Longitudinal improvement and stability of the SNOT-22 survey in the evaluation of surgical management for chronic rhinosinusitis

Background There is no data currently available to direct nuanced treatment for recurrent acute and chronic rhinosinusitis (RARS, CRS) in patients on daily, long term medications that suppress the immune system. Objective This study sought to evaluate the outcomes of different treatment pathways when treating immunosuppressed patients with chronic rhinosinusitis or recurrent acute rhinosinusitis. Methods A retrospective review of patients on immune suppressing medication presenting to a tertiary care center with RARS or CRS between the years 2014–2019 was completed. Patients were categorized into three groups based on treatment: medical management alone (MM), surgery after medical management (SAMM), or upfront surgery (US). Lund-Kennedy scores (LKS) and SNOT-22 scores were evaluated at baseline, 1 month, 3 months and 6 months from presentation. Results 68 patients met inclusion criteria, with no difference in demographics between groups. Patients who were treated with US and SAMM had significantly higher baseline LKS than those who were treated with MM alone (p = 0.050, p = 0.039). Once this difference was controlled for, there was no significant difference in overall change of LKS between the three groups over time. There was no significant disparity in baseline SNOT-22 scores between the three groups, but patients who underwent US had a significantly higher improvement in SNOT-22 from baseline compared to those undergoing MM alone (p = 0.013). Conclusion Patients experiencing chronic rhinosinusitis and recurrent acute rhinosinusitis who are taking immunosuppressive medication can significantly improve from both medical and surgical management, but upfront surgical management appears to result in greater disease resolution relative to medical management in those with CRS. More study is needed in the RARS patient population regarding upfront surgery versus medical management.

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Chronic rhinosinusitis: medical versus surgical management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212451 ◽

2021 ◽

Vol 7 (7) ◽

pp. 1150

Author(s):

Seema Patel ◽

Tanvi S. Rekhade ◽

Rameshwar T. Pawar ◽

Ashok Z. Nitnaware

Keyword(s):

Chronic Rhinosinusitis ◽

Surgical Management ◽

Medical Therapy ◽

Medical Management ◽

Nasal Polyposis ◽

Individual Case ◽

Treatment Modalities ◽

The Difference ◽

Maximal Medical Therapy ◽

Snot 22

Background: Management protocols of chronic rhinosinusitis (CRS) recommend initial treatment with maximal medical therapy with surgery reserved for refractory cases. Literature comparing the effectiveness of these two treatment modalities is limited. The purpose of this study was to compare the outcome of medical and surgical management for CRS.Methods: This was a prospective cohort study. Patients registered for the study were diagnosed as CRS based on history, clinical examination and investigation findings. All patients were initially subjected to medical management for 3 weeks and refractory cases were then subjected to surgical intervention. Subjective and objective improvements assessed with SNOT-22 score and Lund-Kennedy (LK) score respectively were analysed statistically.Results: Out of the 100 patients registered for the study, 37% had nasal polyposis while 63% were without polyposis. When subjective and objective improvements were compared between groups receiving medical management alone and those receiving combined management, the difference was not found to be statistically significant (p<0.05).Conclusions: Although the decision regarding treatment modality to be used in CRS should depend on individual case, all cases can be subjected to a maximal medical therapy initially while reserving surgery for cases which do not improve.

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Item Response Theory for Psychometric Properties of the SNOT-22 (22-Item Sinonasal Outcome Test)

Otolaryngology ◽

10.1177/01945998211018383 ◽

2021 ◽

pp. 019459982110183

Author(s):

David T. Liu ◽

Katie M. Philips ◽

Marlene M. Speth ◽

Gerold Besser ◽

Christian A. Mueller ◽

...

Keyword(s):

