PRS59 QUALITATIVE ASSESSMENT OF THE CONTENT VALIDITY OF THE SNOT-22 IN PATIENTS WITH NASAL POLYPS

Abstract Background A previous qualitative assessment of the psychosocial consequences of labelling hypertension describes the diagnosis of hypertension as a labelling event with potential unintended negative long-term psychosocial consequences (labelling effects). Until now, the benefits of diagnosing hypertension have been far more reported than the harms. To obtain the net result of the preventive interventions for cardiovascular disease, such as diagnosing and treating mild hypertension, assessing benefits and harms in the most comprehensive way possible is necessary, including the psychosocial consequences of labelling. When measuring psychosocial consequences of labelling hypertension, a questionnaire with high content validity and adequate psychometric properties is needed. Objectives The aim of this study was to describe the psychometric parameters of face and content-validated pool of items. Other objectives were also to screen the item pool by using Rasch model analysis and confirmatory factor analysis (CFA) for identifying such items with sufficient fit to the hypothesised models. Methods We surveyed the pool of items as a draft questionnaire to Brazilians recruited via social networks, sending e-mails, WhatsApp® messages and posting on Facebook®. The inclusion criteria were to be older than 18 years old, to be healthy and to have only hypertension. We used Rasch model analysis to screen the item pool, discarding items that did not fit the hypothesised domain. We searched for local dependence and differential item functioning. We used CFA to confirm the derived measurement models and complementarily assessed reliability using Cronbach’s coefficient alpha. Results The validation sample consisted of 798 respondents. All 798 respondents completed Part I, whereas 285 (35.7%)—those with hypertension—completed Part II. A condition-specific questionnaire with high content validity and adequate psychometric properties was developed for people labelled with hypertension. This measure is called ‘Consequences of Labelling Hypertension Questionnaire’ and covers the psychosocial consequences of labelling hypertension in two parts, encompassing a total of 71 items in 15 subscales and 11 single items. Conclusion We developed a tool that can be used in future research involving hypertension, especially in scenarios of screening, prevention, population strategies and in intervention studies. Future use and testing of the questionnaire may still be required.

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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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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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“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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Azithromycin for chronic eosinophilic rhinosinusitis with nasal polyp: a placebo-controlled trial

Rhinology Journal ◽

10.4193/rhin20.071 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

I.S. De Oliveira ◽

A.F. Guimaraes ◽

G.F. Arantes Pêgas ◽

C.J. Machado ◽

G.D. Cassali ◽

...

Keyword(s):

Nasal Polyp ◽

Nasal Polyps ◽

Therapeutic Option ◽

Controlled Trial ◽

Subjective Improvement ◽

Double Blind ◽

Aspirin Intolerance ◽

Snot 22

BACKGROUND: Chronic eosinophilic rhinosinusitis with nasal polyps (CRSwNP eosinophilic) is characterised by the formation of benign and bilateral nasal polyps. We aimed to compare the effectiveness of azithromycin as an immunomodulator with the use of a placebo in patients presenting with CRSwNP concomitant with asthma and aspirin intolerance after 3 months of treatment and at a 1-year follow-up. METHODOLOGY: We performed a randomised, double-blind, placebo-controlled trial. Patients received 500 mg azithromycin orally three times/week for 12 weeks. Improvement was evaluated by staging, the Sino-Nasal Outcome Test (SNOT-22), and nasal polyp biopsy. Data collected at pretreatment and 3 months posttreatment were compared. Quality of life was evaluated at the 1-year follow-up. RESULTS: Twenty-seven and 21 patients were treated with azithromycin and a placebo, respectively. The medication was well tolerated overall. Twenty patients (74%) in the azithromycin group and three patients (14%) in the placebo group were not refer- red for surgery at the end of the 3-month treatment. Regarding subjective improvement, there was a median decrease only in the azithromycin group, and the between-group difference was significant. SNOT-22 improvement was maintained in the azithromy- cin group at the 1-year follow-up. CONCLUSIONS: Azithromycin could be considered a therapeutic option for patients presenting with CRSwNP concomitant with asthma and aspirin intolerance.

