Predictive value of SNOT-22 on additional opiate prescriptions after endoscopic sinus surgery

Abstract Background Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients. Methods This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS. Results The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value = < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value = < 0.001); ear/facial symptoms (t-test = 6.34, p-value = < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value = < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = − 2.16, df = 66, p = 0.035). Conclusion Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life. Level of evidence Prospective observational.

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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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The Effects of Endoscopic Sinus Surgery on Voice Characteristics in Chronic Rhinosinusitis Patients

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419861124 ◽

2019 ◽

Vol 128 (12) ◽

pp. 1129-1133

Author(s):

Danny B. Jandali ◽

Ashwin Ganti ◽

Inna A. Husain ◽

Pete S. Batra ◽

Bobby A. Tajudeen

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Tertiary Care ◽

Voice Quality ◽

Upper Airway ◽

Sinus Surgery ◽

Perceptual Evaluation ◽

Snot 22

Objectives: Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed. Methods: Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms. Results: 18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p = .005) and VHI (10-4.7, p < .001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p < .001). Conclusions: Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality.

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“In-Office Balloon Sinus Ostial Dilation with Concurrent Antiplatelet and Anticoagulant Therapy for Chronic Rhinosinusitis without Nasal Polyps”

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419887195 ◽

2019 ◽

Vol 129 (3) ◽

pp. 280-286

Author(s):

Thomas S. Higgins ◽

Bülent Öcal ◽

Ridwan Adams ◽

Arthur W. Wu

Keyword(s):

Antiplatelet Therapy ◽

Chronic Rhinosinusitis ◽

Anticoagulant Therapy ◽

Endoscopic Sinus Surgery ◽

Nasal Polyps ◽

Sinus Surgery ◽

Bleeding Events ◽

Safe Alternative ◽

Systemic Complications ◽

Snot 22

Objective: Functional endoscopic sinus surgery (FESS) and balloon sinus ostial dilation (BSD) are well-recognized minimally invasive surgical treatments for chronic rhinosinusitis without nasal polyps (CRSsNP) refractory symptoms to medical therapy. Patients on antiplatelet and anticoagulant therapies (AAT) usually are recommended to discontinue their medications around the period of endoscopic sinus surgery. The goal of this study is to assess the clinical experience of BSD in CRSsNP patients with concurrent anticoagulant or antiplatelet therapy. Methods: A review of prospectively-collected clinical data from October 2012 to March 2017 were used to perform a cohort study of subjects with CRSsNP who met criteria for surgical intervention while on antiplatelet and anticoagulant therapy. Data were collected on demographics, details of the procedures, type of AAT used, pre- and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores, and complications. Results: Thirty-five patients underwent in-office BSD while on antiplatelet and/or anticoagulant therapy. The mean difference in pre- and postoperative SNOT-22 scores of 9.9 (SD 14.4, P < .001) was both statistically significant and exceeded the minimal clinically important difference of 8.9. Absorbable nasal packing was used for persistent bleeding immediately post-procedure in two patients. Intraoperative bleeding was associated with aspirin 325 mg and warfarin. FESS was required for further management of chronic sinusitis in four patients after anticoagulant/antiplatelet therapy could be discontinued. There were no systemic complications. None of the patients experienced significant bleeding events postoperatively after leaving the office. Conclusion: In-office BSD appears to be a safe alternative to endoscopic sinus surgery in select patients who cannot discontinue antiplatelet and anticoagulant therapy. Levels of Evidence: IV

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Using preoperative SNOT-22 score to inform patient decision for Endoscopic sinus surgery

The Laryngoscope ◽

10.1002/lary.25108 ◽

2014 ◽

Vol 125 (7) ◽

pp. 1517-1522 ◽

Cited By ~ 55

Author(s):

Luke Rudmik ◽

Zachary M. Soler ◽

Jess C. Mace ◽

Adam S. DeConde ◽

Rodney J. Schlosser ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Patient Decision ◽

Snot 22

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Endoscopic sinus surgery improves Eustachian tube function in patients with chronic rhinosinusitis: a multicenter prospective study

Rhinology Journal ◽

10.4193/rhin21.209 ◽

2021 ◽

Vol 59 (6) ◽

pp. 560-566

Author(s):

X. Chen ◽

H. Dang ◽

Q. Chen ◽

Z. Chen ◽

Y. Ma ◽

...

