel Wahab MM. Development and Validation of the Sinonasal Outcome Test-12. J Prim Care Community Health 2023; 14:21501319231189060. [PMID: 37501403 PMCID: PMC10388610 DOI: 10.1177/21501319231189060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVES Quality of life (QoL) questionnaires are widely used in clinical interviews to assess the impact of medical interventions or measure the outcomes of healthcare services. The main aim of such questionnaires is the subjective assessment of health status and its impact on QoL. This study aimed to develop an efficient, short sinonasal disease assessment instrument, the sinonasal outcomes test-12 (SNOT-12), and to compare it with the preexisting SNOT-22. METHODS This was a two-phase cross-sectional study. The study was performed between June 2019 and February 2020 using the electronic files of the ORL department outpatient clinics at King Fahd University Hospital, affiliated with Imam Abdulrahman Bin Faisal University. The study was performed in 2 phases: an item reduction phase, which resulted in an initial SNOT-12 scale, and a validation phase, using a comparative analysis of the initial SNOT-12 and the SNOT-22. RESULTS The developed short-form SNOT-12 maintained the 4 latent factors extracted in EFA (nasal, Sleep/extra nasal, psychological, ear/facial). It strongly correlated with SNOT-22 (r = 0.973). It had good construct reliability (0.705-0.901) and validity and a higher discrimination power than the SNOT-22. CONCLUSIONS The SNOT-12 is a short, valid, and reliable instrument that may prove useful for the initial screening and monitoring of patients with chronic rhinosinusitis.
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Affiliation(s)
- Salma S. Al Sharhan
- Department of Otorhinolaryngology, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Mohammed H. Al Bar
- Department of Otorhinolaryngology, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Abdulmalik S. Al Saied
- Department of Otorhinolaryngology, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Maha I. Al Somali
- Department of Otorhinolaryngology, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Moataza M. Abdel Wahab
- Division of Epidemiology and Biostatistics, Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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Tripathi SH, Corr A, Kumar A, Ungerer H, Salmon M, Adappa ND, Bosso JV. SNOT-22 scores after 6 months of aspirin therapy are predictive of long-term quality of life in AERD. Allergy Asthma Proc 2023; 44:78-80. [PMID: 36719696 DOI: 10.2500/aap.2023.44.220091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Aspirin exacerbated respiratory disease (AERD) is an inflammatory condition that consists of eosinophilic asthma, chronic rhinosinusitis with nasal polyps, and respiratory reactions to cyclooxygenase-1 inhibitors. Aspirin therapy after aspirin desensitization (ATAD) is the most extensively studied treatment paradigm for AERD. Objective: The objective was to identify which time point of ATAD was most predictive of long-term outcomes as measured by the 22-item Sino-Nasal Outcome Test (SNOT-22). Methods: A retrospective chart review was conducted of patients at a single institution who underwent endoscopic sinus surgery, followed by ATAD, and had remained on ATAD for 2 consecutive years. SNOT-22 scores were recorded at predesensitization as well as at the 3-, 6-, 12-, and 24-month postdesensitization time points. The patients were separated into two cohorts at each of the data collection time points based on whether their SNOT-22 scores were < 20 (responders) or ≥ 20 (nonresponders). Responder status was compared between each time point and at 24-month postdesensitization. The odds ratios (OR) were then calculated between the two groups at each of the following time points: postsurgery/predesensitization, and 3-, 6-, and 12-month postdesensitization. Results: There were 70 patients who met the inclusion criteria of having 24-month postdesensitization SNOT-22 scores available. Responder status at 6 months after surgery had the most predictive OR 16.5 (95% confidence interval, 3.71-73.44) for long-term outcomes at 24 months. Conclusion: The SNOT-22 scores after 6 months of ATAD showed the greatest predictive value for long-term quality-of-life outcomes and, therefore, poor 6-month SNOT-22 scores could serve as a basis for consideration of alternative therapies.
