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Alsaleh S, Kamal N, Hopkins C, Al Rand H, Marglani OA, Alterki A, Abu Suliman O, Alandejani T, Kamel R, Al Abri R, Alotaibi NH, Al Amadi A, Bahakim A, Han JK, Javer A, Sedaghat AR, Gevaert P. Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool. Laryngoscope Investig Otolaryngol 2024; 9:e1277. [PMID: 38803462 PMCID: PMC11129554 DOI: 10.1002/lio2.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Background Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. Methods To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. Results The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment. Conclusion The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Level of evidence Oxford Level 3.
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Affiliation(s)
- Saad Alsaleh
- Department of Otolaryngology—Head and Neck Surgery, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Nehal Kamal
- Global Medical Immunology – Specialty CareSanofiUnited Arab Emirates
| | | | - Hussain Al Rand
- Health Centers and Clinics and Public HealthMinistry of HealthAbu DhabiUnited Arab Emirates
| | - Osama A. Marglani
- The Department of Ophthalmology and Otolaryngology, College of MedicineUmm Al‐Qura UniversityMakkahSaudi Arabia
- Department of OtolaryngologyKing Faisal Specialist Hospital & Research CenterJeddahSaudi Arabia
| | - Abdulmohsen Alterki
- Department of Otolaryngology, Head and Neck SurgeryZain and Al Sabah HospitalsKuwait CityKuwait
- Medical DepartmentDasman Diabetes InstituteKuwait CityKuwait
| | - Omar Abu Suliman
- Department of Rhinology, Sinus, and Skull Base SurgeryKing Abdullah Medical CityMakkahSaudi Arabia
| | - Talal Alandejani
- Department of Surgery, Faculty of MedicineKing Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
| | - Reda Kamel
- ENT Department, Kasr Al‐Ainy Faculty of MedicineCairo UniversityCairoEgypt
| | - Rashid Al Abri
- ENT Division, Department of Surgery, College of Medicine & Health SciencesSultan Qaboos UniversityMuscatSultanate of Oman
| | - Naif H. Alotaibi
- Otolaryngology, Head & Neck Surgery Department, King Faisal Specialist Hospital and Research CenterAlfaisal UniversityRiyadhSaudi Arabia
| | - Ahmad Al Amadi
- ENT DepartmentAl Kuwait Hospital, Ministry of HealthDubaiUnited Arab Emirates
| | - Abdullah Bahakim
- Department of Otolaryngology, Head, and Neck SurgeryKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Joseph K. Han
- Department of Otolaryngology ‐ Head and Neck SurgeryEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Amin Javer
- Rhinology and Skull Base Surgery, St. Paul's Sinus Center, Division of OtolaryngologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ahmad R. Sedaghat
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Philippe Gevaert
- Upper Airways Research Laboratory, Department of OtorhinolaryngologyGhent UniversityGhentBelgium
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Zhou Q, Ma J, Biswal S, Rowan NR, London NR, Riley CA, Lee SE, Pinto JM, Ahmed OG, Su M, Liang Z, Du R, Ramanathan M, Zhang Z. Air pollution, genetic factors, and chronic rhinosinusitis: A prospective study in the UK Biobank. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 940:173526. [PMID: 38825199 DOI: 10.1016/j.scitotenv.2024.173526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a prevalent upper respiratory condition that manifests in two primary subtypes: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). While previous studies indicate a correlation between air pollution and CRS, the role of genetic predisposition in this relationship remains largely unexplored. We hypothesized that higher air pollution exposure would lead to the development of CRS, and that genetic susceptibility might modify this association. METHODS This cohort study involving 367,298 adult participants from the UK Biobank, followed from March 2006 to October 2021. Air pollution metrics were estimated at residential locations using land-use regression models. Cox proportional hazard models were employed to explore the associations between air pollution exposure and CRS, CRSwNP, and CRSsNP. A polygenic risk score (PRS) was constructed to evaluate the joint effect of air pollution and genetic predisposition on the development of CRS. RESULTS We found that the risk of CRS increased under long-term exposure to PM2.5 [the hazard ratios (HRs) with 95 % CIs: 1.59 (1.26-2.01)], PM10 [1.64 (1.26-2.12)], NO2 [1.11 (1.04-1.17)], and NOx [1.18 (1.12-1.25)], respectively. These effects were more pronounced among participants with CRSwNP, although the differences were not statistically significant. Additionally, we found that the risks for CRS and CRSwNP increased in a graded manner among participants with higher PRS or higher exposure to PM2.5, PM10, or NOx concentrations. However, no multiplicative or additive interactions were observed. CONCLUSIONS Long-term exposure to air pollution increases the risk of CRS, particularly CRSwNP underscoring the need to prioritize clean air initiatives and environmental regulations.