Keyword(s):

Allergic Rhinitis ◽

Prospective Study ◽

Eustachian Tube ◽

Endoscopic Sinus Surgery ◽

Valsalva Maneuver ◽

Sinus Surgery ◽

Eustachian Tube Function ◽

Tube Dysfunction ◽

Tube Function ◽

Snot 22

Background: Patients with chronic rhinosinusitis (CRS) often have Eustachian tube dysfunction (ETD) symptoms. This study aimed to prospectively investigate the effect of endoscopic sinus surgery (ESS) on improvement of Eustachian tube function in CRS patients with ETD from a Chinese population and determine factors associated with improvement. Methods: A prospective study was performed in CRS patients with ETD who underwent ESS from 3 tertiary medical centers in south China. The Eustachian tube Dysfunction Questionnaire 7 (ETDQ-7), Sinonasal Outcome Test 22 (SNOT-22), tympanograms, endoscopic findings and Valsalva maneuver were recorded and analyzed preoperatively and postoperatively at 8-12 weeks. Results: A total of 70 CRS patients with ETD were included in this study. The ETDQ-7 score and the ability of positive Valsalva maneuver in CRS patients were significantly improved postoperatively at 8-12 weeks. The number of patients with type A tympanogram was increased postoperatively. Reduced Eustachian tube mucosal inflammation was also observed postoperatively. In addition, ESS appeared to reverse slight tympanic membrane atelectasis after 8-12 weeks. Moreover, improvement in tympanogram was presented in more than half of CRS patients with concomitant otitis media with effusion postoperatively at 8-12 weeks. Univariate and multivariate analysis revealed failure of normalization of ETDQ-7 postoperatively was associated with concomitant allergic rhinitis and higher preoperative SNOT-22 score. Conclusions: This study confirms Eustachian tube function is often improved after ESS in CRS patients with ETD. Concomitant allergic rhinitis and higher preoperative SNOT-22 score are associated with failure of normalization of ETD symptoms.

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The Effect of Endoscopic Sinus Surgery on Eustachian Tube Dysfunction Symptoms

Otolaryngology ◽

10.1177/0194599820917396 ◽

2020 ◽

Vol 163 (3) ◽

pp. 603-610

Author(s):

Michael T. Chang ◽

Davood K. Hosseini ◽

Sun Hee Song ◽

Jayakar V. Nayak ◽

Zara M. Patel ◽

...

Keyword(s):

Eustachian Tube ◽

Endoscopic Sinus Surgery ◽

Retrospective Chart Review ◽

Eustachian Tube Dysfunction ◽

Sinus Surgery ◽

Level Of Evidence ◽

Factors Associated ◽

Academic Center ◽

Tube Dysfunction ◽

Snot 22

Objective We assessed how eustachian tube dysfunction (ETD) changed with endoscopic sinus surgery (ESS) and identified factors associated with improvement. Study Design Retrospective chart review. Setting Academic center. Subjects and Methods Patients undergoing ESS for chronic rhinosinusitis with and without nasal polyposis (CRSwNP, CRSsNP) or recurrent acute rhinosinusitis (RARS) completed the Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months. Included in analyses were demographics, comorbidities, Sinonasal Outcome Test 22 (SNOT-22), radiographic score, endoscopy score, procedure, and medication use. Regression analysis identified factors associated with improvement, defined as ΔETDQ-7 >3.5. Results In total, 302 patients were studied. ETD prevalence was 68% in CRSsNP, 48% in CRSwNP, and 88% in RARS. Patients with ETD had a mean baseline ETDQ-7 of 25.8 ± 8.0 and improved postoperatively at 2 weeks (19.9 ± 8.1, P < .001), 6 weeks (17.8 ± 9.3, P < .001), 3 months (16.8 ± 8.5, P < .001), and 6 months (16.4 ± 7.9, P < .001). At 6 months, ETD improved in 89% of patients with CRSsNP, 68% with CRSwNP, and 78% with RARS. On multivariate analysis, ETD improvement was associated with higher preoperative ETDQ-7 score (adjusted odds ratio [aOR], 1.12; 95% confidence interval [CI], 1.04-1.22; P = .030), higher preoperative SNOT-22 score (aOR, 1.02; 95% CI, 1.02-1.08; P = .001), higher preoperative SNOT-22 ear subscore (aOR, 1.27; 95% CI, 1.02-1.65; P = .034), posterior ethmoidectomy (aOR, 1.59; 95% CI, 1.22-4.92; P = .025), and postoperative corticosteroid spray use (aOR, 1.57; 95% CI, 1.17-1.66; P = .008). Conclusion ETD symptoms often improve following ESS. Factors associated with improvement include higher preoperative disease burden, posterior ethmoidectomy, and postoperative corticosteroid spray. Level of Evidence: 4