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Racette SD, Schneider AL, Ganesh M, Huang JH, Lehmann DS, Price CP, Rodegherio SG, Reddy AT, Eide JG, Conley DB, Welch KC, Kern RC, Shintani‐Smith S, Kato A, Schleimer RP, Tan BK. CRS-PRO and SNOT-22 correlations with type 2 inflammatory mediators in chronic rhinosinusitis. Int Forum Allergy Rhinol 2022; 12:1377-1386. [PMID: 35363947 PMCID: PMC9525449 DOI: 10.1002/alr.23002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 12/30/2022]
Abstract
The 22-item Sino-Nasal Outcome Test (SNOT-22) and 12-item Patient Reported Outcomes in Chronic Rhinosinusitis (CRS-PRO) instrument are validated patient-reported outcomes measures in CRS. In this study we assess the correlation of these with type 2 (T2) biomarkers before and after endoscopic sinus surgery (ESS). METHODS Middle meatal mucus data were collected and the SNOT-22 and CRS-PRO were administered to 123 patients (71 CRS without nasal polyps [CRSsNP], 52 CRS with nasal polyps [CRSwNP]) with CRS before and 6 to 12 months after undergoing ESS. Interleukin (IL)-4, IL-5, IL-13, and eosinophilic cationic protein (ECP) were measured using a multiplexed bead assay and enzyme-linked immunoassay. Pre- and post-ESS SNOT-22 and CRS-PRO were compared with T2 biomarkers. RESULTS Before ESS neither PROM correlated with any biomarker. After ESS, CRS-PRO showed a correlation with 2 mediators (IL-5 and IL-13: p = 0.012 and 0.003, respectively) compared with none for the SNOT-22. For CRSwNP patients, pre-ESS CRS-PRO and SNOT-22 correlated with IL-4 (p = 0.04 for both). However, after ESS, CRS-PRO correlated with 3 biomarkers (IL-5, IL-13, and ECP: p = 0.02, 0.024, and 0.04, respectively) and SNOT-22 with 2 biomarkers (IL-5 and IL-13: p = 0.038 and 0.02, respectively). There were no significant relationships between any of the T2 biomarkers pre- or post-ESS among patients with CRSsNP. Exploratory analyses of the subdomains showed the SNOT-22 rhinologic and CRS-PRO rhinopsychologic subdomains correlated better with the T2 biomarkers. On individual item analysis, IL-13 correlated significantly post-ESS with 8 of 12 items on the CRS-PRO vs 6 of 22 items on the SNOT-22. CONCLUSION The CRS-PRO total score showed a significant correlation with T2 biomarkers especially when assessed post-ESS and among CRSwNP patients.
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Affiliation(s)
- Samuel D. Racette
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Alexander L. Schneider
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Meera Ganesh
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Julia H. Huang
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - David S. Lehmann
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Caroline P.E. Price
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Samuel G. Rodegherio
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Abhita T. Reddy
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Jacob G. Eide
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - David B. Conley
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Kevin C. Welch
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Robert C. Kern
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Stephanie Shintani‐Smith
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Atsushi Kato
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
- Division of Allergy and ImmunologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Robert P. Schleimer
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
- Division of Allergy and ImmunologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Bruce K. Tan
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
- Division of Allergy and ImmunologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
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Busse WW, Wellman A, Diamant Z, Cohen NA, Chaker AM, Bachert C, Siddiqui S, Zhang H, Nash S, Khan AH, Jacob-Nara JA, Rowe PJ, Deniz Y. Impact of dupilumab on SNOT-22 sleep and function scores in CRSwNP. J Allergy Clin Immunol Pract 2022; 10:2479-2482.e3. [PMID: 35618213 DOI: 10.1016/j.jaip.2022.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- William W Busse
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI.