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Affiliation(s)
- Qinfeng Zhou
- Department of Global Health, The Peking University School of Public Health, Beijing, China
| | - Junxiong Ma
- Department of Global Health, The Peking University School of Public Health, Beijing, China
| | - Shyam Biswal
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Stella E Lee
- Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jayant M Pinto
- Section of Otolaryngology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Omar G Ahmed
- Department of Otolaryngology, Houston Methodist Academic Institute, Houston, TX, USA
| | - Mintao Su
- Department of Global Health, The Peking University School of Public Health, Beijing, China
| | - Zhisheng Liang
- Department of Global Health, The Peking University School of Public Health, Beijing, China
| | - Runming Du
- Department of Global Health, The Peking University School of Public Health, Beijing, China
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Zhenyu Zhang
- Department of Global Health, The Peking University School of Public Health, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China; Institute of Carbon Neutrality, Peking University, Beijing, China.
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Fan H, Han Z, Gong X, Wu Y, Fu Y, Zhu T, Li H. Prevalence and predictors of depression and anxiety in patients with chronic rhinosinusitis: a systematic review and meta-analysis. BMJ Open 2024; 14:e079273. [PMID: 38490652 PMCID: PMC10946353 DOI: 10.1136/bmjopen-2023-079273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/25/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a persistent inflammation of the sinuses. As a result of long-term discomfort, patients may experience symptoms of common mental disorders such as anxiety and depression. This may affect the quality of life and disease progression. However, there is still uncertainty about the extent of the problem. OBJECTIVE This meta-analysis aimed to determine the prevalence of depression and anxiety symptoms in patients with CRS. SEARCH STRATEGY We searched PubMed, Embase, Web of Science, Cochrane Library, and CBM databases for relevant studies published before 15 July 2022 in patients with CRS with concomitant depression and anxiety symptoms. DATA COLLECTION AND ANALYSIS Two authors independently performed screening and quality assessment using validated tools. Extraction of data using predefined standardised data collection spreadsheets. Heterogeneity and inconsistency were checked using the I² statistic. RESULTS The meta-analysis included 32 articles involving 56 933 patients. The prevalence of depression and anxiety symptoms was estimated at 24.7% (95% CI, 21.3% to 28. 1%) and 29.7% (95% CI, 19.3% to 40.2%). Subgroup analysis revealed the following: (1) CRS without nasal polyps (CRSsNP): 26.2% (95% CI, 21.9% to 30.5%), CRS with nasal polyps(CRSwNP): 20% (95% CI, 15.9% to 24%); (2) Female patients: 36. 1% (95% CI, 25.3% to 46.9%), male patients: 24.3% (95% CI, 12. 1% to 36.6%); and (3) The average age≤50 years patients: 29.8% (95% CI, 21.3% to 38.2%), the average age>50 years patients: 22. 1% (95% CI, 17.1% to 27%). CONCLUSION A significant proportion of people with CRS have symptoms of depression and anxiety, and early screening for depression and anxiety in people with CRS is critical. And, more attention needs to be given to females and patients with CRSsNP during screening. PROSPERO REGISTRATION NUMBER CRD42022345959).
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Affiliation(s)
- Hongli Fan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhoutong Han
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinru Gong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuqi Wu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yijie Fu
- School of Preclinical Medicine, Chengdu University, Chengdu, Sichuan, China
| | - Tianmin Zhu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Li
- School of Preclinical Medicine, Chengdu University, Chengdu, Sichuan, China
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Luke L, Lee L, Gokani SA, Boak D, Boardman J, Philpott C. Understanding the Impact of Chronic Rhinosinusitis with Nasal Polyposis on Smell and Taste: An International Patient Experience Survey. J Clin Med 2023; 12:5367. [PMID: 37629408 PMCID: PMC10455838 DOI: 10.3390/jcm12165367] [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: 07/13/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
The aim is to understand the patient experience of living with chronic rhinosinusitis with nasal polyposis (CRSwNP), clinician interactions and how symptoms, smell and taste disturbance are managed. An anonymized, online survey was distributed through a UK charity, Fifth Sense, a UK otolaryngology clinic and online support groups to capture qualitative and quantitative data. Data were collected from 1st December 2022 to 1st February 2023. A total of 124 individuals participated. The majority were female (66%) and in the age range of 41-70 years; 74.2% of participants were from the UK with the rest from North America, Europe and Asia. A total of 107 participants declared they had CRSwNP. Rhinologists and general otolaryngology clinicians scored the highest for patient satisfaction whilst general practitioners scored the lowest. Satisfaction with the management of smell and taste disturbance was lower amongst all clinicians compared to overall satisfaction. Ratings correlated with response to therapy and clinician interactions. Respondents reported hyposmia/anosmia to be the most debilitating symptom. Surgery and oral steroids were considered to be effective; however, the benefit lasted less than six months (62%). Hyposmia/anosmia is a key CRSwNP symptom that has limited treatment options and is frequently undervalued by clinicians. There is a need for more effective management options, education and patient support.