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A Qualitative Assessment of the Content Validity of the ICECAP-A and EQ-5D-5L and Their Appropriateness for Use in Health Research

PLoS ONE ◽

10.1371/journal.pone.0085287 ◽

2013 ◽

Vol 8 (12) ◽

pp. e85287 ◽

Cited By ~ 42

Author(s):

Thomas Keeley ◽

Hareth Al-Janabi ◽

Paula Lorgelly ◽

Joanna Coast

Keyword(s):

Content Validity ◽

Health Research ◽

Qualitative Assessment

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Efficacy of Clarithromycin Versus Methylprednisolone in the Treatment of Non-Eosinophilic and Eosinophilic Nasal Polyposis: A Randomized Controlled Trial

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v33i2.257 ◽

2018 ◽

Vol 33 (2) ◽

pp. 6-13

Author(s):

Jemilyn C. Gammad ◽

Antonio H. Chua ◽

Charmaine S. Templonuevo-Flores

Keyword(s):

Randomized Controlled Trial ◽

Nasal Polyps ◽

Nasal Polyposis ◽

Controlled Trial ◽

Well Being ◽

Randomized Controlled ◽

Eosinophil Cell ◽

Significant Difference ◽

Snot 22 ◽

Better Than

Objective: To compare the efficacy of Clarithromycin versus Methylprednisolone in the treatment of non-eosinophilic and eosinophilic nasal polyposis. Methods: Study Design: Randomized controlled trial Setting: Tertiary Government Training Hospital Subjects: Forty two patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) were grouped into non-eosinophilic and eosinophilic groups after biopsy determination of eosinophil count. Both groups were further randomized into a treatment arm given Clarithromycin (CLA) 500 mg/ day and another arm given Methylprednisolone (METH) 32 mg/ day tapering to 8 mg/ day for 15 days. All participants underwent pre– and post–treatment evaluation via anterior rhinoscopy, Sino-Nasal Outcome Test (SNOT-22) and Endoscopic Appearance (EA) Scoring. Data were encoded and subjected to statistical analysis using Mann-Whitney U test. Results: For the 9 participants in the non-eosinophilic group, 4 were given CLA and 5 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p= .007). The METH arm did not demonstrate significant improvement by the 7th (p= .44) or 15th day (p= .22). Comparison of the improvement in SNOT-22 scores between the two arms showed that on both 7th and 15th days, CLA outperformed METH (p= .026 and p= .004, respectively). For the EA scoring, both the CLA and METH groups significantly improved by the 7th (p= .027 and p= 0.017, respectively), and 15th day (p= .013 and p= .027, respectively). Comparison of the improvement in EA scores between the two arms showed significant difference on the 15th day (p= .01), with the CLA performing better than METH. Overall, the results suggest that the CLA arm performed significantly better than the METH arm in the treatment of non-eosinophilic patients. Of the 33 eosinophilic patients, 17 were given CLA and 16 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p < .001), while the METH arm on both 7th (p= .033) and 15th day (p< .001). Comparison of the improvement in SNOT-22 results between the two arms showed no significant differences (7th day p= .494; 15th day p= .587). For the EA scoring, both treatment groups showed significant improvement by the 7th and 15th day (p< .001). Comparison of the improvement in EA scores between the two arms showed significant differences (p< .001) on both 7th and 15th day, suggesting that METH was more effective than CLA. Overall, the results showed that both CLA and METH were effective in the treatment of eosinophilic nasal polyps. However, METH was significantly better than CLA in terms of superior EA scores. Conclusion: In terms of improving symptoms and well-being, as well as decreasing nasal polyp size and reducing discharge and edema as reflected in superior SNOT-22 and EA scores, Clarithromycin was significantly more effective than Methylprednisolone in the treatment of non-eosinophilic nasal polyps. While both Clarithromycin and Methylprednisolone were shown to be effective in the treatment of eosinophilic nasal polyps, Methylprednisolone was significantly better than Clarithromycin in terms of superior EA scores. A biopsy for tissue eosinophil cell count prior to treatment is recommended to establish the predominant inflammatory cell in nasal polyps in order to provide appropriate targeted treatment, i.e. Clarithromycin for non-eosinophilic nasal polyps and Methylprednisolone for eosinophilic polyps. Keywords: macrolides, clarithromycin, methylprednisolone, nasal polyps, eosinophils