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Zuzana Diamant
- Department of Respiratory Medicine & Allergology, Lund University, Lund, Sweden; Department of Microbiology, Immunology & Transplantation, Catholic University Leuven, Leuven, Belgium
| | - Noam A Cohen
- Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Adam M Chaker
- Department of Otolaryngology and ZAUM, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Bachert
- Department of Otorhinolaryngology, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm, Sweden; The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shahid Siddiqui
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Haixin Zhang
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Asif H Khan
- Global Medical Affairs, Sanofi, Chilly-Mazarin, France
| | | | - Paul J Rowe
- Global Medical Affairs, Sanofi, Bridgewater, NJ
| | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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Dholakia SS, Yang A, Kim D, Borchard NA, Chang MT, Khanwalkar A, Lechner M, Nayak JV. Long-Term Outcomes of Inferior Meatus Augmentation Procedure to Treat Empty Nose Syndrome. Laryngoscope 2021; 131:E2736-E2741. [PMID: 33991117 DOI: 10.1002/lary.29593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/12/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS We sought to report the long-term, symptom-focused, prospective outcomes in empty nose syndrome (ENS) patients after undergoing inferior meatus augmentation procedure (IMAP) through use of four validated questionnaires: Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), 22-item Sino-Nasal Outcome Test (SNOT-22), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). STUDY DESIGN Prospective case series. METHODS A single-center prospective case series was performed for patients diagnosed with ENS who underwent IMAP between July 2017 and February 2020. Diagnosis of ENS was based on the following criteria: 1) reported discomfort with nasal breathing and/or paradoxical nasal obstruction after inferior turbinate reduction, 2) a positive ENS6Q score of at least 11, and 3) a positive cotton test. Questionnaire responses were recorded prior to surgery as well as 1, 3, 6, and 12 months postoperatively. RESULTS Seventeen eligible patients were included. Mean ENS6Q scores were significantly reduced at all postoperative time points (p < .0001, p < .0001, p < .0001, p = .0003). Of the six ENS6Q subdomains, five (suffocation, dryness, sense of diminished airflow, nasal crusting, and nasal burning) were significantly reduced 1-year postoperatively (p < .0001, p = .0004, p = .0136, p = .0114, p = .0080, respectively). SNOT-22 scores were significantly reduced at all time points (p = .0021, p = .0227, p = .0004, and p = .0025). Of the SNOT-22 subdomains, the sleep subdomain was significantly reduced 1-year postoperatively (p = .0432). Low baseline GAD-7 and PHQ-9 scores were recorded at 7 and 9.4, respectively, and although scores at all postoperative time points were reduced, there was no statistical significance. CONCLUSION IMAP via implant of cadaveric rib cartilage provides significant, long-term improvements in ENS-specific and general sinonasal symptoms. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2736-E2741, 2021.
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Affiliation(s)
- Sachi S Dholakia
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Angela Yang
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Dayoung Kim
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Nicole A Borchard
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Michael T Chang
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Ashoke Khanwalkar
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Matt Lechner
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Jayakar V Nayak
- Department of Otolaryngology - Head and Neck Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, U.S.A
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Brown HJ, Tajudeen BA, Kuhar HN, Gattuso P, Batra PS, Mahdavinia M. Defining the Allergic Endotype of Chronic Rhinosinusitis by Structured Histopathology and Clinical Variables. J Allergy Clin Immunol Pract 2021; 9:3797-3804. [PMID: 34174492 PMCID: PMC8511331 DOI: 10.1016/j.jaip.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Atopy has a strong association with chronic rhinosinusitis (CRS). OBJECTIVE To understand whether patients with atopy and CRS can be defined by markers of tissue histopathology, systemic biomarkers, and clinical factors, which may guide their response to new pharmacologic agents. METHODS In a retrospective cohort of CRS patients who underwent functional endoscopic sinus surgery, a structured histopathology report consisting of 12 variables, comorbid conditions, preoperative total serum IgE levels, and preoperative modified Lund-Kennedy endoscopic and sinonasal outcome test (SNOT-22) scores were compared between atopic CRS (aCRS) and non-aCRS control patients in a multivariable model. RESULTS A total of 380 CRS patients were enrolled, 286 of whom had comorbid atopy (aCRS). Compared with non-aCRS, aCRS patients had significantly higher preoperative total SNOT-22 scores (40.45 ± 22.68 vs 29.70 ± 20.68, P = .015) and symptom-specific SNOT-22 scores in all domains except psychological dysfunction. Relative to non-aCRS, aCRS patients had increased tissue eosinophilia (P < .0001), eosinophil aggregates (P < .0001), Charcot-Leyden crystals (P < .04), fibrosis (P < .02), total serum IgE levels (P < .04), polyploid disease (P < .001), and a prevalence of comorbid asthma (P < .0001) and aspirin exacerbated respiratory disease (AERD) (P < .003). Patients with aCRS demonstrated increased tissue eosinophilia compared with non-aCRS patients even after controlling for polypoid disease, asthma, and AERD. CONCLUSION In the context of CRS, atopy appears to be a specific predictor of CRS severity linked to specific histopathologic variables, including enhanced eosinophilic aggregates. Moving forward, allergic status may be a useful way to identify an atopic endotype of CRS patients. Furthermore, after surgery, patients are often maintained on intranasal corticosteroids. In patients whose disease is unresponsive to steroids, we may look to atopic status to identify another management therapy. Atopic CRS patients, irrespective of polyp and asthmatic status, could be optimal candidates for biologic agents such as T-helper cell, eosinophil, and/or IgE-targeted therapies.