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Affiliation(s)
- Louis Luke
- Ear, Nose and Throat (ENT) Department, James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth NR31 6LA, UK;
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Liam Lee
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Shyam Ajay Gokani
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Duncan Boak
- Fifth Sense, Unit 2, Franklins House, Wesley Lane, Bicester OX26 6JU, UK
| | - Jim Boardman
- Fifth Sense, Unit 2, Franklins House, Wesley Lane, Bicester OX26 6JU, UK
| | - Carl Philpott
- Ear, Nose and Throat (ENT) Department, James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth NR31 6LA, UK;
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
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5
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Zhu Z, Lan J, Wei R, Xu Y, Hong Y, Bao W, He G. Microbiome and
Th
cytokines association in chronic rhinosinusitis with or without nasal polyp. Laryngoscope Investig Otolaryngol 2023; 8:335-345. [PMID: 37090867 PMCID: PMC10116975 DOI: 10.1002/lio2.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/20/2022] [Accepted: 02/12/2023] [Indexed: 03/11/2023] Open
Abstract
Objective Chronic rhinosinusitis (CRS), a common disease in otorhinolaryngology, seriously affects the life quality of patients. The existing therapy has certain limitations, and it is very urgent to deeply explore the pathogenesis and classification of CRS. Microbiome and inflammation are considered the causes of CRS, but the precise roles and the associations between these two factors in the pathogenesis of CRS remain controversial. Methods Secretions were collected from the middle nasal canal, maxillary sinus and ethmoid sinus in CRS patients, then subjected to 16 S rRNA gene sequencing to profile microbiota community. Operational Taxonomic Units clustering and species annotation were adopted to obtain species diversity, prevalence rate and average relative abundance. Comparisons were performed at the level of microbial species and genus between CRS and control using NMDS, Anosim and MetaStat analysis. Th1 cytokines and Th2 cytokines were detected by ELISA. Spearman analysis were adopted to probe into the correlation between Th cytokines and microbial species in CRS. Results Thirty-seven patients were enrolled, among them 22 with CRS and 15 were controls. The most abundant genera were Corynebacterium and Staphylococcus no matter in CRS patients or control. Corynebacterium propinquum was significant decreased in CRS patients no matter with nasal polyp or not. The abundances of Prevotella birria and Carnobacterium maltaromaticum were significantly different between CRSsNP and CRSwNP group. The levels of cytokines IL-2, TNF-α, IFN-ɣ, IL-4, IL-6, IL-10 were all increased in CRS patients. The cytokines levels were associated with specific microbial species in nasal tissue. Conclusion The changes of species richness and complexity in nasal microbiome were obvious in CRS patients with nasal polyps or not. The different cytokines levels and microbiome between CRS patients without nasal polyps and patients with nasal polyps suggest heterogeneity in pathogenesis of chronic rhinosinusitis. Distinct microbiota and different cytokines were strongly linked in CRS. Level of Evidence NA.
