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Gu Z, Wei P, Kou W, Tang XY, Yao HB, Liu EM. Analysis of Multimorbidity of Moderate to Severe Allergic Rhinitis in Children: A Real-World Study. Int Arch Allergy Immunol 2023; 184:882-892. [PMID: 37290409 DOI: 10.1159/000530842] [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: 01/12/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Allergic rhinitis (AR) in children is associated with various comorbidities, posing challenges for treatment and management. There have been few investigations of these multimorbidities in Chinese children with AR. Here, we investigated the prevalence of multimorbidities in children with moderate to severe AR and analyzed the influencing factors using real-world data. METHODS In total, 600 children who visited the outpatient clinic of our hospital and were diagnosed with moderate-severe AR were prospectively enrolled. All children underwent allergen detection and electronic nasopharyngoscopy. Parents or guardians completed a questionnaire that included age, sex, mode of delivery, feeding pattern, and familial history of allergy. The multimorbidities investigated included atopic dermatitis (AD), asthma, allergic conjunctivitis (AC), chronic rhinosinusitis (CRS), adenoid hypertrophy (AH), tonsil hypertrophy (TH), recurrent epistaxis, and recurrent respiratory tract infections (RRTIs). RESULTS The AR multimorbidities reported in children were as follows: recurrent epistaxis (46.5%), AC (46.3%), AD (40.7%), asthma (22.5%), RRIs (21.3%), CRS (20.5%), AH (19.7%), and TH (12.5%). In univariate logistic regression analysis, age (<6 years), birth mode, familial history of allergy, and single dust mite allergy were associated with AR multimorbidity (p < 0.05). Multivariate logistic regression revealed that a familial history of allergy was an independent risk factor for AC (odds ratio [OR] = 1.539, 95% confidence interval [CI]: 1.104-2.145) and AH (OR = 1.506, 95% CI: 1.000-2.267) (p < 0.05). Age (<6 years) was independently associated with the risk of AD (OR = 1.405, 95% CI: 1.003-1.969) and RRTIs (OR = 1.869, 95% CI: 1.250-2.793) (p < 0.05), cesarean section with AR and CRS risk (OR = 1.678, 95% CI: 1.100-2.561), and single dust mite allergy with asthma (OR = 1.590, 95% CI: 1.040-2.432) and CRS (OR = 1.600, 95% CI: 1.018-2.515) risk (p < 0.05). Further, non-dust mite allergy was independently associated with AR and CRS (OR = 2.056, 95% CI: 1.084-3.899). CONCLUSION AR was found to be accompanied by different comorbidities, including both allergic and non-allergic comorbidities, complicating disease treatment. These findings demonstrated that age (<6 years), familial history of allergy, types of allergens, and cesarean section were risk factors for different multimorbidities associated with AR.
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Affiliation(s)
- Zheng Gu
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China,
| | - Ping Wei
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Wei Kou
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Xin-Ye Tang
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Hong-Bing Yao
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - En-Mei Liu
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
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Calvo-Henriquez C, Tucciarone M, Lechien JR, Maniaci A, Graham E, Maza-Solano J, Metwaly O, Martinez-Capoccioni G, Mariño-Sanchez F, Plaza G, Martin-Martin C. Turbinate surgery in pediatric patients: A worldwide survey. Acta Otorrinolaringologica (English Edition) 2023; 74:93-100. [PMID: 37005043 DOI: 10.1016/j.otoeng.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/04/2022] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Impaired nasal breathing is a common condition among pediatric patients, being rhinitis the most common cause. In recent years, turbinate surgery, mainly turbinate radiofrequency ablation (TRA), has increased in popularity amongst pediatric otolaryngologists and rhinologists as a safe and useful technique to address turbinate hypertrophy in pediatric patients. The present paper is designed with the aim of assessing the current worldwide clinical practice regarding turbinate surgery in pediatric patients. METHODS The questionnaire was developed based on previous researches, by a group of 12 experts from the rhinology and pediatric otolaryngology research group belonging to the Young Otolaryngologists of the International Federation of Otorhinolaryngological societies (YO-IFOS). The survey was then translated to 7 languages and sent to 25 scientific otolaryngologic societies around the globe. RESULTS 15 scientific societies agreed to distribute the survey to their members. There were 678 responses from 51 countries. From them, 65% reported to usually perform turbinate surgery in pediatric patients. There was a statistically significant increased likelihood of performing turbinate surgery for those practicing rhinology, sleep medicine, and/or pediatric otolaryngology compared to other subspecialties. The main indication to perform turbinate surgery was nasal obstruction (93.20%); followed by sleep disordered breathing (53.28%), chronic rhinosinusitis (28.70%) and facial growth alterations (22.30%). CONCLUSIONS There is no general consensus on the indications and ideal technique for turbinate reduction in children. This dissension arises mainly from the lack of scientific evidence. The points with highest agreement (>75%) between respondents is the use of nasal steroids prior to surgery; reintroducing nasal steroids in allergic patients; and performing turbinate surgery as day-case surgery.
