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Higgins TS, Shutt TA, Ting JY, Illing EA, Tang DM, Kosaraju N, Potts K, Cash L, Liu D, Sheeley KA, Wu AW. Development of the 12-Item Facial Complaints Evaluation Scale (FaCES-12). Ann Otol Rhinol Laryngol 2024; 133:495-502. [PMID: 38380629 PMCID: PMC11022522 DOI: 10.1177/00034894241233034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES Chronic rhinosinusitis and related rhinologic disorders are common in routine otolaryngologic practice. Common presenting symptoms include nasal obstruction, facial pain, facial pressure, headache, and a subjective feeling of the face feeling "swollen," a perceptual distortion. No validated scale exists to assess facial pain in addition to perceptual distortion or headache. The objective was to develop a novel scale for assessment of facial symptoms experienced by patients presenting for rhinologic evaluation. METHODS This was a prospective validation cross-sectional study. A patient questionnaire, the 12-item Facial Complaints Evaluation Scale (FaCES-12), was created to evaluate facial symptoms based on clinical experience and the literature, including severity and timing of facial pain, facial pressure, facial perceptual swelling, and headache. Each item was assessed utilizing an 11-point Likert scale ranging from 0 to 10 in severity. Data was collected prospectively from 210 patients in 1 private and 2 academic otolaryngologic practices from August to December 2019 along with the PROMIS Pain Intensity Scale 3a and 22-Item Sino-nasal Outcome Test. Construct validity was determined using Pearson correlation and exploratory factor analysis. Internal consistency and test-retest reliability were assessed by calculating Cronbach's alpha and assessing test-retest scores. RESULTS A new 12-item scale named FaCES-12 was developed. FaCES-12 demonstrated high reliability with a Cronbach's alpha of .94 and high test-retest reliability (r = .90). The scale revealed very strong correlation with the PROMIS Pain Intensity Scale 3a (r = .81) and moderate correlation with the Sino-nasal Outcome Test (r = .48). Exploratory factor analysis demonstrated the scale contained interrelated variables that measured unique components of facial sensations. CONCLUSION The FaCES-12 is a valid and reliable instrument for use in the evaluation of facial symptoms. Further research into the application of this scale is warranted.
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Affiliation(s)
- Thomas S. Higgins
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose & Throat, Louisville, KY, USA
| | - Travis A. Shutt
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jonathan Y. Ting
- Department of Otolaryngology—Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elisa A. Illing
- Department of Otolaryngology—Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dennis M. Tang
- Department of Otolaryngology—Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nikitha Kosaraju
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kevin Potts
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Liz Cash
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - David Liu
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kathleen A. Sheeley
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose & Throat, Louisville, KY, USA
| | - Arthur W. Wu
- Department of Otolaryngology—Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Huang T, Zhou J, Yuan F, Yan Y, Wu D. The percentage of controlled chronic rhinosinusitis after treatment: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:2183-2194. [PMID: 38108847 DOI: 10.1007/s00405-023-08363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Chronic rhinosinusitis (CRS) is a chronic disease with a high recurrence rate, and the aim of treating CRS is to maintain disease control. Recently, a series of CRS control instruments have been developed to assess the control levels. We pooled existing studies to evaluate the percentage of controlled CRS after treatment in patients with CRS. METHODS A systematic literature review and meta-analysis using PubMed, Google Scholar, Scopus, and Cochrane databases was conducted to identify studies assessing CRS control. Both comprehensive assessments and self-report of CRS control were included. RESULTS 9 studies with 1931 patients after treatment and 295 patients before treatment were included. CRS control assessments of the 2012 European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2012), EPOS 2020, and Sinus Control Test (SCT) were comprehensive assessments utilized in the clinic practice. The self-report assessment included patient-reported global level of CRS control. These existing disease control instruments categorized patients into three (uncontrolled, partly controlled, and controlled) or five (not at all, a little, somewhat, very, and completely) control categories. Only 8% (95% CI 0.05-0.11) of patients with CRS stayed well controlled before treatment assessed by comprehensive assessments. About 35% (95% CI 0.22-0.49) of patients achieved well controlled after treatment when assessed by the comprehensive measures. Meanwhile, 40% (95% CI 0.28-0.52) of patients reported well controlled after treatment when using self-report. CONCLUSION About 35-40% of patients with CRS showed well controlled after treatment, which stressed the importance of identifying these undertreated patients with CRS.
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Affiliation(s)
- Tianhao Huang
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Jiahui Zhou
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Fan Yuan
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yan Yan
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Dawei Wu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.
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Chapurin N, Schlosser RJ, Gutierrez J, Mace JC, Smith TL, Bodner TE, Khan S, Mulligan JK, Mattos JL, Alt JA, Ramakrishnan VR, Soler ZM. All chronic rhinosinusitis endotype clusters demonstrate improvement in patient-reported and clinical outcome measures after endoscopic sinus surgery. Int Forum Allergy Rhinol 2024; 14:765-774. [PMID: 37563836 PMCID: PMC10858289 DOI: 10.1002/alr.23255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND It is unclear whether chronic rhinosinusitis (CRS) endotypes show a differential response to endoscopic sinus surgery (ESS). We explored patient mucous inflammatory cytokine expression and associations with patient-reported and clinically measured post-operative outcome measures. METHODS Patients with CRS were prospectively recruited between 2016 and 2021 into a national multicenter, observational study. Mucus was collected from the olfactory cleft preoperatively and evaluated for 26 biomarkers using cluster analysis. Patient-reported outcome measures included the 22-item Sino-Nasal Outcome Test (SNOT-22) and Questionnaire of Olfactory Dysfunction (QOD). Additional clinical measures of disease severity included threshold, discrimination, and identification (TDI) scores using "Sniffin' Sticks" testing and Lund-Kennedy endoscopic score (LKES). RESULTS A total of 115 patients were clustered into type 2 inflammatory, non-type 2 inflammatory, noninflammatory, and two indeterminate clusters based on individual protein levels. Overall, the type 2 inflammatory cluster was found to have the highest mean improvement in both SNOT-22 (-28.3 [standard deviation, ±16.2]) and TDI (6.5 [standard deviation, ±7.9]) scores 6 months after ESS. However, on average, all endotype clusters demonstrated improvement in all outcome measures after ESS without statistically significant between-group differences in SNOT-22 (p = 0.738), QOD (p = 0.306), TDI (p = 0.358), or LKES (p = 0.514) measures. CONCLUSIONS All CRS endotype clusters responded favorably to surgery and showed improvements in patient-reported and objective outcome measures. Thus, ESS should be considered a more generalized CRS therapy, and benefits appear to not be limited to specific endotypes.