Item Response Theory ◽

Psychometric Properties ◽

Item Response ◽

Chronic Rhinosinusitis ◽

Facial Pain ◽

Item Discrimination ◽

High Quality ◽

Graded Response ◽

Sinonasal Outcome Test ◽

Snot 22

Objective The SNOT-22 (22-item Sinonasal Outcome Test) is a high-quality outcome measure that assesses chronic rhinosinusitis–specific quality of life. The aim of this study was to gain greater insight into the information provided by the SNOT-22 by determining its item-based psychometric properties. Study Design Retrospective cohort study. Setting Tertiary care academic centers. Methods This study used a previously described data set of the SNOT-22 completed by 800 patients with chronic rhinosinusitis. Item response theory graded response models were used to determine parameters reflecting item discrimination, difficulty, and information provided by each item toward the SNOT-22 subdomain to which it belonged. Results The unconstrained graded response model fitted the SNOT-22 data best. Item discrimination parameters and total information provided showed the greatest variability within the nasal subdomain, and the item related to sense of smell/taste demonstrated the lowest discrimination and provided the least amount of information overall. The dizziness item provided disparately lower total information and discrimination in the otologic/facial pain subdomain. Items in the sleep and emotional subdomains generally provided high discrimination. While items in the nasal, sleep, and otologic/facial pain subdomains spanned all levels of difficulty, emotional subdomain items covered higher levels of difficulty, indicating greater information provided at higher levels of disease severity. Conclusion The item-specific psychometric properties of the SNOT-22 support it as a high-quality instrument. Our results suggest the need and possibility for revision of the smell/taste dysfunction item, for example its wording, to improve its ability to discriminate among the different levels of disease burden.

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Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or Olfactory Function in Chronic Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.1177/1945892420987439 ◽

2021 ◽

pp. 194589242098743

Author(s):

Nyssa F. Farrell ◽

Jess C. Mace ◽

David A. Sauer ◽

Andrew J. Thomas ◽

Mathew Geltzeiler ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Nasal Polyposis ◽

Cross Sectional Study ◽

Olfactory Function ◽

Sinus Surgery ◽

Small Subset ◽

Cross Sectional ◽

Snot 22

Background Chronic rhinosinusitis (CRS) is often differentiated by histopathologic phenotypes (eosinophilic versus neutrophilic), which may impact disease severity measures and outcomes. As such, it has been suggested that counts of cellular elements be included as part of a standard pathological report following endoscopic sinus surgery (ESS). Objectives This cross-sectional study evaluated associations of mucosal eosinophilia and neutrophilia with measures of quality-of-life (QoL) and olfactory function. Methods Patients with medically refractory CRS completed the SNOT-22 survey and Brief Smell Identification Test (BSIT) at enrollment. In addition, baseline Lund-Mackay computed tomography (CT) and Lund-Kennedy endoscopy scores were collected. Ethmoid mucosa was biopsied during ESS and reviewed using microscopy to quantify densest infiltrate of eosinophils or neutrophils per high-powered-field (HPF). Eosinophilic CRS (eCRS) and neutrophilic CRS (nCRS), both with and without nasal polyposis (NP), were compared across SNOT-22 and BSIT scores. Results 77/168 patients demonstrated mucosal eosinophilia (eCRS) while a total of 42/168 patients demonstrated mucosal neutrophilia (nCRS). After adjusting for polyp status, 35/168 had eCRSsNP, 42/168 eCRSwNP, 75/168 non-eCRSsNP, 16/168 non-eCRSwNP. Additionally, 22/161 were noted to have nCRSsNP, 20/161 nCRSwNP, 84/161 non-nCRSwNP, and 35/161 non-nCRSsNP. A small subset of patients demonstrated both eosinophilia and neutrophilia: 14 CRSwNP and 7 CRSsNP. When evaluating average Lund-Mackay Scores (LMS), significant differences existed between non-eCRSsNP and eCRSsNP (p = 0.006). However, after controlling for nasal polyps, eosinophilia did not significantly associate with differences in the Lund-Kennedy Score. Neutrophilia did not significantly associate with any changes in LMS or LKS after controlling for NP. Eosinophilic and neutrophilic histopathologic subtypes did not significantly associate with differences in baseline SNOT-22 or BSIT measures after controlling for NP. Conclusion Neither the presence of mucosal eosinophilia nor mucosal neutrophilia demonstrated significant associations with SNOT-22 quality-of-life or BSIT olfactory function scores when controlling for comorbid nasal polyposis.

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JAK2 Phosphorylation Signals and Their Associated Cytokines Involved in Chronic Rhinosinusitis with Nasal Polyps and Correlated with Disease Severity

Biomolecules ◽

10.3390/biom11071059 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1059

Author(s):

Yu-Tsai Lin ◽

Wei-Chih Chen ◽

Ming-Hsien Tsai ◽

Jing-Ying Chen ◽

Chih-Yen Chien ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Disease Severity ◽

