Concha Bullosa Affects Baseline and Postoperative Quality-of-Life Measures in Surgically Managed Chronic Rhinosinusitis

Background Concha bullosa (CB) is a prevalent anatomic variant and frequent surgical target in endoscopic sinus surgery (ESS). However, whether CB impacts quality-of-life (QOL) in chronic rhinosinusitis (CRS) is not well established. The purpose of this study was to investigate baseline and post-ESS QOL differences in patients with medically recalcitrant CRS with and without CB. Methods Demographic and surgical characteristics, baseline and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores for 137 patients with CRS who underwent primary ESS at our institution were recorded. Computed tomography (CT) scans were reviewed for Lund–Mackay score and presence of CB. Multiplanar CT was used to measure CB dimensions and estimate volume. Multivariable analysis was performed to identify differences in SNOT-22 overall and symptom-domain scores between patients with upper quartile (≥0.8 mL) CB and without CB. Results CB was found in 37% of patients with mean volume of 0.67 mL. There were no significant differences in distribution of clinicodemographic variables by large CB status. At baseline, large CB was associated with higher SNOT-22 extranasal-rhinologic domain score (9.8 vs 6.0, P < .01). Following ESS, patients with large CB reported greater improvement in SNOT-22 extranasal-rhinologic domain score (multivariable mean absolute improvement 3.8, P = .01; relative 56% vs 30%). Conclusion Patients with medically recalcitrant CRS and concomitant large CB have higher SNOT-22 extranasal-rhinologic domain scores at baseline, but also report greater intradomain improvement exceeding the subdomain’s mean clinically important difference. To our knowledge, this is the first demonstration that CB has a clinically significant impact on QOL in CRS, and surgical intervention may be helpful to address these symptoms.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Voice-Related Quality of Life in Patients with Chronic Rhinosinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420924061 ◽

2020 ◽

Vol 129 (10) ◽

pp. 983-987

Author(s):

Arthur W. Wu ◽

Evan S. Walgama ◽

Michela Borrelli ◽

James Mirocha ◽

Anca M. Barbu ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Correlation Coefficient ◽

Pearson Correlation ◽

Sinus Surgery ◽

Entire Study ◽

Related Quality ◽

The Mean ◽

Snot 22

Objective: Chronic rhinosinusitis (CRS) has long been associated with vocal dysfunction. However, studies quantifying the presence of voice dysfunction in CRS patients or the effects of functional endoscopic sinus surgery (FESS) are sparse. The goal of this study was to determine the voice-related quality of life in patients undergoing FESS for CRS using the validated Voice Related Quality of Life Survey (VRQL). We correlated the preoperative VRQL scores to the Sino-Nasal Outcome Test (SNOT-22) scores, and we determined the effect of FESS on postoperative VRQL scores. Methods: Consecutive patients undergoing FESS were preoperatively administered both the VRQL and the SNOT-22 surveys. Spearman (ρ) and Pearson ( r) correlation coefficients were calculated. The VRQL was mailed to patients postoperatively between 3 and 6 months. The paired t-test was used to compare pre- and post-FESS scores. Results: A total of 102 patients were enrolled, and 81 patients completed the two surveys. A total of 51 (62.9%) patients had raw VRQL score ≥ 10, signifying presence of significant vocal symptoms. The mean ± standard deviation (SD) raw VRQL score of the entire study population was 12.4 ± 4.6, and the mean SNOT-22 score was 37.8 ± 19.2. The Spearman correlation coefficient between VRQL and the total SNOT-22 score was 0.34 ( P =.002), and the Pearson correlation coefficient was 0.36 ( P = .001). Both correlations were similar, demonstrating that increasing severity of CRS symptoms correlates with decreasing voice-related quality of life (QOL). Seventy patients completed the postoperative survey for an 86% retention rate. Thirty-six of these patients had abnormal preoperative VRQL scores, and these patients improved significantly after FESS. The mean preoperative versus postoperative raw scores were 15.2 ± 5.6 versus 12.5 ± 4.1, respectively ( P = .003). Conclusion: This study demonstrates the increasing presence of vocal complaints with increasing severity of CRS. It also demonstrates that VRQL scores improve after FESS in those patients with preoperative vocal complaints. Level of Evidence: IV

Download Full-text

Quality of Life in Patients with Chronic Rhinosinusitis with Nasal Polyposis Before and After Functional Endoscopic Sinus Surgery: A Study Based on SINO-NASAL OUTCOME TEST

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.6n.1p.11 ◽

2018 ◽

Vol 6 (1) ◽

pp. 11

Author(s):