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Yaseen NK. OUTCOMES OF SEPTOPLASTY IN CHILDREN. Pol Merkur Lekarski 2023; 51:140-143. [PMID: 37254761 DOI: 10.36740/merkur202302106] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Aim: The aim of the study was to present the experience of a local hospital surgical department where septoplasty is performed on children suffering from its degeneration. PATIENTS AND METHODS Materials and methods: A retrospective cohort study with 100 patients aged between 3 and 18 years were taken. Both males and females out of 100 patients were followed up for 7 years. The patients were treated with using septoplasty as well as the related clinical procedures such as cauterization of the inferior turbinate. We performed clinical evaluation and nasal endoscopy of the cases in the postoperative period. The longest observation period was 7 years. RESULTS Results: The male and female child enrolled in the study were 60 (60%) and 40 (40%), respectively. Out of this number of patients, 92 (92%) had inferior turbinate cauterization. In all the 100 cases, we did not notice any intraoperative complication. Also, all the cases were evaluated in 15th, 30th, and 60th days of observation. CONCLUSION Conclusions: When performed correctly, septoplasty in children is a good clinical intervention as it allows the right growth and development of the crani-ofacial region and prevents abnormalities in psychic and somatic components in young patients. Moreover, this study confirms the previous studies that have demystified the point of view, that the setoplasty should only be recommended when the patients reach the ages of 17 and 18.
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Calvo-Henriquez C, Tucciarone M, Lechien JR, Maniaci A, Graham E, Maza-Solano J, Metwaly O, Martinez-Capoccioni G, Mariño-Sanchez F, Plaza G, Martin-Martin C. Turbinate surgery in pediatric patients: A worldwide survey. Acta Otorrinolaringológica Española 2022. [DOI: 10.1016/j.otorri.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mullol J, Del Cuvillo A, Lockey RF. Rhinitis Phenotypes. J Allergy Clin Immunol Pract 2020; 8:1492-503. [PMID: 32389274 DOI: 10.1016/j.jaip.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different "phenotypes," based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment.
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Mariño-Sánchez F, Valls-Mateus M, de Los Santos G, Plaza AM, Cobeta I, Mullol J. Multimorbidities of Pediatric Allergic Rhinitis. Curr Allergy Asthma Rep 2019; 19:13. [PMID: 30793232 DOI: 10.1007/s11882-019-0843-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Most children and adolescents with allergic rhinitis (AR) present extra-nasal multimorbid conditions, including conjunctivitis, asthma, atopic dermatitis, rhinosinusitis, or seromucous otitis. Additionally, they may present nasal obstructive disorders, such as septal deformity, turbinate enlargement, and adenoidal hyperplasia, which worsen nasal symptoms, especially nasal obstruction. This is a narrative review on the current state of the concomitant presence of AR and one or more multimorbidities. RECENT FINDINGS The presence of AR and one or more accompanying multimorbidities is associated to a higher severity and duration of the disease, a negative impact on quality of life, with worse control and lack of improvement with medical treatment. Therefore, AR needs to be managed with a multidisciplinary collaborative approach. Pediatric AR needs to be considered in the context of a systemic disease, which requires a coordinated therapeutic strategy.