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Affiliation(s)
- Nikita Chapurin
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Rodney J. Schlosser
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jorge Gutierrez
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Timothy L. Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Sofia Khan
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer K. Mulligan
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Jose L. Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jeremiah A. Alt
- Department of Otolaryngology – Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Vijay R. Ramakrishnan
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zachary M. Soler
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Ali A, Fakunle DR, Yu V, McDermott S, Previtera MJ, Meier JC, Phillips KM, Sedaghat AR. Heterogeneity in the definition of chronic rhinosinusitis disease control: a systematic review of the scientific literature. Eur Arch Otorhinolaryngol 2023; 280:5345-5352. [PMID: 37378726 DOI: 10.1007/s00405-023-08090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/21/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE Disease control is conceptually recognized to be an important outcome measure for chronic rhinosinusitis (CRS). However, inconsistent usage is a significant factor in disadoption of important concepts and it is presently unclear how consistently the construct of CRS 'control' is being defined/applied. The objective of this study was to determine the heterogeneity of CRS disease control definitions in the scientific literature. METHODS Systematic review of PubMed and Web of Science databases from inception through December 31, 2022. Included studies used CRS disease control as an explicitly stated outcome measure. The definitions of CRS disease control were collected. RESULTS Thirty-one studies were identified with more than half published in 2021 or later. Definitions of CRS control were variable, although 48.4% of studies used the EPOS (2012 or 2020) criteria to define control, 14 other unique definitions of CRS disease control were also implemented. Most studies included the burden CRS symptoms (80.6%), need for antibiotics or systemic corticosteroids (77.4%) or nasal endoscopy findings (61.3%) as criteria in their definitions of CRS disease control. However, the specific combination of these criteria and prior time periods over which they were assessed were highly variable. CONCLUSION CRS disease control is not consistently defined in the scientific literature. Although many studies conceptually treated 'control' as the goal of CRS treatment, 15 different criteria were used to define CRS disease control, representing significant heterogeneity. Scientific derivation of criteria and collaborative consensus building are needed for the development of a widely-accepted and -applied definition of CRS disease control.
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Affiliation(s)
- Ayad Ali
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA
| | - Damilola R Fakunle
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA
| | - Victor Yu
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Sean McDermott
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA
| | - Melissa J Previtera
- Health Sciences Library, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Josh C Meier
- University of Nevada, Reno School of Medicine, Reno, NV, USA
- Nevada ENT and Hearing Associates, Reno, NV, USA
| | - Katie M Phillips
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA.
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Sedaghat AR, Caradonna DS, Chandra RK, Franzese C, Gray ST, Halderman AA, Hopkins C, Kuan EC, Lee JT, McCoul ED, O'Brien EK, Pletcher SD, Pynnonen MA, Wang EW, Wise SK, Woodworth BA, Yao WC, Phillips KM. Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control. Int Forum Allergy Rhinol 2023; 13:2004-2017. [PMID: 37042828 DOI: 10.1002/alr.23168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/21/2023] [Accepted: 04/09/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND We identify chronic rhinosinusitis (CRS) manifestations associated with how rhinologists assess CRS control, with a focus on patient perspectives (patient-reported CRS control). METHODS Fifteen rhinologists were provided with real-world data from 200 CRS patients. Participating rhinologists first classified patients' CRS control as "controlled," "partly controlled," and "uncontrolled" using seven CRS manifestations reflecting European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) CRS control criteria (nasal obstruction, drainage, impaired smell, facial pain/pressure, sleep disturbance, use of systemic antibiotics/corticosteroids in past 6 months, and nasal endoscopy findings) and patient-reported CRS control. They then classified patients' CRS control without knowledge of patient-reported CRS control. Interrater reliability and agreement of rhinologist-assessed CRS control with patient-reported CRS control and EPOS guidelines were determined. RESULTS CRS control classification with and without knowledge of patient-reported CRS control was highly consistent across rhinologists (κw = 0.758). Rhinologist-assessed CRS control agreed with patient-reported CRS control significantly better when rhinologists had knowledge of patient-reported CRS control (κw = 0.736 vs. κw = 0.554, p < 0.001). Patient-reported CRS control, nasal obstruction, drainage, and endoscopy findings were most strongly associated with rhinologists' assessment of CRS control. Rhinologists' CRS control assessments weakly agreed with EPOS CRS control guidelines with (κw = 0.529) and without (κw = 0.538) patient-reported CRS control. Rhinologists classified CRS as more controlled than EPOS guidelines in almost 50% of cases. CONCLUSIONS This study directly demonstrates the importance of patient-reported CRS control as a dominant influence on rhinologists' CRS control assessment. Knowledge of patient-reported CRS control may better align rhinologists' CRS control assessments and treatment decisions with patients' perspectives.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David S Caradonna
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christine Franzese
- Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Claire Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Erin K O'Brien
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Melissa A Pynnonen
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | | | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Sedaghat AR, Phillips KM. Chronic rhinosinusitis disease control: a review of the history and the evidence. Expert Rev Clin Immunol 2023; 19:903-910. [PMID: 37343511 DOI: 10.1080/1744666x.2023.2229027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Control is an important concept and outcome measure for chronic incurable diseases, defined as the extent to which manifestations of a disease are within acceptable limits. Control reflects a global metric of disease status and serves as the goal of treatment. This review will encompass the history of the disease control concept applied to chronic rhinosinusitis (CRS) and the body of scientific literature that has focused on the definition of CRS disease control. AREAS COVERED A review of the scientific literature identified historical studies and guidelines that have developed definitions of CRS disease control, as well as recent studies identifying the most significant determinants of CRS control. A particular focus was made on studies that investigated patients' and physicians' perspectives of CRS control. EXPERT OPINION Patients and physicians have well-aligned perspectives about the definition, criteria, and application of CRS disease control, with a specific prioritization of patients' assessments of their own CRS control, as well as the symptoms of nasal obstruction and nasal drainage. The development of future guidelines for assessing CRS control must be based on criteria supported by evidence as essential to the assessment of CRS control but should also be the subject of broad international consensus.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Zhou J, Yuan F, Huang T, Zhu L, Wu D. Current understanding of disease control and its application in patients with chronic rhinosinusitis. Front Cell Infect Microbiol 2023; 13:1104444. [PMID: 37342244 PMCID: PMC10277650 DOI: 10.3389/fcimb.2023.1104444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/22/2023] [Indexed: 06/22/2023] Open
