Evaluation of chronic rhinosinusitis management using the SNOT-22 in adult cystic fibrosis patients

OBJECTIVES

Sinonasal disease (SND) is a common finding in subjects with Cystic Fibrosis (CF). Even though it does not play a key role in the life expectancy of these patients, it increases the morbidity rate of CF, with deterioration of the quality of life and of general health status. The aim of this study is the evaluation of the impact of sinonasal disease and Extensive Endoscopic Sinus Surgery (eESS) on the quality of life (QOL) of CF patients by means of the 22 item Sino-Nasal Outcome Test (SNOT-22) and define if there is a correlation between SNOT-22 and the Lund-Mackay score.

PATIENTS AND METHODS

We performed a prospective study in 33 CF patients with medically refractory SND. The extent of polyposis was graded both endoscopically and on computed tomography images in accordance with the Lund-Mackay score. All patients underwent eESS. The SNOT was administered in order to assess the quality of life related to SND both before surgery and during follow-up at 6 months, 1 year and 2 years postoperatively.

RESULTS

The SNOT-22 and Lund-Mackay score showed a remarkable mean improvement during follow-up. The differences between the initial examination and last score were significant (p < 0.001), but there was no statistic correlation between SNOT-22 and Lund-Mackay.

CONCLUSIONS

More attention should be paid to sinonasal symptoms in CF patients and SNOT-22 is a simple and effective tool for this purpose. This score is also important for indicating the outcome of the eESS procedure. In all patients SNOT showed a significant improvement in QoL.

The evaluation of adenoid hypertrophy and obstruction grading based on rhinomanometry after nasal decongestant test in children

OBJECTIVES

Adenoid hypertrophy (AH) is a very common problem in children. Nasal Fiberoptic Endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. The aim of our study was to analyze the grade of nasal obstruction caused by AH, in a group of children, with rhinomanometry standard and after ND test versus NFE.

PATIENTS AND METHODS

Two hundred and eighty-four of 300 collaborative children, diagnosed as chronic oral breathers, were enrolled. All children underwent a complete physical examination, anterior active rhinomanometry and a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using Nasal Fiberoptic Endoscopy (NFE).

RESULTS

At rhinomanometry nasal obstrucion was found of grade 1 in 102 (35.9%) children, of grade 2 in 41 (14.4%), of grade 3 in 52 (18.3%), of grade 4 in 37 (13%) and of grade 5 in 52 (18.3%). Those patients were tested also with rhinomanometry after ND: grade 1 in 108 (38%) children, grade 2 in 52 (18.3%), grade 3 in 56 (19.7%), grade 4 in 23 (8.1%) and grade 5 in 45 (15.8%). At NFE: 83 (29.2%) patients presented a grade 0, 73 (28.7%) a grade 1, 51 (17.9%), 34 (11.9%) a grade 3 and 43 (15.1%) a grade 4. Comparing the grade of nasal obstruction in NFE and in RM after ND we found a great correlation for grade 1 and grade 5 (respectively 84.3% and 79,1%, p < 0.001) and low correlation for the others grades of obstruction. When compared to NFE, rhinomanometry test after ND had 81.1% sensitivity and 84.3% specificity. Operating Characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to Rhinomanometry after ND vs NFE.

CONCLUSIONS

Rhinomanometry after ND, compared to rmhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children. RM after ND is a great tool to assess the severity of nasal obstruction. In fact, the minimum and maximum degrees of obstruction to the RM after ND correlate significantly (p < 0.01) with those of NFE.