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Affiliation(s)
- Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Ill
| | - Bobby A Tajudeen
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Ill
| | - Hannah N Kuhar
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Ill
| | - Pete S Batra
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Ill
| | - Mahboobeh Mahdavinia
- Section of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill.
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15
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Chang GH, Lin YS, Hsu KH, Cheng YC, Yang PR, Tsai MS, Tsai YT, Hsu CM, Chang PJ, Shi CS, Yang YH, Wu CY. Nasal irrigation with Glycyrrhiza glabra extract for treatment of allergic rhinitis - A study of in vitro, in vivo and clinical trial. J Ethnopharmacol 2021; 275:114116. [PMID: 33857594 DOI: 10.1016/j.jep.2021.114116] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Glycyrrhiza glabra, a family of licorice and a traditional Chinese medicine with sweet taste and favorable smell, has anti-inflammatory, anti-allergic and immunomodulatory functions. AIM OF THE STUDY We developed a licorice extract (LE) by using glycyrrhiza glabra and administered it through nasal irrigation to treat allergic rhinitis (AR). MATERIALS AND METHODS LE was prepared into extract powder, and the anti-inflammatory effect of the LE was evaluated by calcium ionophore-induced activated mast cell model (in vitro). Then, local passive anaphylaxis assays were applied to investigate the anti-IgE-mediated allergic reaction of the LE in mice (in vivo). A developed LE was administered through nasal irrigation to treat AR in clinic settings. A total of 60 participants diagnosed with AR were included in this clinical trial; they were randomly assigned to three interventions: licorice nasal irrigation (LNI), corticosteroid nasal irrigation (CNI), and saline nasal irrigation (SNI). They performed nasal irrigation once a day for 1 month. Both subjective questionnaires (22-item Sino-Nasal Outcome Test [SNOT-22] and visual analog scale [VAS]) and objective examinations (acoustic rhinometry and nasal endoscopy) were used for effectiveness assessments. RESULTS All three interventions could improve SNOT-22 scores, but the effects of LNI and CNI were more significant. According to VAS scores for nasal blockage, rhinorrhea, sneezing, nasal pruritus, postnasal discharge, and olfactory disturbance, the effect of LNI was superior to those of CNI and SNI. The results of rhinometry revealed that LNI significantly improved nasal resistance. Endoscopic analysis showed that both LNI and CNI, but not SNI, could significantly improve turbinate hypertrophy. Moreover, the best procedural comfort was found for LNI, which had no side effects or complications during the trial. CONCLUSIONS LNI is a natural, safe, and innovative therapy that can effectively treat AR. Its effect is superior to those of CNI and SNI, and it has greatly improved procedural comfort.
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Affiliation(s)
- Geng-He Chang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chia-Yi 61363, Taiwan; Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Yu-Shih Lin
- Department of Pharmacy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Ke-Hsin Hsu
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Yu-Ching Cheng
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Pei-Rung Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ming-Shao Tsai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chia-Yi 61363, Taiwan; Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Yao-Te Tsai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Cheng-Ming Hsu
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Pey-Jium Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan.
| | - Chung-Sheng Shi
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan.