Nasal Polyps ◽

Inflammatory Diseases ◽

Janus Kinase ◽

Sinus Surgery ◽

Control Group ◽

Jak2 Inhibitor ◽

Ifn Γ ◽

Snot 22

Janus kinase 2 (JAK2) is a member of the JAK family that transduces cytokine-mediated signals via the JAKs/STATs (signal transducer and activator of transcription proteins) pathway, which plays an important role in many inflammatory diseases. This study investigates the association of p-JAK2 and JAK2-associated cytokines from nasal polyp (NP) tissue with disease severity, and evaluates the p-JAK2-mediated STATs in chronic rhinosinusitis (CRS) with NP. Sixty-one CRSwNP patients with nasal polyps undergoing endoscopic sinus surgery were enrolled, while the turbinate tissues from 26 nasal obstruction patients were examined as the control group. Elevated levels of p-JAK2 were detected in CRSwNP, and significantly correlated with scores of disease severity (LMK-CT, TPS, and SNOT-22). Expressions of the JAK2-associated cytokines, such as IL-5, IL-6, IL-13, G-CSF, and IFN-γ were significantly higher in CRSwNP than in the controls, while the levels of IL-5, IL-6, IL-13, or G-CSF had positive correlation with scores of disease severity. Moreover, markedly increased expression of p-STAT3 in CRSwNP was observed relative to the control. Taken together, these data showed that the JAK2-associated cytokines including IL-6 and G-CSF may stimulate JAK2 phosphorylation to activate p-STAT3, indicating an association with disease severity and supporting its development of JAK2 inhibitor as a potential therapeutic agent for CRS.

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Clinical Traits Characterizing an Exacerbation-Prone Phenotype in Chronic Rhinosinusitis

Otolaryngology ◽

10.1177/0194599819865474 ◽

2019 ◽

Vol 161 (5) ◽

pp. 890-896 ◽

Cited By ~ 3

Author(s):

Katie M. Phillips ◽

Eric Barbarite ◽

Lloyd P. Hoehle ◽

David S. Caradonna ◽

Stacey T. Gray ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Disease Burden ◽

Tertiary Care ◽

Symptom Burden ◽

Cross Sectional ◽

Patient Reported ◽

Oral Corticosteroids ◽

Sinonasal Outcome Test ◽

Snot 22

Objective Acute exacerbation of chronic rhinosinusitis (AECRS) is associated with significant quality-of-life decreases. We sought to determine characteristics associated with an exacerbation-prone phenotype in chronic rhinosinusitis (CRS). Study Design Cross-sectional. Setting Tertiary care rhinology clinic. Subjects Patients with CRS (N = 209). Methods Patient-reported number of sinus infections, CRS-related antibiotics, and CRS-related oral corticosteroids taken in the last 12 months were used as metrics for AECRS frequency. Sinonasal symptom burden was assessed with the 22-item Sinonasal Outcome Test (SNOT-22). Ninety patients reporting 0 for all AECRS metrics were considered to have had no AECRS in the prior 12 months. A total of 119 patients reported >3 on at least 1 AECRS metric and were considered as having an exacerbation-prone phenotype. Characteristics associated with patients with an exacerbation-prone phenotype were identified with exploratory regression analysis. Results An exacerbation-prone phenotype was positively associated with comorbid asthma (adjusted odds ratio [ORadj] = 3.68, 95% CI: 1.42-9.50, P = .007) and SNOT-22 (ORadj = 1.06, 95% CI: 1.04-1.09, P < .001). Polyps were negatively associated (ORadj = 0.27, 95% CI: 0.11-0.68, P = .005) with an exacerbation-prone phenotype. SNOT-22 score ≥24 identified patients with an exacerbation-prone phenotype with a sensitivity of 93.3% and a specificity of 57.8%. Having either a SNOT-22 score ≥24 with a nasal subdomain score ≥12 or a SNOT-22 score ≥24 with an ear/facial discomfort subdomain score ≥3 provided >80% sensitivity and specificity for detecting patients prone to exacerbation. Conclusions In total, these results point to a CRS exacerbation-prone phenotype characterized by high sinonasal disease burden with comorbid asthma but interestingly without polyps.