Mehrnoosh Musavi Aghdas ◽

Nikzad Shahidi ◽

Daryoush Sheikhzadeh ◽

Maryam Ebrahimzadeh

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Nasal Polyposis ◽

Sinus Surgery ◽

Before And After ◽

The Mean ◽

Preoperative Score ◽

Snot 22

Background: Chronic rhinosinusitis is one of the most common diseases in the world. The high prevalence and chronicity of disease increasing burden of disease. Burden of this disease, productivity and the quality of life of patients decreased. The aim of this study was to evaluate the effect of endoscopic sinus surgery on the quality of life of patients with chronic rhinosinusitis with nasal polyposis.Method: This prospective study was performed on 59 patients suffering chronic rhinosinusitis with nasal polyposis referring to ENT clinic of educational hospital of Tabriz University of medical sciences during 2015 to 2017. These patients underwent Endoscopic Sinus Surgery as treatment. For all patients, SINO-NASAL OUTCOME (TEST) (SNOT-22) was completed before and twelve months after surgery.Results: Fifty-nine patients were enrolled in this study. 21 were female (35.6%) and 38 were male (64.40%). The mean age of the studied population was 40.88 ± 16.11 years. The mean score of the preoperative score was 59.38 ± 5.84 and the mean score of the postoperative score was 24.01 ± 10.48. The results of the statistical analysis showed that endoscopic surgery reduced The SNOT-22 questionnaire score is significant. (P < 0.000). The results of the test showed that the increase in preoperative score increases the gain after surgery. (Spearman correlation coefficient: 0.419 and P: 0.001)Conclusion: Endoscopic sinus surgery seems to improve the symptoms and quality of Life in patients with chronic rhinosinusitis.

Download Full-text

Machine-Learning Points at Endoscopic, Quality of Life, and Olfactory Parameters as Outcome Criteria for Endoscopic Paranasal Sinus Surgery in Chronic Rhinosinusitis

Journal of Clinical Medicine ◽

10.3390/jcm10184245 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4245

Author(s):

Jörn Lötsch ◽

Constantin A. Hintschich ◽

Petros Petridis ◽

Jürgen Pade ◽

Thomas Hummel

Keyword(s):

Quality Of Life ◽

Machine Learning ◽

Chronic Rhinosinusitis ◽

Paranasal Sinus ◽

Endoscopic Sinus Surgery ◽

Relevant Information ◽

Olfactory Function ◽

Sinus Surgery ◽

Paranasal Sinus Surgery

Chronic rhinosinusitis (CRS) is often treated by functional endoscopic paranasal sinus surgery, which improves endoscopic parameters and quality of life, while olfactory function was suggested as a further criterion of treatment success. In a prospective cohort study, 37 parameters from four categories were recorded from 60 men and 98 women before and four months after endoscopic sinus surgery, including endoscopic measures of nasal anatomy/pathology, assessments of olfactory function, quality of life, and socio-demographic or concomitant conditions. Parameters containing relevant information about changes associated with surgery were examined using unsupervised and supervised methods, including machine-learning techniques for feature selection. The analyzed cohort included 52 men and 38 women. Changes in the endoscopic Lildholdt score allowed separation of baseline from postoperative data with a cross-validated accuracy of 85%. Further relevant information included primary nasal symptoms from SNOT-20 assessments, and self-assessments of olfactory function. Overall improvement in these relevant parameters was observed in 95% of patients. A ranked list of criteria was developed as a proposal to assess the outcome of functional endoscopic sinus surgery in CRS patients with nasal polyposis. Three different facets were captured, including the Lildholdt score as an endoscopic measure and, in addition, disease-specific quality of life and subjectively perceived olfactory function.

Download Full-text

Reliability and telephone validity of the Stroke-specific Quality of Life (SS-QOL) scale

Stroke ◽

10.1161/str.32.suppl_1.339-b ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 339-339

Author(s):

Linda S Williams ◽

Gayle Redmon ◽

D’Anna C Saul ◽

Morris Weinberger

Keyword(s):

Quality Of Life ◽

Domain Score ◽

Rater Reliability ◽

Quality Of Life Scale ◽

Trained Interviewer ◽

Individual Domain ◽

Highly Correlated ◽

Ir Study ◽

Domain Scores

P3 Background/Purpose: The SS-QOL is a validated 49-item stroke-specific quality of life scale. Scale stability over time, between raters and with different administration modes are necessary for use in large studies. The purpose of this study is to examine SS-QOL test-retest (TR) and inter-rater reliability (IR), and validity of telephone (PH) administration. Methods: Ischemic stroke survivors with no significant language or cognitive impairments were recruited as part of an ongoing study of SS-QOL version 2.0. In the TR study (N=47), a trained interviewer re-administered the SS-QOL within 2 hours of the initial interview. In the IR study (N=24), a second trained interviewer re-administered the SS-QOL within 2 hours of the first interview. The PH interview (N=34) was conducted within 48 hours of a face to face interview. Pearson correlations were used to assess the relationship between the overall SS-QOL scores and individual domain scores. Because scores may be highly correlated yet biased, paired t-tests were used to assess response bias. Overall SS-QOL score and domain scores range from 1.0 (worst) to 5.0 (best). Domains are: Mobility, Upper Extremities, Work, Self-care, Energy, Family Roles, Vision, Language, Social Roles, Cognition, Personality, and Mood. Results: 98–100% of the 3 samples were male, 88–94% were white and mean age was 66–67 years. Mean time since stroke was 4 months in the TR and IR samples and 5 months in the PH sample. SS-QOL scores were highly correlated and unbiased on TR (r=.92), IR (r=.92), and PH (r=.93) testing. All individual domain scores were also highly correlated in IR, TR and PH testing. Cognition and Personality domain scores were slightly higher on re-test and the Language domain score was slightly higher on PH administration. These differences were all < 1/4 of a standard deviation in domain score. Conclusions: The SS-QOL has excellent test-retest and inter-rater reliability. Telephone administration of the SS-QOL is accurate and unbiased. Individual domain scores are also highly reliable and observed differences in domain scores are rare and small. Validation of SS-QOL mail administration is ongoing.

Download Full-text