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chia-Yi 61363, Taiwan; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-Yuan Wu
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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16
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Shkorbotun Y. EVALUATION OF THE UKRAINIAN VERSION OF SNOT-22 QUESTIONNAIRE VALIDITY FOR ASSESSING THE QUALITY OF LIFE IN PATIENTS WITH CHRONIC RHINOSINUSITIS AND NASAL SEPTUM DEVIATION. Georgian Med News 2020:43-47. [PMID: 33395639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
One of the world's most widely recognized and widely used questionnaires for assessing the impact of nasal diseases on the quality of life is sinonasal outcome test 22 (SNOT-22). The objective of the study was to develop the Ukrainian version of SNOT-22 questionnaire and to study its effectiveness while evaluating the impact of nasal diseases on quality of life of patients. The validity of the results obtained by using the Ukrainian version of SNOT-22 questionnaire was calculated by comparing the results obtained in the survey of patients with chronic rhinosinusitis (50), and patients with nasal septum deviation (50) with impaired nasal breathing, and two control groups (30 persons each): people with non-sinonasal symptoms and practically healthy people. The average results of SNOT-22 questionnaire for patients with chronic rhinosinusitis was 39.89 (SD=15.3), for patients with the nasal septum deviation it was 31.23 (SD=11.9). At the same time nonsinonasal patients, and control group representatives had the average SNOT-22 results 12.43(SD=4.5) and 10.34(SD=3,8), respectively. The Ukrainian version of SNOT-22 questionnaire is an effective statistical tool that can be used to study the impact of such a pathology as chronic rhinosinusitis and the nasal septum deviation on the quality of life of patients.
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Affiliation(s)
- Y Shkorbotun
- State Institution of Science "Research and Practical Center of Preventive and Clinical Medicine "State Administrative Department, Department of Miniinvasive Surgery; Shupyk National Medical Academy of Postgraduate Education, Department of Otolaryngology, Kiev, Ukraine
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Abstract
BACKGROUND Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), is responsible for the largest pandemic since the 1918 influenza A virus subtype H1N1 influenza outbreak. The symptoms presently recognized by the World Health Organization are cough, fever, tiredness, and difficulty breathing. Patient-reported smell and taste loss has been associated with COVID-19 infection, yet no empirical olfactory testing on a cohort of COVID-19 patients has been performed. METHODS The University of Pennsylvania Smell Identification Test (UPSIT), a well-validated 40-odorant test, was administered to 60 confirmed COVID-19 inpatients and 60 age- and sex-matched controls to assess the magnitude and frequency of their olfactory dysfunction. A mixed effects analysis of variance determined whether meaningful differences in test scores existed between the 2 groups and if the test scores were differentially influenced by sex. RESULTS Fifty-nine (98%) of the 60 patients exhibited some smell dysfunction (mean [95% CI] UPSIT score: 20.98 [19.47, 22.48]; controls: 34.10 [33.31, 34.88]; p < 0.0001). Thirty-five of the 60 patients (58%) were either anosmic (15/60; 25%) or severely microsmic (20/60; 33%); 16 exhibited moderate microsmia (16/60; 27%), 8 mild microsmia (8/60; 13%), and 1 normosmia (1/60; 2%). Deficits were evident for all 40 UPSIT odorants. No meaningful relationships between the test scores and sex, disease severity, or comorbidities were found. CONCLUSION Quantitative smell testing demonstrates that decreased smell function, but not always anosmia, is a major marker for SARS-CoV-2 infection and suggests the possibility that smell testing may help, in some cases, to identify COVID-19 patients in need of early treatment or quarantine.