Abstract
Background Disease control is a primary treatment goal for patients with chronic rhinosinusitis (CRS). This study aims to summarize the evaluation parameters of disease control and then identify predictors of poorly controlled CRS. Methods A systematic review of the literature was performed on PubMed, Google Scholar, Scopus, and Cochrane databases to identify studies relating to disease control in CRS. Results The concept of disease control in patients with CRS involved the longitudinal assessment of the disease state and was also an important goal of treatment. As a metric of the disease state, the disease control reflected the ability to keep disease manifestations within certain limits, the efficacy after treatment, and the impact on quality of life. Validated measurements, such as EPOS2012 criteria, EPOS2020 criteria, Sinus Control Test, and patient/physician-reported global level of CRS control, have been utilized in clinical practice. These existing disease control instruments incorporated various disease manifestations and categorized patients into two (well-controlled and poor-controlled), three (uncontrolled, partly controlled, and controlled), or five (not at all, a little, somewhat, very, and completely) control categories. Eosinophilia, high computerized tomography score, bilateral sinonasal disease, asthma, allergic rhinitis, female gender, aspirin intolerance, revision surgery, low serum amyloid A, and specific T cell subtype would predict poorly controlled CRS. Conclusion The concept of disease control and its application were gradually developed in patients with CRS. The existing disease control instruments demonstrated a lack of uniformity regarding the controlled criteria and included parameters.
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Affiliation(s)
- Jiahui Zhou
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, China
| | - Fan Yuan
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tianhao Huang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wen Zhou, China
| | - Li Zhu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, China
| | - Dawei Wu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, China
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Abdulghany A, Surda P, Hopkins C. Core Outcome Measures in Chronic Rhinosinusitis With Nasal Polyps: In Practice and Research. Am J Rhinol Allergy 2023; 37:232-239. [PMID: 36848282 DOI: 10.1177/19458924231154070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Heterogeneity in outcomes used in clinical trials prevents meta-analysis and contributes to research waste. Core outcome sets aim to address this by defining a small number of essential outcomes that should be measured in all effectiveness trials. Adoption in routine clinical practice can further improve outcomes for patients.There has been a rapid growth in therapeutic options available for patients with chronic rhinosinusitis with nasal polyps, but difficulty comparing results leads to uncertainty into optimum management, and there is a need to define a core outcome set. We consider whether work already undertaken needs to be modified for patients with nasal polyps.We recommend that a core outcome set should include assessment of disease specific quality of life, nasal polyp score, evaluation of sense of smell, alongside need for OCS and surgical treatment and complications from the disease or treatment. Further work is required to achieve international consensus regarding the choice of nasal polyp scoring system.
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Affiliation(s)
| | - Pavol Surda
- ENT Department, Guy's and St Thomas' NHS Trust, London, UK
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas' NHS Trust, London, UK
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Abstract
PURPOSE OF REVIEW Control is a global disease metric defined as the extent to which manifestations of a disease are within acceptable limits. Control serves as the goal of treatment for chronic diseases, such as chronic rhinosinusitis (CRS), that cannot be cured. The objective of this review is to summarize recommendations for assessment of CRS control with a specific focus on how these recommendations align with patients' and healthcare providers' perspectives of CRS control. RECENT FINDINGS Several staging systems for CRS control have been developed with the first and most widely recognized by the 2012 European Position Paper on Rhinosinusitis and Nasal Polyps, which was developed through expert opinion. Patients' and providers'/guideline-based assessments of CRS control frequently do not align. Patients understand the concept of CRS control and their assessment is dominated by the perceived severity of nasal symptoms. In comparison, providers' and guideline-based assessments of control are more global, incorporating nasal and extra-nasal symptoms, need for systemic antibiotics and corticosteroids, and nasal endoscopy. SUMMARY Although more research is needed, future development of CRS control criteria through consensus around explicitly determined perspectives of healthcare providers and patients may one day serve as the foundation for a standardized approach to treatment of CRS.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology - Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Hopkins C, Lee SE, Klimek L, Soler ZM. Clinical Assessment of Chronic Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1406-1416. [PMID: 35183784 DOI: 10.1016/j.jaip.2022.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 12/15/2022]
Abstract
Chronic rhinosinusitis (CRS) is a common disease that affects >10% of the adult population in Europe and the United States. It has been delineated phenotypically into CRS without nasal polyps and CRS with nasal polyps. Both have a high disease burden and an overlapping spectrum of symptoms such as nasal obstruction, olfactory dysfunction, facial pain, pressure, and nasal discharge. Primary assessment includes evaluation of patient symptoms and impact on quality of life, nasal endoscopic examination, and imaging. Significant progress has been made in the understanding of CRS pathophysiology. There is a move toward describing CRS in terms of the predominant endotype or inflammatory pattern pathomechanism rather than the traditional classification of patients with and without nasal polyps. An increased elucidation of the disease endotypes, as characterized by their inflammatory pathways and mediators, is leading to a tailored more personalized treatment approach to the different disease subtypes.