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Affiliation(s)
- ZhongShou Zhu
- The Third Clinical Medical College Fujian Medical University Fuzhou China
| | - Jiao Lan
- Department of Otolaryngology Ningde Municipal Hospital Affliated of Ningde Normal University (Ningde Institute of Otolaryngology) Ningde Fujian China
| | - Rifu Wei
- Department of Otolaryngology Ningde Municipal Hospital Affliated of Ningde Normal University (Ningde Institute of Otolaryngology) Ningde Fujian China
| | - Yangbin Xu
- Department of Otolaryngology Ningde Municipal Hospital Affliated of Ningde Normal University (Ningde Institute of Otolaryngology) Ningde Fujian China
| | - Yiyun Hong
- Department of Otolaryngology Ningde Municipal Hospital Affliated of Ningde Normal University (Ningde Institute of Otolaryngology) Ningde Fujian China
| | - Weijing Bao
- Department of Otolaryngology Ningde Municipal Hospital Affliated of Ningde Normal University (Ningde Institute of Otolaryngology) Ningde Fujian China
| | - Guanwen He
- Department of Otolaryngology Ningde Municipal Hospital Affliated of Ningde Normal University (Ningde Institute of Otolaryngology) Ningde Fujian China
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Chen S, Biswas M, Scott M, Small M, Lee L, Ruiz S, Emmanuel B. Symptom burden and health-related quality of life in moderate to severe chronic rhinosinusitis with nasal polyposis. RHINOLOGY ONLINE 2022. [DOI: 10.4193/rhinol/22.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) affects up to 4% of individuals. Common symptoms include nasal congestion/obstruction, nasal discharge, facial pain, and reduced sense of smell. This study describes patient- and physician-reported CRSwNP symptom burden and health-related quality of life (HRQOL) in a real-world clinical setting. Methods: This multinational, geographically diverse, point-in-time survey invited physicians to evaluate 5 consecutive adults with confirmed bilateral moderate to severe CRSwNP (consecutive sampling) plus the next 2 patients with recurrent nasal polyps and ≥1 surgery for polyp removal (oversampling). Patients’ and physicians’ surveys were assessed in the entire consecutive sample and by categories of physician-determined CRSwNP severity, and by categories of asthma comorbidity (total sample). Patients’ and physicians’ responses were compared in a matched sample. Results: The total sample of 1,782 patients comprised 1,296 (72.7%) from consecutive sampling and 486 (27.3%) from oversampling. Among the consecutive sample (mean age, 46.9 years), 1,122 (86.6%) had moderate and 174 (13.4%) had severe CRSwNP. Of 1,697 patients from total sampling with known asthma status, 708 (41.7%) had asthma and 989 (58.3%) did not. Patients’ self-reported symptom frequency, severity, and burden on HRQOL worsened with increasing CRSwNP severity and comorbid asthma. Physicians underreported prevalence, severity, and impact of symptoms on daily activities compared with patients (matched sample). Conclusion: Patients and physicians from real-world settings both described a considerable burden of CRSwNP, but physicians consistently reported fewer and less severe symptoms than patients. This suggests a more patient-centric view is needed when assessing CRSwNP symptom burden and HRQOL.
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Liu DT, Phillips KM, Houssein FA, Speth MM, Besser G, Mueller CA, Sedaghat AR. Dedicated Olfaction and Taste Items do not Improve Psychometric Performance of the SNOT-22. Laryngoscope 2022; 132:1644-1651. [PMID: 35353381 PMCID: PMC9544569 DOI: 10.1002/lary.30120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/15/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
Abstract
Objective Previous work has shown the chemosensory dysfunction item of the 22‐item Sinonasal Outcome Test (SNOT‐22) that assesses problems with “taste/smell” has poor psychometric performance compared with other items on the SNOT‐22, which we have hypothesized is due to the simultaneous assessment of two different senses. Our aim was to determine whether distinct smell and taste items in the SNOT‐22 would improve psychometric performance. Methods One hundred and eighty‐one CRS patients were recruited and completed the SNOT‐22. Additional items querying problems with the senses of “smell” and “taste,” using the same response scale and recall period were given to study participants. Item response theory (IRT) was used to determine IRT parameters, including item discrimination, difficulty, and information provided by each SNOT‐22 item. Results Confirming previous studies, the chemosensory item of the SNOT‐22 (reflecting “taste/smell”) had poor psychometric performance. Use of a distinct smell or taste item instead of the combined “taste/smell” item did not improve psychometric performance. However, a dedicated smell question resulted in a left shift of threshold parameters, showing that the dedicated smell item better captures moderate CRS disease burden than the original taste/smell item of the SNOT‐22, which by virtue of near‐identical IRT parameters appears to more greatly reflect problems with taste. Conclusions A dedicated smell‐ or taste‐specific item, rather than the combined “taste/smell” item currently in the SNOT‐22 does not provide significantly greater psychometric performance. However, a dedicated smell item may better capture moderate CRS disease burden compared with the current chemosensory item on the SNOT‐22. Laryngoscope, 132:1644–1651, 2022
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Affiliation(s)
- David T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Firas A Houssein
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Marlene M Speth
- Department of Otorhinolaryngology, Kantonsspital Aarau, Aarau, Switzerland
| | - Gerold Besser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian A Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - 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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Leland EM, Vohra V, Seal SM, Zhang Z, Ramanathan M. Environmental air pollution and chronic rhinosinusitis: A systematic review. Laryngoscope Investig Otolaryngol 2022; 7:349-360. [PMID: 35434330 PMCID: PMC9008184 DOI: 10.1002/lio2.774] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Chronic rhinosinusitis (CRS) is a highly prevalent and burdensome disease. The pathophysiology is not fully elucidated, but environmental pollutants have been suggested to impact the inflammatory component of the disease process. This review aims to summarize the role of environmental pollution in CRS onset and disease severity. Methods A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were queried in August 2021. Original articles reporting on air pollution exposure in CRS were included. Other forms of sinonasal disease were excluded. Results Literature search produced 11,983 articles, of which 10 met inclusion criteria. Outcomes evaluated included incidence/prevalence, disease severity, quality of life, and histopathologic/microbial changes. Air pollutant exposure was associated with higher odds of CRS, particularly with particulate matter (PM) exposure. Increasing air pollution exposure was also associated with worsened disease severity and detectable histopathologic changes. Impact on quality of life was less clear. Conclusion Air pollution (particularly PM) is correlated with CRS incidence/prevalence and disease severity, with evidence of histopathologic changes in CRS tissue samples. Further research is warranted to better understand the mechanisms by which air pollution components may cause CRS and type 2 inflammation. Level of Evidence 3a Recent evidence suggests a role for air pollution in the onset and severity of CRS, most notably with relation to PM2.5 exposure. This systematic review supports previous in vitro and in vivo models of pollution in CRS. This study further adds to the existing body of literature demonstrating the many negative health impacts of exposure to air pollution, including impacts on upper airway disease, lower airway disease, cardiac disease, and overall morbidity and mortality.