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Surgical Management of Chronic Rhinosinusitis in Children

Pediatric Nasal and Sinus Disorders - Lung Biology in Health and Disease ◽

10.1201/b14160-38 ◽

2005 ◽

pp. 551-555

Author(s):

Patrick Froehlich

Keyword(s):

Chronic Rhinosinusitis ◽

Surgical Management

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Development of Sinonasal Outcome Test ( SNOT ‐22) Domains in Chronic Rhinosinusitis With Nasal Polyps

The Laryngoscope ◽

10.1002/lary.29766 ◽

2021 ◽

Author(s):

Asif H. Khan ◽

Matthew Reaney ◽

Isabelle Guillemin ◽

Lauren Nelson ◽

Shanshan Qin ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Sinonasal Outcome Test ◽

Snot 22

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Change in symptomatology score after functional endoscopic sinus surgery in cases of chronic rhinosinusitis

Romanian Journal of Rhinology ◽

10.2478/rjr-2021-0007 ◽

2021 ◽

Vol 11 (41) ◽

pp. 34-40

Author(s):

Pragya Rajpurohit ◽

Ishwar Singh ◽

Ravi Meher

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Full Range ◽

Change Score ◽

Physical Symptoms ◽

Clinical Encounter ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Percentage Decrease ◽

Snot 22

Abstract BACKGROUND. Chronic rhinosinusitis (CRS) is one of the most common health problems in adults, which not only causes physical symptoms, but also results in functional and emotional impairment. The aim of the present study was to investigate the effect of functional endoscopic sinus surgery (FESS) on SNOT-22 in cases of chronic rhinosinusitis. MATERIAL AND METHODS. A total of 50 patients, between 18-60 years of age, who had taken treatment for CRS but found no improvement, were enrolled in the study. Before surgery, all patients were asked to fill the SNOT-22 form, the CT score was evaluated, and FESS was performed. A reevaluation with SNOT-22 questionnaire was performed 10 days, 1 and 3 months after surgery. The preoperative and postoperative scores and change score were calculated. RESULTS. The initial preoperative mean score was 39.96±13.41. The percentage decrease in symptom score on the 10th day, the first and third month postoperatively was 42%, 74% and 91% respectively. Males had scored higher as compared to females. There was no correlation between the CT score and SNOT-22 score. Rhinological symptoms scored more than 74% in chronic rhinosinusitis cases. CONCLUSION. SNOT-22 can be used in routine clinical practice to inform clinicians about a full range of problems associated with chronic rhinosinusitis. Responses on the instrument can help focus the clinical encounter. It can also aid researchers in assessing the degree and effect of rhinosinusitis on health status, QoL and to measure treatment response.

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Changes in Sleep Quality Following Treatment for Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

American Journal of Rhinology and Allergy ◽

10.1177/19458924211061442 ◽

2021 ◽

pp. 194589242110614

Author(s):

Jacob Fried ◽

Erick Yuen ◽

David A. Gudis ◽

Rodney J. Schlosser ◽

Shaun A. Nguyen ◽

...

Keyword(s):

Sleep Apnea ◽

Sleep Quality ◽

Chronic Rhinosinusitis ◽

Meta Analysis ◽

Patient Reported Outcome Measures ◽

Cochrane Library ◽

Patient Reported ◽

Sleep Parameters ◽

The Impact ◽

Snot 22

Background Chronic rhinosinusitis (CRS) presents with broad and systemic manifestations, including impaired sleep; however, the impact of CRS treatments upon sleep is unknown. Objective To establish the effect of medical or surgical CRS treatment on subjective and objective sleep metrics for patients not previously diagnosed with sleep apnea. Methods Review of PubMed, Scopus, Web of Science, and the Cochrane Library was performed from the databases’ date of inception through August 13, 2020, for studies evaluating the effect of CRS treatment on sleep quality. All studies reporting on subjective and objective sleep parameters for patients with CRS, with completed pre- and posttreatment data were included. Studies composed of patients with diagnosed sleep apnea were excluded. Results Sixteen unique studies reporting data on a total of 1770 patients (mean age, 50.6 ± 15.6 (n = 1675) years) following treatment for CRS were included. Patient-reported outcome measures, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Fatigue Severity Scale, demonstrated mean posttreatment differences of −2.8 (95% CI: −4.9 to −0.7), −2.4 (95% CI: −3.7 to −1.2), and −1.2 (95% CI: −1.6 to −0.7), respectively. The SNOT-22 and its sleep domain demonstrated a mean posttreatment difference of −23.5 (95% CI: −31.7 to −15.3) and −5.4 (95% CI: −6.8 to −4.0), respectively. EpSS, FSS and SNOT-22 exceeded their respective reported MCID values. Objective findings did not significantly change with treatment; mean difference: AHI: 0.7 (95% CI: −1.5 to 2.9), oxygen nadir: 0.3 (95% CI: −0.4 to 0.9). Conclusions Treatment of CRS may lead to clinically meaningful reduction in disease burden and improvements in both overall sleep quality and patient-reported fatigue. Despite clinically meaningful quality of life improvements, objective sleep parameters did not demonstrate corresponding posttreatment improvements.

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