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Affiliation(s)
| | - Stella E Lee
- Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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11
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Walker V, Trope M, Tichavakunda AA, Speth MM, Sedaghat AR, Phillips KM. Disease control in chronic rhinosinusitis: a qualitative study of patient perspectives. Rhinology 2022; 60:282-292. [PMID: 35608041 DOI: 10.4193/rhin21.448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The definition of disease control in chronic rhinosinusitis (CRS) is an active area of study. However, investigations have not engaged CRS patients in how they think about disease control. This study seeks to understand the patient perspective on CRS disease control. METHODS Qualitative phenomenological study using constant comparative methodology was applied. The research team conducted 10, one-on-one interviews with CRS patients ranging from 22 to 55 minutes in length. The content of the interview protocol was determined through iterative discussion amongst all authors. Two authors served as coders to identify recurrent themes. Themes were analyzed for meaning and conclusions were summarized. RESULTS Three recurring themes determined from patients were that (1) use of the terminology "control" adequately represents this phenomenon, (2) components of control could be classified into four main themes relating to CRS symptomatology, exacerbation of comorbid disease, quality of life and acute exacerbations of CRS, and (3) when patients deem their CRS is uncontrolled they are more willing to escalate their treatment to include escalating their daily maintenance regimen, seeking otolaryngology referral, taking rescue medication or undergoing endoscopic sinus surgery. CONCLUSIONS CRS patients consider their daily symptoms, the severity and frequency of CRS exacerbations, impact on quality of life as well as exacerbation of comorbid disease when thinking about their disease control. Disease control is a goal of treatment for patients and uncontrolled disease motivates patients to seek further treatment. Physicians should explore all components of CRS control when considering disease status and need for further treatment.
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Affiliation(s)
- V Walker
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - M Trope
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - A A Tichavakunda
- Department of Education Leadership, School of Education, University of Cincinnati, Cincinnati, OH, USA
| | - M M Speth
- Department of Otorhinolaryngology, Kantonsspital Aarau, Aarau, Switzerland
| | - A R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - K M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Phillips KM, Singerman KW, Sedaghat AR. Individual symptom visual analogue scale severity scores for determining EPOS guideline-based chronic rhinosinusitis disease control. Rhinology 2022; 60:229-235. [PMID: 35229832 DOI: 10.4193/rhin21.446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The goal of this study was to determine how to translate visual analogue scale (VAS) symptom scores to the binary, descriptive symptom scales used in the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria for chronic rhinosinusitis (CRS) disease control. METHODS 309 CRS patients were recruited. All patients rated their burden of 5 symptoms (nasal blockage, rhinorrhea/postnasal drip, facial pain/pressure, smell loss, sleep disturbance or fatigue) using the binary EPOS descriptive symptom scales and a VAS (on a scale of 0 to 10). In addition, participants completed a 22-item Sinonasal Outcome Test (SNOT-22) and rated their overall CRS disease control as "controlled", "partly controlled" or "uncontrolled". RESULTS Symptom burdens measured by VAS, binary descriptive EPOS scale and SNOT-22 were associated with worsening CRS disease control reported by participants. Each symptom had a distinct VAS score cut-off that strongly predicted the uncontrolled option on the corresponding binary descriptive EPOS symptom scale. However, the predictive ability of VAS for rhinorrhea/ postnasal drip was disparately worse than the other 4 symptoms. When considering all symptom data simultaneously, a VAS score >3.5 strongly predicted the uncontrolled option on the corresponding binary descriptive EPOS symptom scale for all 5 symptoms. CONCLUSIONS A VAS symptom score of >3.5 translates to the uncontrolled option in the binary, descriptive symptom scale of the EPOS control criteria. The rhinorrhea/postnasal drip descriptive symptom scale translates disparately worse to VAS scores and may be considered for revision in future criteria.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - K W Singerman
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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13
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Phillips KM, Houssein FA, Singerman K, Boeckermann LM, Sedaghat AR. Patient-reported chronic rhinosinusitis disease control is a valid measure of disease burden. Rhinology 2021; 59:545-551. [PMID: 34762075 DOI: 10.4193/rhin21.282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Disease control is an important treatment goal for chronic uncurable conditions such as chronic rhinosinusitis (CRS). The objective of this study was to determine whether patient-reported CRS disease control is a valid reflection of disease burden. METHODS Prospective longitudinal study of 300 CRS patients (35% CRS with nasal polyps, 65% CRS without nasal polyps). At enrollment and at a subsequent follow-up timepoint, all participants were asked to rate their CRS disease control as "not at all," "a little," "somewhat," "very," or "completely", as well as to complete a 22-item Sinonasal Outcome Test (SNOT-22) and the 5-dimension EuroQol general health questionnaire from which the visual analogue scale (EQ-5D VAS) was used. RESULTS At enrollment and follow-up timepoints, patient-reported CRS disease control was significantly correlated with SNOT-22 and EQ-5D VAS scores. The change in patient-reported CRS disease control was significantly correlated with change in SNOT-22 and change in EQ-5D VAS scores. There was significant cross-sectional and longitudinal correlation between patient-reported control and all SNOT-22 subdomain scores. A SNOT-22 score of ≤ 25 points or lower, or an EQ-5D VAS score of ≥77 was predictive of having well - (i.e. "very" or "completely") controlled CRS. CONCLUSIONS Patient-reported CRS disease control is a valid measure of CRS disease burden and general QOL. A patient-reported assessment of CRS disease control could be considered as a component of a more comprehensive measure of CRS disease control.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - F A Houssein
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - K Singerman
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - L M Boeckermann
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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14
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Predictors of sinonasal disease onset, progression, and severity in pediatric cystic fibrosis patients. Am J Otolaryngol 2021; 42:103016. [PMID: 33836483 DOI: 10.1016/j.amjoto.2021.103016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Pediatric cystic fibrosis (CF) patients have a variable onset, severity, and progression of sinonasal disease. The objective of this study was to identify genotypic and phenotypic factors associated with CF that are predictive of sinonasal disease, recurrent nasal polyposis, and failure to respond to standard treatment. METHODS A retrospective case series was conducted of 30 pediatric patients with CF chronic rhinosinusitis with and without polyps. Patient specific mutations were divided by class and categorized into high risk (Class I-III) and low risk (Class IV-V). Severity of pulmonary and pancreatic manifestations of CF, number of sinus surgeries, nasal polyposis and recurrence, age at presentation to Otolaryngology, and Pediatric Sinonasal Symptom Survey (SN-5)/Sinonasal Outcome Test (SNOT-22) scores were examined. RESULTS 27/30 patients (90%) had high risk mutations (Class I-III). 21/30 (70.0%) patients had nasal polyposis and 10/30 (33.3%) had recurrent nasal polyposis. Dependence on pancreatic enzymes (23/27, 85.2% vs 0/3, 0.0%, p = 0.009) and worse forced expiratory volumes (FEV1%) (mean 79, SD 15 vs mean 105, SD 12, p = 0.009) were more common in patients with high risk mutations. Insulin-dependence was more common in those with recurrent polyposis (5/10, 50% vs 2/20, 10%, p = 0.026). There was no statistical difference in ages at presentation, first polyps, or sinus surgery, or in polyposis presence, recurrence, or extent of sinus surgery based on high risk vs. low risk classification. CONCLUSION CF-related diabetes was associated with nasal polyposis recurrence. Patients with more severe extra-pulmonary manifestations of CF may also be at increased risk of sinonasal disease.