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Affiliation(s)
- Evelyn M. Leland
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
| | - Varun Vohra
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
| | - Stella M. Seal
- Welch Medical Library Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Zhenyu Zhang
- Department of Global Health School of Public Health, Peking University Beijing China
- Institute for Global Health and Development Peking University Beijing China
| | - Murugappan Ramanathan
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
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Liu DT, Bartosik TJ, Campion NJ, Bayer K, Tu A, Victoria S, Besser G, Mueller CA, Gangl K, Eckl‐Dorna J, Schneider S. Chronic rhinosinusitis symptoms differentially impact the likelihood of major depressive disorders. Laryngoscope Investig Otolaryngol 2022; 7:29-35. [PMID: 35155780 PMCID: PMC8823175 DOI: 10.1002/lio2.733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/29/2021] [Accepted: 01/01/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The extent to which sinonasal symptoms impact the likelihood of major depressive disorders in chronic rhinosinusitis patients with nasal polyposis (CRSwNP) remains incompletely characterized. In this study, we sought to determine whether individual symptom clusters differentially impact the likelihood of depression in a cohort of CRSwNP patients. METHODS We retrospectively included 77 patients with CRSwNP. The severity of sinonasal symptoms was assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22) and grouped according to a previously validated four-subdomain structure: nasal, otologic/facial pain, sleep, and emotional subdomains. The likelihood of major depressive disorders was assessed using the Patient Health Questionnaire-2 (PHQ-2). The clinical characteristic of symptom severity (nasal polyp size) and disease-specific information, such as the number of previous sinonasal surgeries, were also collected. RESULTS The sleep subdomain was most strongly associated with the likelihood of major depressive disorders, followed by the otologic/facial pain subdomain, after controlling for demographics and clinical indicators of symptom severity (nasal polyp size). We found a SNOT-22 score ≥ 30.5 to be an accurate indicator of scoring higher than or equal to 2 on the PHQ-2 in CRSwNP patients. This had a sensitivity of 83.33% and a specificity of 75.47%. CONCLUSION Distinct sinonasal symptom clusters differentially impact the likelihood of depression in CRSwNP patients. Raising awareness for those with severe sinonasal symptomatology might help identify more patients with a higher probability of comorbid depression. Level of Evidence: 4.
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Affiliation(s)
- David T. Liu
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Tina J. Bartosik
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Nicholas J. Campion
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Karina Bayer
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Aldine Tu
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Stanek Victoria
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Gerold Besser
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Christian A. Mueller
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Katharina Gangl
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Julia Eckl‐Dorna
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Sven Schneider
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
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Baiardini I, Paoletti G, Mariani A, Malvezzi L, Pirola F, Spriano G, Mercante G, Puggioni F, Racca F, Melone G, Malipiero G, Ferri S, Canonica GW, Heffler E. Nasal Polyposis Quality of Life (NPQ): Development and Validation of the First Specific Quality of Life Questionnaire for Chronic Rhinosinusitis with Nasal Polyps. Healthcare (Basel) 2022; 10:healthcare10020253. [PMID: 35206869 PMCID: PMC8871881 DOI: 10.3390/healthcare10020253] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
To date, no disease-specific tool has been available to assess the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on health-related quality of life (HRQoL). Therefore, the purpose of this study was to develop and validate a questionnaire specifically designed to this aim: the Nasal Polyposis Quality of Life (NPQ) questionnaire. As indicated in the current guidelines, the development and validation of the NPQ occurred in two separate steps involving different groups of patients. The questionnaire was validated by assessing internal structure, consistency, and validity. Responsiveness and sensitivity to changes were also evaluated. In the development process of NPQ an initial list of 40 items was given to 60 patients with CRSwNP; the 27 most significant items were selected and converted into questions. The validation procedure involved 107 patients (mean age 52.9 ± 12.4). NPQ revealed a five-dimensional structure and high levels of internal consistency (Cronbach’s alpha 0.95). Convergent validity (Spearman’ coefficient r = 0.75; p < 0.01), discriminant validity (sensitivity to VAS score), and reliability in a sample of patients with a stable health status (Interclass Coefficient 0.882) were satisfactory. Responsiveness to clinical changes was accomplished. The minimal important difference was 7. NPQ is the first questionnaire for the assessment of HRQoL in CRSwNP. Our results demonstrate that the new tool is valid, reliable, and sensitive to individual changes.