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Affiliation(s)
- Shima T Moein
- School of Biological Sciences, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Seyed MohammadReza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Mansourafshar
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Khorram-Tousi
- School of Biological Sciences, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Richard L Doty
- Smell & Taste Center, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Yin G, Tu B, Ye L. Correlation of intensity-modulated radiation therapy at a specific radiation dose with the prognosis of nasal mucous damage after radiotherapy. Radiat Environ Biophys 2020; 59:245-255. [PMID: 32030481 DOI: 10.1007/s00411-020-00830-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
Objective of the present study was to investigate the tolerant radiation dose of nasal mucosa by observing and analyzing patients who received intensity-modulated radiation therapy (IMRT). Patients with nasopharyngeal carcinoma (N = 66) were selected for this study. The modified saccharin assay, endoscopy test, magnetic resonance imaging, and sino-nasal outcome test-20 (SNOT-20) survey were performed for the patients before and at 0 (T0), 3 (T1), 6 (T2), and 12 (T3) months after radiotherapy. The threshold doses of IMRT before radiotherapy and at T0, T1, T2, and T3 were determined as, respectively, 37 Gy, 37 Gy, 39 Gy, and 37 Gy for the saccharin test; 38 Gy, 37 Gy, 40 Gy, and 38 Gy for the endoscopy test; and 39 Gy, 37 Gy, 39 Gy, and 39 Gy for the nasal-related symptom scoring test. The modified saccharin assay, endoscopy test, and SNOT-20 survey revealed that a low dose (< threshold dose) of IMRT was associated with higher mucocilia transport rate (MRT), better endoscopy test score, and improved SNOT-20 score. The patients who received IMRT at a dose less than the threshold had the least damaged nasal mucosa morphology, and functional impairment scores were highest at T1 of IMRT. We conclude that nasal mucosa showed the most serious damage within 3 months after IMRT. If the radiation dose can be controlled within the threshold, the nasal mucosa can recover in the following few months, but recovery will be difficult otherwise.
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Affiliation(s)
- Gendi Yin
- Department of Otolaryngology and Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Bo Tu
- Department of Otolaryngology and Head and Neck Surgery, The First Affiliated Hospital of Ji Nan University, Guangzhou, 510632, Guangdong, China
| | - Ling Ye
- Department of Oncology, The First Affiliated Hospital of Ji Nan University, No. 613 Huang Pu Road west, Guangzhou, 510632, Guangdong, China.
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19
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Wu AW, Walgama ES, Higgins TS, Borrelli M, Vardanyan N, Hopp S, Shamsian A, Hopp ML. Eustachian Tube Quality of Life and Severity of Disease in Patients With Chronic Rhinosinusitis. Am J Rhinol Allergy 2020; 34:532-536. [PMID: 32188265 DOI: 10.1177/1945892420912366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has long been a suspected risk factor for Eustachian tube dysfunction (ETD). However, there have been few studies quantifying the presence of ETD in CRS patients. We sought to determine the prevalence of ETD symptoms in patients undergoing functional endoscopic sinus surgery (FESS) for CRS using the validated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and to correlate the ETDQ-7 scores with scores of CRS symptom severity based on the 22-item Sino-Nasal Outcome Test (SNOT-22). METHODS Patients for FESS were preoperatively administered both the ETDQ-7 and the SNOT-22 validated quality of life instruments. Pearson and Spearman correlation coefficients were calculated. Changes in ETDQ-7 were measured at 3 months and differences were compared via paired t test. RESULTS A total of 82 patients completed the surveys. Thirty-nine (47.6%) patients had ETDQ-7 score ≥14.5, signifying clinically significant ETD symptoms. The mean ETDQ-7 score of the study population was 15.8 ± 8.8, and the mean SNOT-22 score was 37.5 ± 19.7. The Pearson and Spearman correlation coefficients between ETDQ-7 and the total SNOT-22 score were 0.52 (P > .0001) and 0.51 (P < .0001), respectively. There was significant improvement in ETDQ-7 scores postoperatively. CONCLUSION While the association between ETD and CRS has long been known, this is one of the few prospective patient studies evaluating otologic symptoms in a CRS population. We found that a significant percentage of CRS patients suffer from ETD symptoms based on patient-reported subjective outcome measures. This study demonstrates that otologic symptoms increase with CRS severity and improve after FESS.