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The extent of endoscopic sinus surgery in patients with severe chronic rhinosinusitis with nasal polyps (AirGOs Operative)

Rhinology online ◽

10.4193/rhinol/21.029 ◽

2021 ◽

Vol 4 (4) ◽

pp. 154-160

Author(s):

M.J. Lilja ◽

P. Virkkula ◽

S. Hammaren-Malmi ◽

A. Laulajainen-Hongisto ◽

L. Hafren ◽

...

Keyword(s):

Nasal Polyps ◽

Controlled Trial ◽

Sinus Surgery ◽

Health Related Quality ◽

Randomized Controlled ◽

Related Quality ◽

Health Related ◽

Snot 22

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nose and paranasal sinuses characterized by intense inflammation, decreased health-related quality of life (HRQoL), and in severe cases high frequency of co-morbidities and recurrence despite treatment. Conservative treatment consists of nasal lavage, intranasal corticosteroids, and courses of oral corticosteroids, and antibiotics in exacerbations. Endoscopic sinus surgery (ESS) and/or biological therapy is considered if appropriate conservative treatment is not sufficient. The optimal extent of ESS in recalcitrant CRSwNP is not known. The aim of this randomized controlled trial is to evaluate and compare the efficacy and safety of limited ESS with partial ethmoidectomy with extended ESS with total ethmoidectomy in patients with severe CRSwNP. Methods: AirGOs Operative is a randomized controlled trial. It is an investigator-driven multicenter trial led by Helsinki University Hospital. The two surgery arms are compared. The primary outcome is the change in the SNOT-22 score at the 12-month follow-up. Secondary outcomes include the change in the SNOT-22 score at 24-months follow-up, the changes in polyp score, Lund-Mackay (LM) CT score, health-related quality of life (HRQoL), loss of productivity, nasal patency (peak nasal inspiratory flow (PNIF) ± acoustic rhinometry (ARM), olfaction test (Sniffin’ Sticks, identification), lung function (spirometry and PEF) and findings in pathological analysis at 12/24-months follow-up. Discussion: AirGOs Operative trial will lead to a better understanding of the optimal extent of ethmoidectomy in the treatment of recalcitrant severe CRSwNP.

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Stratification of SNOT-22 scores into mild, moderate or severe and relationship with other subjective instruments

Rhinology Journal ◽

10.4193/rhino15.072 ◽

2016 ◽

Vol 54 (2) ◽

pp. 129-133

Author(s):

Shamim Toma ◽

Claire Hopkins

Keyword(s):

Quality Of Life ◽

Nasal Polyps ◽

Position Paper ◽

Classification Methods ◽

Treatment Algorithms ◽

Positive Correlation ◽

Vas Scores ◽

Snot 22

Aims and objectives: The European Position Paper on Rhinosinusitis and Nasal Polyps provides treatment algorithms based on the mild/moderate/severe (MMS) classification. To date there has been no statistically validated stratification of the SNOT-22 score according to this classification. Methods: 65 consecutive patients diagnosed with CRS completed a SNOT-22, VAS and rated their symptoms according to MMS and impact on quality of life. Results: The median SNOT 22 scores varied between the 3 MMS categories. The interquartile ranges for the respective MMS groups were: Mild 8-17, Moderate 22.5-48, Severe 54-83. Median values for the respective MMs groups were: Mild 12, Moderate 36 and Severe 66. 15.38% of patients in the Mild category, 95.24% in the Moderate category and 100% in the Severe category feel their QoL is affected. There was a strongly positive correlation between the SNOT-22 and VAS scores. Conclusion: We propose a statistically validated definition for stratification of the SNOT-22, with Mild being defined on the SNOT-22 score as 8-20 inclusive, Moderate as >20-50 and Severe as >50.

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