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Affiliation(s)
- Ilaria Baiardini
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Giovanni Paoletti
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
- Correspondence: ; Tel.: +39-02-2440-1821; Fax: +39-02-3440-6684
| | - Alessia Mariani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Luca Malvezzi
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (L.M.); (F.P.)
| | - Francesca Pirola
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (L.M.); (F.P.)
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (L.M.); (F.P.)
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (L.M.); (F.P.)
| | - Francesca Puggioni
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Francesca Racca
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
| | - Giulio Melone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Giacomo Malipiero
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
| | - Sebastian Ferri
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Enrico Heffler
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
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11
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Factors Associated with Revision Sinus Surgery in Patients with Chronic Rhinosinusitis. J Pers Med 2022; 12:jpm12020167. [PMID: 35207656 PMCID: PMC8878652 DOI: 10.3390/jpm12020167] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Endoscopic sinus surgery (ESS) is performed in patients diagnosed with Chronic Rhinosinusitis (CRS) refractory to primary medical therapy to achieve adequate disease control. This study aimed to assess which factors and phenotypes of CRS are associated with revision surgery in patients undergoing ESS. This retrospective, single-center study included 667 patients undergoing ESS between 2012 and 2015. We performed group comparisons to detect differences between CRS patients undergoing primary or revision surgery and computed binary logistic regression models. Logistic regression analysis revealed higher odds for revision surgery in CRS patients with older age (p-value < 0.001), male gender (p-value = 0.011), diagnosis of AERD (p-value = 0.005), and presence of asthma (p-value < 0.001) or allergies (p-value = 0.031). Confirming previous studies, we found that the factors of age, CRSwNP, AERD, allergies, and asthma are associated with revision ESS and identified surgical techniques that were predominantly used in revision cases.
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12
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Phillips KM, Houssein FA, Boeckermann LM, Singerman KW, Liu DT, Sedaghat AR. Multi-institutional minimal clinically important difference of the 22-item Sinonasal Outcome Test in medically managed chronic rhinosinusitis. Rhinology 2021; 59:552-559. [PMID: 34708838 DOI: 10.4193/rhin21.253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND With a rapid proliferation of clinical trials to study novel medical treatments for CRS, the objective of this study was to study the minimal clinically important difference (MCID) of the 22-item Sinonasal Outcome Test (SNOT-22) in medically-managed CRS patients. METHODS A total of 183 medically-treated CRS patients were recruited. All patients completed a SNOT-22 at enrollment and subsequent follow up visit. Distribution and anchor-based methods were used for MCID calculation. These data were combined with data from a previously published study on SNOT-22 MCID in 247 medically managed CRS patients to determine a final recommended MCID value using the combined cohort of 430 patients. RESULTS In our cohort, distribution- and anchor-based methods-using both sinus-specific and general health anchors-provided greatest support for a 12-point SNOT-22 MCID, which had approximately 55% sensitivity but 81% specificity for detecting patients explicitly reporting improvement in their sinus symptoms and general health. In the combined cohort of 430 patients, we also found greatest support for a 12-point SNOT-22 MCID, which had approximately 57% sensitivity and 81% specificity for detecting patients explicitly reporting improvement in their sinus symptoms and general health. We also find evidence that the MCID value may be higher in CRS patients without nasal polyps compared to those with nasal polyps. CONCLUSIONS Our results - which include data from patients from two different institutions and regions - confirm a SNOT-22 MCID of 12 in medically managed CRS patients. The SNOT-22 MCID was specific but not sensitive for identifying CRS patients experiencing improvement in symptoms or general health.