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15
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McCann AC, Trope M, Walker VL, Kavoosi TA, Speth MM, Gengler I, Phillips KM, Sedaghat AR. Olfactory Dysfunction is not a Determinant Of Patient-Reported Chronic Rhinosinusitis Disease Control. Laryngoscope 2020; 131:E2116-E2120. [PMID: 33300623 DOI: 10.1002/lary.29280] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS As a cardinal symptom of chronic rhinosinusitis (CRS), hyposmia has been recommended to be assessed as a component of CRS disease control. Herein we determine the significance of hyposmia in CRS in the context of nasal obstruction and drainage symptoms. STUDY DESIGN Prospective, cross-sectional METHODS: Cross-sectional study of 308 CRS patients (102 CRSwNP, 206 CRSsNP) without prior endoscopic sinus surgery. The burden of nasal obstruction and hyposmia were assessed using the corresponding item scores on the 22-item Sinonasal Outcome Test (SNOT-22). Burden of nasal discharge was assessed using the mean of "thick nasal discharge" and "thick post-nasal discharge" SNOT-22 item scores. Patients were all asked to rate their CRS symptom control as "not at all," "a little," "somewhat," "very," or "completely." RESULTS In CRSwNP, only 4.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. In CRSsNP, only 1.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. On univariate association, CRS symptom control was significantly associated with nasal obstruction, hyposmia, and drainage in both CRSwNP and CRSsNP (P < .05 in all cases). Using multivariable regression to account for all nasal symptoms, only nasal obstruction and nasal discharge scores (but not hyposmia) were significantly associated with CRS symptom control. CONCLUSIONS Hyposmia rarely occurs without nasal obstruction or nasal drainage, and may therefore be redundant to assess for CRS disease control. Moreover, hyposmia was not associated with patient-reported CRS symptom control when accounting for the burden of nasal obstruction and drainage. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2116-E2120, 2021.
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Affiliation(s)
- Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Michal Trope
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Victoria L Walker
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Tazheh A Kavoosi
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Marlene M Speth
- Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Switzerland
| | - Isabelle Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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Lee SE, Farzal Z, Kimple AJ, Senior BA, Thorp BD, Zanation AM, Ebert CS. Readability of patient-reported outcome measures for chronic rhinosinusitis and skull base diseases. Laryngoscope 2020; 130:2305-2310. [PMID: 31603564 DOI: 10.1002/lary.28330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Outcome measures in healthcare that presume a higher level of patient health and overall literacy may inadequately estimate the disease experiences of less-educated patients and further disadvantage them. Patient-Reported Outcome Measures (PROMs) are widely used communication tools for clinical practice and are often used to evaluate and guide management for chronic rhinosinusitis (CRS) and skull base diseases. However, their readability and subsequent incomprehensibility for patients have not been assessed. The aim of this study is to evaluate the readability of commonly used PROMs for these conditions and whether they meet recommended readability levels. METHODS Three readability measures, Gunning Fog, Simple Measure of Gobbledygook (SMOG), and FORCAST were used in the evaluation of commonly used PROMs for CRS and skull base disease. PROMs with sixth-grade readability level or lower were considered to meet health literacy experts' recommendations. RESULTS A total of 11 PROMs were reviewed (8 CRS, 3 skull base). Gunning Fog consistently estimated the easiest readability, whereas FORCAST the most difficult. One hundred percent of CRS and 67% of skull base PROMs were above National Institutes of Health and health literacy experts' recommended reading levels. PROMs developed more recently had easier readability. CONCLUSION PROMs are important clinical tools in otolaryngology that help guide management of disease for improved patient-centered care. Like many other fields of medicine, those used in otolaryngology are beyond recommended reading levels. Development of PROMs in the future should meet recommended readability levels to fully assess the disease experience of our patients. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2305-2310, 2020.
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Affiliation(s)
- Saangyoung E Lee
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Zainab Farzal
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Adam J Kimple
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Brent A Senior
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Brian D Thorp
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Charles S Ebert
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
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Little RE, Schlosser RJ, Smith TL, Storck KA, Alt JA, Beswick DM, Mace JC, Mattos JL, Ramakrishnan VR, Soler ZM. Disease control after surgery for chronic rhinosinusitis: prospective, multi-institutional validation of the Sinus Control Test. Int Forum Allergy Rhinol 2020; 11:106-114. [PMID: 32713106 DOI: 10.1002/alr.22659] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/12/2020] [Accepted: 07/01/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Sinus Control Test (SCT) is a 4-question, patient-reported questionnaire that assesses disease control in chronic rhinosinusitis (CRS). This prospective, multicenter study examines SCT outcomes following endoscopic sinus surgery (ESS), further validating its use as a control instrument for CRS. METHODS Adults with CRS undergoing ESS were prospectively enrolled from 5 centers across North America. The SCT was administered at baseline and once 6 months after surgery. Quality of life and disease burden were evaluated using the 22-item Sino-Nasal Outcome Test (SNOT-22) and Lund-Kennedy endoscopy scores. Linear regression was used to determine whether specific demographic, comorbidity, or disease severity measures were independently associated with changes in SCT scores postoperatively. RESULTS A total of 218 patients, 111 females (50.9%) and 107 males (49.1%), were enrolled, with mean ± standard deviation age of 50.1 ± 15.6 years. Mean SCT score improved from 8.9 ± 3.5 to 4.3 ± 3.7 postoperatively (p < 0.001). Preoperatively, 21.6% were uncontrolled, 71.5% partially controlled, and 6.9% controlled. Postoperatively, 6.0% were uncontrolled, 42.6% partially controlled, and 51.4% controlled (p < 0.001). Change in SCT score correlated independently with change in SNOT-22 (r = 0.500, p < 0.001) and endoscopy scores (r = 0.310, p < 0.001). Endoscopy scores did not correlate with control status among patients with CRS without nasal polyposis (CRSsNP) nor between uncontrolled and partially controlled patients. Demographics and comorbidities were not associated with changes in SCT. CONCLUSION Improvement in disease control following ESS as measured by the SCT correlated with improvements in SNOT-22 and endoscopy scores. The SCT is an easily administered instrument that provides information complementary to existing patient-reported and objective measures of disease severity.