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Quality of life after functional endoscopic sinus surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202202 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1049

Author(s):

Raies Ahmad Begh ◽

Aditiya Saraf ◽

Kamal Kishore ◽

Parmod Kalsotra

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Nasal Polyposis ◽

Surgical Intervention ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Time Period ◽

Snot 22

Background: This paper aims to assess improvement in quality of life (QOL) after functional endoscopic sinus surgery through questionnaire sino-nasal outcome test (SNOT)-22.Methods: The present study was conducted on 50 patients in Department of ENT and HNS, SMGS Hospital, GMC Jammu during a time period of July 2017 to September 2019. All the patients with age ≥18 years who failed to respond to medical therapy (3 months) and underwent functional endoscopic sinus surgery (FESS) were included in the study. SNOT-22 questionnaire was used to assess the improvement. Results: In our study, preoperative SNOT scores were higher (54±8.05) but after FESS they reduced significantly at 1st (16.47±5.51), 3rd (13.86±4.19), 6th months (12.9±8.05) post operatively. Chronic rhinosinusitis (CRS) with nasal polyposis group had greater mean difference of SNOT-22 scores (43.93) between preoperative period and 3 months postoperative period than patients grouped as CRS without nasal polyposis (41.47).Conclusions: We concluded that FESS is the best surgical intervention for chronic rhinosinusitis. It significantly improves the quality of life of patients of chronic rhinosinusitis.

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Quality of life after endoscopic sinus surgery or balloon sinuplasty: a randomized clinical study

Rhinology Journal ◽

10.4193/rhino12.198 ◽

2014 ◽

Vol 52 (4) ◽

pp. 300-305

Author(s):

A.J. Bizaki ◽

R. Taulu ◽

J. Numminen ◽

M. Rautiainen

Keyword(s):

Quality Of Life ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Balloon Sinuplasty ◽

Randomized Clinical Study ◽

Material Cost ◽

Computer Tomography Scan ◽

Significant Difference ◽

Snot 22

Objectives: To conduct the first prospective randomized controlled trial that evaluates and compares the clinical outcome and impact of ballonsinuplasty and endoscopic sinus surgery (ESS) on the quality of life of patients suffering from chronic or recurrent rhinosinusitis (CRS) of the maxillary sinus. Methods: Adult patients with symptomatic chronic or recurrent rhinosinusitis without severe findings in the sinuses, as documented in the sinus’ Computer Tomography scan and clinical exam, were randomized in 2 groups: ESS and Balloon Sinuplasty.The main variable in our study is the Sinonasal Outcome Test-22 (SNOT 22) and its parameters. These parameters were analysed preoperatively and at 3 months, postoperatively. Results: There was a subjective improvement in symptoms after surgery. We also noticed an objective improvement in the quality of life of our patients seen as a decrease in the total SNOT 22 score. Both balloon sinuplasty and ESS significantly improved almost all the parameters of SNOT22, with no significant difference being found between these two groups. Conclusion: Both balloon sinuplasty and endoscopic sinus surgery improved the quality of life of patients with mild chronic or recurrent rhinosinusitis. However, the remarkably higher material cost of balloon sinuplasty compared to ESS sets limits on its broad use. There is an obvious need for further study to find out if, as an office procedure, balloon sinuplasty could deliver cost-savings high enough to cover the higher material cost of balloon sinuplasty. Our study was, however, too small to enable firm conclusions to be drawn.