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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
| | - L M Boeckermann
- 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
| | - D T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - 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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Leland EM, Zhang Z, Kelly KM, Ramanathan M. Role of Environmental Air Pollution in Chronic Rhinosinusitis. Curr Allergy Asthma Rep 2021; 21:42. [PMID: 34499234 DOI: 10.1007/s11882-021-01019-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a highly prevalent disease with large social and financial burdens. The pathophysiology is multifactorial. Environmental pollutants have been suggested to play a role in the inflammatory component of the disease process. RECENT FINDINGS Recent work has focused on exposure to various pollutants, primarily particulate matter (PM). Exposure to environmental pollutants leads to upregulation of inflammatory markers and ciliary dysfunction at the cellular level. Mouse models suggest a role for epithelial barrier dysfunction contributing to inflammatory changes after pollutant exposure. Clinical studies support the role of pollutants contributing to disease severity in certain populations, but the role in CRS incidence or prevalence is less clear. Research is limited by the retrospective nature of most studies. This review focuses on recent advancements in our understanding of the impact of environmental pollutants in CRS, limitations of the available data, and potential opportunities for future studies.
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Affiliation(s)
- Evelyn M Leland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA
| | - Zhenyu Zhang
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA
| | - Kathleen M Kelly
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA.
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14
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Khan AH, Reaney M, Guillemin I, Nelson L, Qin S, Kamat S, Mannent L, Amin N, Whalley D, Hopkins C. Development of Sinonasal Outcome Test (SNOT-22) Domains in Chronic Rhinosinusitis With Nasal Polyps. Laryngoscope 2021; 132:933-941. [PMID: 34437720 PMCID: PMC9292332 DOI: 10.1002/lary.29766] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 12/30/2022]
Abstract
Objectives/Hypothesis The 22‐item Sinonasal Outcome Test (SNOT‐22) is a validated chronic rhinosinusitis health‐related quality‐of‐life outcome (HRQoL) measure; however, SNOT‐22 domains have not been validated specifically for chronic rhinosinusitis with nasal polyps (CRSwNP). Study Design Validation of SNOT‐22 domain structure, using data from 3 randomized, placebo‐controlled, double‐blinded, multicenter clinical trials of dupilumab in adults with moderate‐to‐severe CRSwNP. Methods Preliminary dimensional structure was derived by exploratory factor analyses of SNOT‐22 data from a phase 2 trial (NCT01920893) of dupilumab for the treatment of CRSwNP. Data from 2 phase 3 clinical trials (NCT02912468 and NCT02898454) were then used for confirmatory factor analysis, and evaluated for reliability, construct validity, and responsiveness. In all three trials, the SNOT‐22 was administered electronically on a tablet and trial participants were required to answer all items. Results Factor analysis supported five domains: Nasal, Ear/Facial, Sleep, Function, and Emotion. Correlations between domains were moderate to high, ranging from 0.53 (Nasal–Emotion) to 0.88 (Function–Sleep). Construct validity was mostly supported; relationships with other measures were almost always in the intended direction and magnitude. Internal consistency reliability also confirmed questionnaire structure with strong Cronbach's alpha values (all >0.80). Moderate‐to‐high correlations were observed between change in SNOT‐22 domain scores and other study patient‐reported outcome measures, along with large effect‐size estimates (≥0.7), demonstrating responsiveness of the Nasal, Sleep, and Function domains. Emotion and Ear/Facial domains had small‐to‐moderate effect sizes. Conclusions Psychometric analyses support the validity, reliability, and responsiveness of five domains of SNOT‐22 (Nasal, Ear/Facial, Sleep, Function, and Emotion) for assessing symptoms and impact on HRQoL in patients with CRSwNP. Laryngoscope, 132:933–941, 2022
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Affiliation(s)
- Asif H Khan
- Global Medical Affairs, Immunology and Inflammation Development, Sanofi, Chilly-Mazarin, France
| | - Matthew Reaney
- Patient-Centered Outcome Assessment, RTI Health Solutions, Research Triangle Park, North Carolina, U.S.A
| | - Isabelle Guillemin
- Patient-Centered Outcome Assessment, RTI Health Solutions, Research Triangle Park, North Carolina, U.S.A
| | - Lauren Nelson
- Patient-Centered Outcome Assessment, RTI Health Solutions, Research Triangle Park, North Carolina, U.S.A
| | - Shanshan Qin
- Patient-Centered Outcome Assessment, RTI Health Solutions, Research Triangle Park, North Carolina, U.S.A
| | - Siddhesh Kamat
- Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, U.S.A
| | - Leda Mannent
- Global Medical Affairs, Immunology and Inflammation Development, Sanofi, Chilly-Mazarin, France
| | - Nikhil Amin
- Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, U.S.A
| | - Diane Whalley
- Patient-Centered Outcome Assessment, RTI Health Solutions, Manchester, U.K
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, U.K
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15