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Affiliation(s)
- Ryan E Little
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Kristina A Storck
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Jose L Mattos
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Virginia, Charlottesville, VA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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Ghadersohi S, Price CPE, Jensen SE, Beaumont JL, Kern RC, Conley DB, Welch KC, Peters AT, Grammer LC, Stevens WW, Calice AM, Stanton E, VanderMeeden MK, Schleimer RP, Tan BK. Development and Preliminary Validation of a New Patient-Reported Outcome Measure for Chronic Rhinosinusitis (CRS-PRO). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:2341-2350.e1. [PMID: 32376490 PMCID: PMC7448958 DOI: 10.1016/j.jaip.2020.04.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patient-reported outcome (PRO) measures developed and validated on patients with the currently defined phenotypes of chronic rhinosinusitis (CRS) are needed to support clinical trials in CRS. OBJECTIVE This study developed and examined the initial reliability and validity of the CRS-PRO, a new PRO measure of CRS. METHODS Instrument development was performed through structured interviews and focus groups with clinical experts and 45 patients with CRS meeting current definitions of disease, 21 patients with CRS without nasal polyps (CRSsNP), and 24 patients with CRS with nasal polyps (CRSwNP) to identify items important to patients. Then another 50 patients (32 with CRSsNP and 18 with CRSwNP) with stable CRS symptoms were enrolled to evaluate the reliability of the instrument. Each patient completed the CRS-PRO, Sinonasal Outcome Test-22 (SNOT-22), and 4 Patient-Reported Outcome Measurement Information System short forms at the baseline visit and then at least 7 days later. RESULTS After the development process, 21 items were identified from the conceptual domains of physical symptoms, sensory impairment, psychosocial effects, and life impact. Using the responses of the 50 patients with CRS, 21 draft items were further refined to 12 items by eliminating conceptually similar or highly correlated items or those with low mean symptom severity. The 12-item questionnaire was shown to have excellent internal consistency (Cronbach α, 0.86) and test-retest reliability with a high intraclass correlation coefficient (0.89) and Pearson's correlation (r = 0.82, P < .0001). The 12-item CRS-PRO correlated highly with the longer SNOT-22 (r = 0.83, P < .0001) demonstrating its concurrent validity. We also demonstrated validity and reliability in a separate analysis for patients with CRSsNP and CRSwNP. CONCLUSION The CRS-PRO is a concise, valid, and reliable measure that was developed with extensive input from patients with CRS with current disease definitions.
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Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Caroline P E Price
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Sally E Jensen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | | | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - David B Conley
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Anju T Peters
- Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Leslie C Grammer
- Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Whitney W Stevens
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Alexis M Calice
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Elizabeth Stanton
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Marisa K VanderMeeden
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Robert P Schleimer
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill.
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19
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Stapleton AL, Shaffer AD, Morris A, Li K, Fitch A, Methé BA. The microbiome of pediatric patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 11:31-39. [PMID: 32348024 DOI: 10.1002/alr.22597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to compare the microbiota of pediatric patients with chronic rhinosinusitis (CRS) who are undergoing adenoidectomy to treat their disease with that of healthy control patients. METHODS Patients undergoing adenoidectomy-only for obstructive sleep apnea (n = 50) and CRS (n = 37) were recruited. Preoperative 22-item Sino-Nasal Outcome Test (SNOT-22) or Sinus and Nasal Quality of Life Survey (SN-5) were collected. Each patient had samples collected from their nasopharynx (adenoid bed) and nasal cavity (sinus) at the onset of surgery. 16S ribosomal ribonucleic acid (rRNA) gene sequencing was subsequently performed to obtain per sample taxonomic abundances. Statistical analyses included permutational multivariate analysis of variance (PERMANOVA), alpha (within sample) diversity measures, and changes in taxonomic abundance. RESULTS Moraxella was the most abundant organism. Nasopharyngeal swabs demonstrated higher alpha diversity compared to the nasal cavity. The diversity was not different based on CRS vs obstructive history. There was an increase in diversity with increasing age, and eczema contributed to a greater difference in diversity between the nasopharynx and nasal cavity. Diversity was not affected by adenoid size; however, use of nasal steroids, inhaled steroids, and antihistamines influenced diversity in both the nasopharynx and nasal cavity. Nasopharyngeal samples were higher in relative abundance for Fusobacterium, Prevotella, Porphyromonas, and Campylobacter compared to the nasal cavity. CONCLUSION The nasopharynx and nasal cavity differed in both microbiota composition and diversity. In contrast, no significant difference in composition or diversity were found in CRS vs control patients. Ecological changes in the nasopharyngeal and sinus site may contribute to the etiology for adenoid hypertrophy in both healthy controls and CRS patients.