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Eliseeva TI, Krasilnikova SV, Babaev SY, Novozhilov AA, Ovsyannikov DY, Ignatov SK, Kubysheva NI, Shakhov AV. Dependence of Anterior Active Rhinomanometry Indices on Nasal Obstructive Disorders in Children with Atopic Bronchial Asthma Complicated by Nasal Symptoms. Biomed Res Int 2018; 2018:1869613. [PMID: 30402463 PMCID: PMC6193332 DOI: 10.1155/2018/1869613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atopic bronchial asthma (BA) in children is associated with upper airways pathology (UAP). Among them, a combination of allergic rhinitis (AR) and nasal obstructive disorders (NOD), including hypertrophy of the pharyngeal tonsil (HPT) and anomalies of the intranasal structures (AINS), is abundant. In such patients, anterior active rhinomanometry (AARM) is an important method of examining nasal patency. However, NOD can influence the AARM parameters in children with BA and nasal symptoms, and this effect must be taken into account in clinical practice. Study goal was to elucidate the effect of NOD on rhinomanometric parameters in this group of patients. METHODS Total of 66 children with BA and AR were examined with AARM, rhinovideoendoscopy, spirometry, and standard clinical tests allowing revealing the structure of comorbid pathologies. In order to avoid the influence of anthropometric parameters of children and their age on AARM parameters, a special index of reduced total nasal airflow was used. RESULTS It has been established that NOD, especially HPT, have a significant negative impact on the indices of anterior active rhinomanometry during the periods of both AR remission and AR exacerbation. The effect of AINS is much weaker and was remarkable only in combination with HPT.
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Affiliation(s)
- Tatyana I. Eliseeva
- MD, DSc, Professor, Chair of Hospital Pediatrics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
| | - Svetlana V. Krasilnikova
- Assistant, Department of ENT Diseases, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
| | - Sergey Yu. Babaev
- MD, Department of ENT Diseases, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
| | - Alexey A. Novozhilov
- MD, Head of the Department of ENT Diseases, Privolzhsky District Medical Center of Federal Medico-Biologic Agency of Russia, 2 Nizhne-Volzhskaya Naberezhnaya, Nizhny Novgorod 603005, Russia
| | - Dmitry Yu. Ovsyannikov
- MD, DSc, Head of the Department of Pediatrics, Medical Institute, Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya St., Moscow 117198, Russia
| | - Stanislav K. Ignatov
- DSc, Professor, Chair of Photochemistry and Spectroscopy, Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Avenue, Nizhny Novgorod 603950, Russia
| | - Nailya I. Kubysheva
- DSc, Senior Researcher, Medical Informatics Research Laboratory of the Higher School of Information Technologies and Information Systems, Kazan Federal University, 18 Kremlyovskaya St., Kazan 420000, Russia
| | - Andrey V. Shakhov
- MD, DSc, Professor, Head of the Department of ENT Diseases, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
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Eliseeva TI, Krasilnikova SV, Geppe NA, Babaev SY, Tush EV, Khaletskaya OV, Ovsyannikov DY, Balabolkin II, Ignatov SK, Kubysheva NI. Effect of Nasal Obstructive Disorders on Sinonasal Symptoms in Children with Different Levels of Bronchial Asthma Control. Can Respir J 2018; 2018:4835823. [PMID: 29854029 DOI: 10.1155/2018/4835823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
Abstract
Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p < 0.0001) and ACQ-5 and SNOT-20 (R=0.42, p < 0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP.