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Philpott C, Ta NH, Hopkins C, Ray J, Ahmed S, Almeyda R, Kara N, Carrie S, Erskine SE, Cathcart R, Sunkaraneni V, Robertson A, Anari S, Kumar BN, Clark A. Socioeconomic, comorbidity, lifestyle, and quality of life comparisons between chronic rhinosinusitis phenotypes. Laryngoscope 2021; 131:2179-2186. [PMID: 33769590 DOI: 10.1002/lary.29527] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 03/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous group of inflammatory sinonasal disorders with key defining symptoms, but traditionally separated into phenotypes by clinical/endoscopic findings. It is not known whether the two phenotypes have differing socioeconomic, comorbidity, and lifestyle differences. This analysis of the Chronic Rhinosinusitis Epidemiology Study (CRES) database sought to analyze any key differences in the socioeconomic variables between those with CRS with nasal polyps (CRSwNPs) and those without nasal polyps (CRSsNPs). We also sought to analyze differences in comorbidities, lifestyle, and quality of life. METHODS Patients with a confirmed diagnosis of CRS in secondary and tertiary care outpatient settings in the UK were invited to participate in a questionnaire-based case-control study. Variables included demographics, socioeconomic factors, comorbidities, lifestyle factors, and health-related quality of life (HRQoL) (level 3 evidence). RESULTS A total of 1204 patients' data were analyzed: 553 CRSsNP and 651 CRSwNP participants. The key socioeconomic variables did not demonstrate any notable differences, nor did lifestyle variables other than alcohol consumption being higher in those with CRSwNP (P = .032), but the latter was not significant after adjusting for age and sex. Aside from confirmation of asthma being more common in CRSwNP, it was notable that this group complained less of upper respiratory tract infections (URTIs), and CRSsNP participants showed evidence of worse HRQoL scores in respect of body pain (P = .001). CONCLUSIONS Patients with CRSwNP experience higher rates of asthma and lower rates of URTIs; patients with CRSsNP have worse body pain scores. Otherwise, there are no demonstrable significant socioeconomic, comorbidity, lifestyle, or quality of life differences between the two phenotypes. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Carl Philpott
- James Paget University Hospital NHS Foundation Trust, Gorleston, UK
- Norwich Medical School, University of East Anglia, Norfolk, UK
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Ngan Hong Ta
- Norwich Medical School, University of East Anglia, Norfolk, UK
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | | | | | | | | | - Sally E Erskine
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | | | | | | | | | | | - Allan Clark
- Norwich Medical School, University of East Anglia, Norfolk, UK
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16
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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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17
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Fried J, Yuen E, Li A, Zhang K, Nguyen SA, Gudis DA, Rowan NR, Schlosser RJ. Rhinologic disease and its impact on sleep: a systematic review. Int Forum Allergy Rhinol 2020; 11:1074-1086. [PMID: 33275331 DOI: 10.1002/alr.22740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Rhinologic disease can be responsible for systemic symptoms affecting mood, cognition, and sleep. It is unclear whether sleep disturbance in specific rhinologic disorders (chronic rhinosinusitis [CRS], rhinitis, and nasal septal deviation [NSD]) is an obstructive phenomenon or due to other mechanisms. In this review we examine the impact of CRS, rhinitis, and NSD on objective and subjective sleep outcome metrics and draw comparisons to normal controls and patients with known obstructive sleep apnea (OSA). METHODS A systematic review of 4 databases (PubMed, Scopus, Cochrane Library, and Web of Science) was performed. Studies reporting on objective (apnea-hypopnea index [AHI], respiratory disturbance index [RDI], oxygen nadir) and subjective (Epworth Sleepiness Scale [EpSS], Pittsburgh Sleep Quality Index [PSQI], Fatigue Severity Scale [FSS]) sleep parameters and disease-specific patient-reported outcome measures (PROMs; 22-item Sino-Nasal Outcome Test [SNOT-22], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], Nasal Obstruction Symptom Evaluation [NOSE]) were included. RESULTS The database search yielded 1414 unique articles, of which 103 were included for analysis. Baseline PROMs were at the high end of normal to abnormal for all 3 conditions: EpSS: CRS (9.8 ± 4.0), rhinitis (9.7 ± 4.3), and NSD (8.9 ± 4.6); and PSQI: CRS (11.0 ± 4.5), rhinitis (6.1 ± 3.7), and NSD (8.6 ± 3.5). Objective measures demonstrated a mild to moderate OSA in the studied diseases: AHI: CRS (10.4 ± 11.5), rhinitis (8.6 ± 8.8), and NSD (13.0 ± 6.9). There were significant differences when compared with reported norms in all measured outcomes (p < 0.001). CONCLUSION Sleep quality is impacted by rhinologic (CRS, rhinitis, NSD) disease. There is likely a mild obstructive component contributing to poor sleep, but other contributing factors may be involved.
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Affiliation(s)
- Jacob Fried
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Erick Yuen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Andraia Li
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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