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Low Frequency Ultrasound in Chronic Rhinosinusitis with Nasal Polyposis and Recovery after Endoscopic Sinus Surgery: A Randomized Controlled Trial

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v32i1.167 ◽

2017 ◽

Vol 32 (1) ◽

pp. 6-13

Author(s):

Roderick B. De Castro ◽

Michelle Angelica B. Cruz-Daylo ◽

Monique Lucia A. Jardin

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Nasal Polyposis ◽

Low Frequency ◽

Sinus Surgery ◽

Endoscopic Appearance ◽

Treatment Groups ◽

Low Frequency Ultrasound ◽

Snot 22 ◽

Frequency Ultrasound

Objective: The study aimed to determine the role of low frequency ultrasound in patients with Chronic Rhinosinusitis with Nasal Polyposis (CRS-NP) and recovery after Endoscopic Sinus Surgery (ESS) using Sino Nasal Outcome Test 22 (SNOT-22) questionnaires, modified Lund MacKay endoscopic appearance, and histopathologic examination. Methods: Study design: Single Blinded Randomized Controlled Trial Setting: Tertiary government hospital Subjects: 42 adult Filipinos aged 19 to 76 years-old diagnosed with Chronic Rhinosinusitis with grade 2 and 3 Nasal Polyposis and failure of maximal medical management (3-month course of antibiotics, nasal douche, topical steroids and other modalities) between June 2013 to June 2015 were randomized into two groups of 21 participants each-- the ultrasound-treated group and control group. Specimens (nasal polyps) from both groups were obtained and processed with Hematoxylin-Eosin (H&E) and gram staining. Specimens from the ultrasound-treated group received low frequency ultrasound (1 MHz, 1.0 watt/cm2, 20% pulsed mode, for 5 minutes at 370C) post-extraction and prior to staining. In phase II, the ultrasound group also received the same ultrasound treatment while the control group underwent ultrasound at 0 MHz frequency, 0 watt/cm2, both twice a week for 3 weeks, beginning one (1) week post operatively. Both groups accomplished SNOT-22 forms and were evaluated via modified Lund MacKay endoscopic appearance at 1 week (week 0 of treatment), 2 weeks, 3 weeks, and 1 month post operatively (week 3 of treatment). Results: Paired T-test showed a statistically significant difference between control and treatment groups in epithelial thickness with a p-value of 2.29E-10 (average of 73.34um for controls and 31.1um for the treatment group) at 95% confidence interval. The inflammatory cell count also differed significantly between control and treatment groups (average 293.85 and 29.65 inflammatory cells per high-power field in 10 random microscopic fields, respectively), p-value of 1.05E-17 on paired T-test; CI 95%. In phase II of the study, SNOT-22 results showed significant differences in improvement of symptoms in ultrasound-treated patients after Endoscopic Sinus Surgery (weekly mean scores of 38.05, 21, 11.3, and 10.45) and in modified Lund Mackay endoscopic appearance scores (weekly mean scores of 7.88, 4.35, 3.02, 2.08). Two-way analysis of variance showed significant differences between control and treatment groups for both SNOT-22 (p = 1.07E-80; 9.71E-119; CI 95%) and modified Lund Mackay endoscopic appearance scores (p = 3.89E-60; 1.85E-95; CI 95%). Conclusion: Low frequency therapeutic ultrasound demonstrated possible efficacy as an agent in disrupting epithelial architecture in patients with CRS-NP as well as in symptom improvement after endoscopic sinus surgery patients based on histopathologic evaluation, SNOT-22 and modified Lund MacKay endoscopic appearance scores. Low frequency ultrasound may be an adjuvant to conventional medical treatment in CRS-NP. Keywords: Biofilm, Sinusitis, Nasal Polyps, Chronic disease, Ultrasonic therapy

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