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Affiliation(s)
- Amanda L Stapleton
- Department of Otolaryngology, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Amber D Shaffer
- Department of Otolaryngology, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Alison Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA
| | - Kelvin Li
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA
| | - Adam Fitch
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA
| | - Barbara A Methé
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA
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Chowdhury N, Smith TL, Beswick DM. Measuring Success in the Treatment of Patients with Chronic Rhinosinusitis. Immunol Allergy Clin North Am 2020; 40:265-279. [DOI: 10.1016/j.iac.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Yoo F, Schlosser RJ, Storck KA, Ganjaei KG, Rowan NR, Soler ZM. Effects of endoscopic sinus surgery on objective and subjective measures of cognitive dysfunction in chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:1135-1143. [DOI: 10.1002/alr.22406] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/14/2019] [Accepted: 07/28/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Frederick Yoo
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
- Department of SurgeryRalph H. Johnson VA Medical Center Charleston SC
| | - Kristina A. Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Kimia G. Ganjaei
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
- Rutgers: Robert Wood Johnson Medical School Piscataway NJ
| | - Nicholas R. Rowan
- Department of Otolaryngology‒Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
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Rowan NR, Schlosser RJ, Storck KA, Ganjaei KG, Soler ZM. The impact of medical therapy on cognitive dysfunction in chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:738-745. [DOI: 10.1002/alr.22323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/09/2019] [Accepted: 02/01/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Nicholas R. Rowan
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore MD
| | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
- Department of Surgery; Ralph H. Johnson VA Medical Center; Charleston SC
| | - Kristina A. Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
| | - Kimia G. Ganjaei
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
- Rutgers Robert Wood Johnson Medical School; Piscataway NJ
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
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Phillips KM, Hoehle LP, Caradonna DS, Gray ST, Sedaghat AR. Determinants of noticeable symptom improvement despite sub‐MCID change in SNOT‐22 score after treatment for chronic rhinosinusitis. Int Forum Allergy Rhinol 2018; 9:508-513. [DOI: 10.1002/alr.22269] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/06/2018] [Accepted: 11/29/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Katie M. Phillips
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston MA
| | - Lloyd P. Hoehle
- Edward Via College of Osteopathic Medicine—Carolinas Spartanburg SC
| | - David S. Caradonna
- Department of OtolaryngologyHarvard Medical School Boston MA
- Division of OtolaryngologyBeth Israel Deaconess Medical Center Boston MA
| | - Stacey T. Gray
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston MA
| | - Ahmad R. Sedaghat
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston MA
- Division of OtolaryngologyBeth Israel Deaconess Medical Center Boston MA
- Department of Otolaryngology and Communications EnhancementBoston Children's Hospital Boston MA
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Sedaghat AR, Hoehle LP, Gray ST. Chronic rhinosinusitis control from the patient and physician perspectives. Laryngoscope Investig Otolaryngol 2018; 3:419-433. [PMID: 30599025 PMCID: PMC6302712 DOI: 10.1002/lio2.208] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The concept of disease control incorporates independent disease characteristics that are longitudinally reflective of disease status and which can be used to make treatment decisions. Chronic rhinosinusitis (CRS) is a chronic condition for which the determination of disease control by both the patient and the treating physician is important. Our objectives were to determine CRS disease characteristics that are associated with patient-reported and physician-rated CRS disease control. STUDY TYPE Cross-sectional. METHODS A total of 209 participants were prospectively recruited. Participants were asked to rate their global level of CRS control as "not at all," "a little," "somewhat," "very," and "completely." All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) and also reported the number of sinus infections, CRS-related antibiotic courses taken, CRS-related oral corticosteroid courses taken, and missed days of work or school due to CRS, all in the last 3 months. Clinical and demographic characteristics were also collected from each participant. A Lund-Kennedy endoscopy score was calculated for each participant from nasal endoscopy. Two rhinologists were then given each participant's SNOT-22 score (as well as SNOT-22 nasal, sleep, otologic/facial pain, and emotional subdomain scores), endoscopy score, and the number of sinus infections, CRS-related antibiotics, CRS-related oral corticosteroid courses and missed days of work or school due to CRS in the preceding 3 months as reported by the patient. The two rhinologists were blinded to all other participant characteristics and each rhinologist independently rated every participant's global control level as "not at all," "a little," "somewhat," "very," and "completely." Associations were sought between CRS disease characteristics (SNOT-22 score, endoscopy score, sinus infections, CRS-related antibiotic usage, CRS-related oral corticosteroid usage, and lost productivity due to CRS) and patient-reported CRS control as well as mean physician-rated CRS control. RESULTS Patient-reported global CRS control was associated only with SNOT-22 (adjusted relative risk [RR] = 0.99, 95% CI: 0.98-0.99, P < .001) but no other CRS disease characteristic. Patient-reported CRS control was specifically associated only with nasal symptoms and not extra-nasal symptoms of CRS. Physician-rated CRS control was associated with SNOT-22 score (adjusted RR [for each 1-unit increase of SNOT-22] = 0.99, 95% CI: 0.98-0.99, P < .001), number of acute bacterial CRS exacerbations-reflected by number of antibiotic courses taken (or sinus infections)-in the last 3 months (adjusted RR = 0.89, 95% CI: 0.82-0.98, P = .014) and the number of CRS-related oral corticosteroid courses taken in the last 3 months (adjusted RR = 0.87, 95% CI: 0.78-0.97, P = .012). Nasal, sleep, and otologic/facial pain symptoms were all associated with physician-rated CRS control. Having used at least one course of antibiotics or oral corticosteroids in the last 3 months was the optimal threshold for detecting poorly controlled CRS. CONCLUSIONS Patients and physicians use different criteria to determine the level of CRS control. While both rely on the burden of CRS symptomatology, patients consider primarily nasal symptoms while physicians include nasal and extra-nasal symptoms of CRS in determining CRS control. Physicians also independently consider CRS-related antibiotic use, as a reflection of acute bacterial CRS exacerbations, and CRS-related oral corticosteroid use in the determination of global CRS control. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Ahmad R. Sedaghat
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsU.S.A
- Division of OtolaryngologyBeth Israel Deaconess Medical CenterBostonMassachusettsU.S.A
- Department of Otolaryngology and Communications EnhancementBoston Children's HospitalBostonMassachusettsU.S.A
| | - Lloyd P. Hoehle
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsU.S.A
| | - Stacey T. Gray
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsU.S.A
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Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) has a significant impact on the quality of life of patients and is a high cost burden to both society and patients. There is a variety of objective and subjective outcome measures that exist to assess the effectiveness of interventions. We aim to review current outcome measures available. RECENT FINDINGS Traditionally, results have focused on objective measures, however, subjective outcome measures are gaining traction as being more important. Outcome measures in chronic rhinosinusitis are currently heterogeneous, thus limiting the impact of meta-analysis of past trial results. The development of a core outcome set may standardize the reporting of outcomes in chronic rhinosinusitis. SUMMARY We outline the outcome measures currently available and discuss a proposed core outcome set that may facilitate further value of research on interventions for CRS in adults.