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Affiliation(s)
- Arthur W Wu
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Evan S Walgama
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Thomas S Higgins
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, & Throat, Department of Otolaryngology-Head & Neck Surgery, University of Louisville, Louisville, Kentucky
| | - Michela Borrelli
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Narine Vardanyan
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Stephanie Hopp
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Arash Shamsian
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Martin L Hopp
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
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Rahman AS, Hwang PH, Alapati R, Lin Y, Nayak JV, Patel ZM, Yan CH. Indications and Outcomes for Patients With Limited Symptoms Undergoing Endoscopic Sinus Surgery. Am J Rhinol Allergy 2020; 34:502-507. [PMID: 32168996 DOI: 10.1177/1945892420912159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous research have suggested that chronic rhinosinusitis (CRS) patients with lower symptomatic scores, demonstrated by a 22-item Sinonasal Outcome Test (SNOT-22) score <20, may not achieve meaningful quality of life improvement following endoscopic sinus surgery (ESS). However, indications for ESS are continuing to be defined and many low SNOT-22 scoring patients still undergo elective surgery for CRS and other benign sinonasal pathologies. The outcomes for these patients have not been previously studied. OBJECTIVES We sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS. METHODS We screened 2829 ESS procedures from 2010-2018 to identify patients with a preoperative SNOT-22 score <20. We reviewed disease characteristics, preoperative Lund-Mackay (LM) scores, and pre- and postoperative SNOT-22 scores in patients with at least 3 months' follow-up. RESULTS Of all surgical ESS patients screened, 114 had low preoperative SNOT-22 scores (4.0%). Indications for these surgeries included CRS (50.0%), odontogenic sinus disease (11.4%), mucocele (10.5%), recurrent acute sinusitis (7.0%), fungal ball (5.3%), and silent sinus syndrome (4.4%). Specifically, among CRS patients, 45.6% had pulmonary comorbidities and/or systemic immunodeficiencies. Moreover, 100% of CRS patients with nasal polyps and 73.1% of CRS without polyps had LM scores >5. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction (P < .001) postoperatively, whereas those with scores between 10 and 14 had a 5.4 point reduction (P < .001), and preoperative scores <9 resulted in no significant decrease in postoperative symptom scores (P = .98). Overall, there was a 3.3 point SNOT-22 reduction among all patients at 3 months postoperatively (P < .001). CONCLUSION Patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores.
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Affiliation(s)
- Arifeen S Rahman
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Peter H Hwang
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Rahul Alapati
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Yan Lin
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jayakar V Nayak
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Zara M Patel
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Carol H Yan
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
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21
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Chowdhury NI, Li P, Chandra RK, Turner JH. Baseline mucus cytokines predict 22-item Sino-Nasal Outcome Test results after endoscopic sinus surgery. Int Forum Allergy Rhinol 2019; 10:15-22. [PMID: 31645085 DOI: 10.1002/alr.22449] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mucus cytokines have been linked to baseline metrics of quality of life and olfactory function in patients with chronic rhinosinusitis (CRS). However, their potential utility in predicting postoperative outcomes has not been assessed. Therefore, in this study we evaluated the role of mucus cytokines in predicting 22-item Sino-Nasal Outcomes Test (SNOT-22) scores after endoscopic sinus surgery (ESS) in a prospective cohort of CRS patients. METHODS One hundred forty-seven patients with CRS electing surgical therapy were enrolled in a longitudinal cohort study. Mucus was collected intraoperatively from the middle meatus and tested for interleukin (IL)-1β, IL-2, -4, -5, -6, -7,- 8, -9, -10, -12, -13, -17A, and -21; tumor necrosis factor (TNF)-α; interferon-γ; eotaxin; and RANTES (regulated-on-activation, normal T-cell expressed and secreted) expression using a multiplex flow-cytometric bead assay. Sixty-two patients were followed postoperatively (average, 10.2 months) with baseline and follow-up SNOT-22 surveys. Stepwise multivariate linear regression was used to model relationships between baseline cytokines, phenotype, and average postoperative SNOT-22 total and domain scores. A machine learning approach using a random forest algorithm was also used to investigate potential nonlinear relationships. RESULTS IL-5 was an independent predictor of postoperative total SNOT-22 improvement (β = -8.8, p < 0.0001), whereas IL-2 levels predicted postoperative worsening (β = 6.97, p = 0.0015). Similar relationships were also seen for postoperative SNOT-22 domain scores. The overall model was also noted to be significant fit for the data (adjusted R2 = 0.398, p < 0.0001). The random forest model similarly identified IL-5, TNF-α, IL-13, and IL-2 as major predictors of postoperative SNOT-22 scores. CONCLUSION Mucus cytokine profiles may help identify CRS patients who are likely to obtain postoperative improvement after ESS.