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Mariño-Sanchez F, Valls-Mateus M, Haag O, Alobid I, Bousquet J, Mullol J. Smell loss is associated with severe and uncontrolled disease in children and adolescents with persistent allergic rhinitis. J Allergy Clin Immunol Pract 2018; 6:1752-1755.e3. [PMID: 29426750 DOI: 10.1016/j.jaip.2017.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/16/2017] [Accepted: 12/19/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Franklin Mariño-Sanchez
- Rhinology Unit, Otorhinolaryngology Department, University Hospital Ramón y Cajal, Madrid, Spain; Pediatric Otorhinolaryngology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain; Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain.
| | - Meritxell Valls-Mateus
- Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Rhinology Unit and Smell Clínic, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Oliver Haag
- Pediatric Otorhinolaryngology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Isam Alobid
- Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Rhinology Unit and Smell Clínic, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jean Bousquet
- INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Joaquim Mullol
- Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Rhinology Unit and Smell Clínic, Hospital Clínic, Barcelona, Catalonia, Spain
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Abstract
PURPOSE OF REVIEW Timing of pediatric nasal surgery has always been a controversial topic. Concern over disrupting growing parts of the face and causing permanent facial deformity has led to a primarily conservative approach. Many surgeons feel that it is prudent to wait until the patient has completed nasal growth after puberty to pursue nasal surgery. RECENT FINDINGS Recently, this attitude has been challenged with evidence that not only is nasal surgery in the pediatric age group not a detriment to facial growth, but failure to correct significant nasal deformity may actually cause dysmorphic facial growth secondary to obligate mouth breathing. Because of this, recent studies have focused on determining safe surgical techniques for pediatric nasal surgery, including inferior turbinate reduction, septoplasty and rhinoplasty. Research focus on this topic has also been expanded to include quality-of-life measures after nasal surgery. SUMMARY Pediatric nasal surgery prior to puberty is not only safe, but may prevent facial deformity in certain patients.
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Valls-Mateus M, Marino-Sanchez F, Ruiz-Echevarría K, Cardenas-Escalante P, Jiménez-Feijoo R, Blasco-Lozano J, Giner-Muñoz MT, Haag O, Alobid I, Plaza Martin AM, Mullol J. Nasal obstructive disorders impair health-related quality of life in adolescents with persistent allergic rhinitis: A real-life study. Pediatr Allergy Immunol 2017; 28:438-445. [PMID: 28423474 DOI: 10.1111/pai.12724] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously reported a higher prevalence of nasal obstructive disorders (NOD) in pediatric patients with persistent allergic rhinitis (PER) not responding to medical treatment. The aim of this study was to determine the impact of NOD on quality of life (QoL) in this population. METHODS Real-life prospective study including 142 patients (41 children, 6-11 years old and 101 adolescents, 12-17 years old) with moderate and severe PER. After 2 months of medical treatment (intranasal steroids and antihistamines), patients were asked whether their symptoms had improved (yes/no) and classified accordingly in R, responders and NR, non-responders. Nasal symptoms (visual analog scale, VAS), NOD (nasal endoscopy), and QoL (PRQLQ, AdolQRLQ) were also assessed. RESULTS Sixty-nine adolescents and 24 children were included in the NR group. NR presented worse QoL overall scores in adolescents (3.16±1.1 vs 1.63±0.99; P=.00001) and children (2.19±0.82 vs 1.51±0.77, P=.02). Medical treatment failure was associated with worse outcomes in QoL (adolescents OR: 1.6, P<.0001; children OR: 1.04, P=.036). Female adolescents presented worse QoL scores than males (3.19 vs 2.36, P=.001). The presence of obstructive septal deviation (OR: 1.02, P=.005), obstructive turbinate hyperplasia (OR: 1.03, P=.0006), and coexistence of both (OR=2.06, P=.001) was associated with worse QoL in adolescents. A strong and highly significant correlation was found between nasal symptoms VAS and QoL. CONCLUSION The presence of NOD, particularly in adolescents, is associated with poor QoL outcomes. Assessment of NOD in pediatric PER should be considered an essential approach to determine the response to treatment and its impact on patient's QoL.
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Affiliation(s)
- Meritxell Valls-Mateus
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.,Unitat de Rinologia i Clínica de l'Olfacte, Otorhinolaringology Department, Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Franklin Marino-Sanchez
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Paulina Cardenas-Escalante
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Jaime Blasco-Lozano
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - María Teresa Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Oliver Haag
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Isam Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Otorhinolaringology Department, Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ana María Plaza Martin
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Otorhinolaringology Department, Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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