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Affiliation(s)
- Fiona Ting
- ENT Department, Guy’s Hospital, Great Maze Pond, London, SE1 9RT UK
| | - Claire Hopkins
- ENT Department, Guy’s Hospital, Great Maze Pond, London, SE1 9RT UK
- King’s College London, London, UK
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Campbell AP, Hoehle LP, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Symptom control in chronic rhinosinusitis is an independent predictor of productivity loss. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:237-241. [PMID: 29724671 DOI: 10.1016/j.anorl.2017.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/22/2017] [Accepted: 05/15/2017] [Indexed: 12/29/2022]
Abstract
AIMS Sinonasal symptoms cause significant productivity losses in patients with chronic rhinosinusitis (CRS). Patient-perceived CRS symptom control is a longitudinal measure of CRS symptomatology and is directly associated with general health-related quality of life (QOL) in patients with CRS. The aim of this study was to better understand the relationship between symptom control and productivity loss in CRS. MATERIALS AND METHODS Prospective cross-sectional cohort study of 200 patients with CRS. Patients categorized their CRS symptom control as "Not at all", "A little", "Somewhat", "Very", and "Completely". Lost productivity was assessed by determining the number of work and/or school days missed in the last 3 months due to CRS symptoms. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22). Associations were sought between lost productivity and patient-perceived CRS symptom control. OBJECTIVE To determine the association between patient-perceived longitudinal symptom control and productivity in patients with CRS. RESULTS A total of 200 participants (48% male, 52% female), with a mean age of 52 years (Standard Deviation [SD]: 16) were enrolled. The mean SNOT-22 score of participants was 33.5 (SD: 22.4). Participants missed a mean of 3 days (SD: 10) of work or school due to CRS. CRS symptom control classified as "not at all" was associated with 11 days of lost productivity due to CRS on univariate analysis (β=11.16, 95% CI: 5.39-16.94, P<0.001) and 8 days of lost productivity on multivariate analysis (β=8.02, 95% CI: 1.92-14.13, P=0.011). None of the other categories of patient-reported CRS symptom control were associated with lost productivity due to CRS. CONCLUSIONS Patient-perceived control of CRS symptoms, an important metric previously shown to be significantly associated with QOL in CRS patients, is independently associated with lost productivity. These results motivate longitudinal studies to determine if improvement of CRS symptom control may reduce losses in productivity.
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Affiliation(s)
- A P Campbell
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - L P Hoehle
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - K M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - S T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - A R Sedaghat
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts, United States of America.
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27
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Wise SK. IFAR Editorial May 2016. Int Forum Allergy Rhinol 2018; 6:451-3. [PMID: 27144768 DOI: 10.1002/alr.21795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gray ST, Phillips KM, Hoehle LP, Caradonna DS, Sedaghat AR. The 22-item Sino-Nasal Outcome Test accurately reflects patient-reported control of chronic rhinosinusitis symptomatology. Int Forum Allergy Rhinol 2017; 7:945-951. [PMID: 28753732 DOI: 10.1002/alr.21992] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patient-reported control of chronic rhinosinusitis (CRS) symptoms is associated with the quality of life impact of CRS. We sought to determine if 22-item Sino-Nasal Outcome Test (SNOT-22) score is predictive of patient-perceived CRS symptom control. METHODS Prospective cross-sectional study of 202 patients with CRS. Participants were asked to rate their CRS symptom control as "not at all," "a little," "somewhat," "very," and "completely." The severity of patient CRS symptomatology was measured using the SNOT-22. The relationship between SNOT-22 score and patient-reported CRS symptom control was determined using regression, analysis of variance (ANOVA), and receiver operating characteristic (ROC) curve analysis. RESULTS SNOT-22 was negatively associated with patient-reported CRS symptom control (adjusted β = -0.03; 95% CI, -0.04 to -0.02; p < 0.001), after controlling for demographic and clinical characteristics. There was a significant difference in SNOT-22 scores of participants reporting each level of symptom control (p < 0.001) with the greatest differences between participants who rated their CRS symptom control as "not at all," "a little," and "somewhat," which we deem poor CRS symptom control, and the group who described their level of CRS symptom control described as "very" and "completely," which we deem well-controlled CRS symptoms. These results were true across all SNOT-22 subdomains scores as well. Using ROC analysis, a SNOT-22 score of 35 identified patients reporting poor vs well-controlled CRS symptom control with 71.4% sensitivity and 85.5% specificity. CONCLUSION SNOT-22 score is associated with how well patients feel their CRS symptomatology is controlled. Moreover, SNOT-22 score can be used to accurately distinguish patients with poor vs well-controlled CRS symptoms.
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Affiliation(s)
- Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Katie M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Lloyd P Hoehle
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, MA
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Gray S, Hoehle L, Phillips K, Caradonna D, Sedaghat A. Patient-reported control of chronic rhinosinusitis symptoms is positively associated with general health-related quality of life. Clin Otolaryngol 2017; 42:1161-1166. [DOI: 10.1111/coa.12841] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 02/04/2023]
Affiliation(s)
- S.T. Gray
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston MA USA
| | - L.P. Hoehle
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston MA USA
| | - K.M. Phillips
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston MA USA
| | - D.S. Caradonna
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Division of Otolaryngology; Beth Israel Deaconess Medical Center; Boston MA USA
| | - A.R. Sedaghat
- Department of Otolaryngology; Harvard Medical School; Boston MA USA
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston MA USA
- Division of Otolaryngology; Beth Israel Deaconess Medical Center; Boston MA USA
- Department of Otolaryngology and Communications Enhancement; Boston Children's Hospital; Boston MA USA
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