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Affiliation(s)
- Naweed I Chowdhury
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Ping Li
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Rakesh K Chandra
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Justin H Turner
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
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My Nguyen DT, Vo TQ, Nguyen TD, Vu TQ, Chung Phan TT. Non-surgical chronic rhinosinusitis and quality of life: A Vietnamese perspective. J PAK MED ASSOC 2019; 69(Suppl 2):S20-S27. [PMID: 31369530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Evidences which illustrate symptoms of chronic rhinosinusitis (CRS) had negative effects on society and individuals are growing these days. The aims of this study are to assess the quality of life (QoL) of individuals with CRS and to analyze the relationship between socio-demographic as well as clinical factors and the quality of life of patients. METHODS A cross-sectional and prevalence-based study was conducted from May to July, 2018. We used The Sinonasal Outcome Test-22 (SNOT-22) questionnaire to evaluate the quality of life of patients with chronic rhinosinusitis. In addition, the univariate logistic regression analysis and logistic regression models were used to calculate the Crude odds ratio (OR), adjusted odds ratio (aOR), and 95% confidence intervals (CIs) for factors. Statistical significance was considered as P-value <0.05. RESULTS Among 315 participants, about two fifths of them were diagnosed with CRS. The statistical test illustrated that all factors illustrated significant differences. The main exposure variable, CRS, was significantly associated with poor quality of life, with a 78.02-fold increase in the odds of having a good quality of life score. CONCLUSIONS Our findings have shown that patients with CRS experience a poorer quality of life than healthy controls. The influencing factors included gender, economic status, exercise and nasal discharge.
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Affiliation(s)
- Dung Thi My Nguyen
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Trung Quang Vo
- Department of Economic and Administrative Pharmacy, Pham Ngoc Thach University of Medicine , Ho Chi Minh City, Vietnam
| | - Thoai Dang Nguyen
- Department of Pharmaceutics and Biopharmaceutics, Pham Ngoc Thach University of Medicine , Ho Chi Minh City, Vietnam
| | - Thang Quoc Vu
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
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Denton E, Bondarenko J, Tay T, Lee J, Radhakrishna N, Hore-Lacy F, Martin C, Hoy R, O'Hehir R, Dabscheck E, Hew M. Factors Associated with Dysfunctional Breathing in Patients with Difficult to Treat Asthma. J Allergy Clin Immunol Pract 2018; 7:1471-1476. [PMID: 30529061 DOI: 10.1016/j.jaip.2018.11.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/01/2018] [Accepted: 11/19/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Understanding of dysfunctional breathing in patients with difficult asthma who remain symptomatic despite maximal inhaler therapy is limited. OBJECTIVE We characterized the pattern of dysfunctional breathing in patients with difficult asthma and identified possible contributory factors. METHODS Dysfunctional breathing was identified in patients with difficult asthma using the Nijmegen Questionnaire (score >23). Demographic characteristics, asthma variables, and comorbidities were assessed. Multivariate logistic regression was performed for dysfunctional breathing, adjusted for age, sex, body mass index, and airflow obstruction. RESULTS Of 157 patients with difficult asthma, 73 (47%) had dysfunctional breathing. Compared with patients without dysfunctional breathing, those with dysfunctional breathing experienced poorer asthma status (symptom control, quality of life, and exacerbation rates) and greater unemployment. In addition, more frequently they had elevated sino-nasal outcome test scores, anxiety, depression, sleep apnea, and gastroesophageal reflux. On multivariate analysis, anxiety (odds ratio [OR], 3.26; 95% CI, 1.18-9.01; P = .02), depression (OR, 2.8; 95% CI, 1.14-6.9; P = .03), and 22-item sino-nasal outcome test score (OR, 1.03; 95% CI, 1.003-1.05; P = .03) were independent risk factors for dysfunctional breathing. CONCLUSIONS Dysfunctional breathing is common in difficult asthma and associated with worse asthma status and unemployment. The independent association with psychological disorders and nasal obstruction highlight an important interaction between comorbid treatable traits in difficult asthma.
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Affiliation(s)
- Eve Denton
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Janet Bondarenko
- Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - TunnRen Tay
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Joy Lee
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Fiona Hore-Lacy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Catherine Martin
- Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ryan Hoy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn O'Hehir
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eli Dabscheck
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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