Extending the use of the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire in a cross-sectional study: Patients with chronic rhinosinusitis versus healthy controls.

OBJECTIVES: There are several instruments to assess health-related quality of life (HRQoL) in chronic rhinosinusitis (CRS). Unfortunately, none of them evaluates all three health domains (physical, social and psychological) important to assess the overall well-being of the patient. The Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES-Q) does assess all these elements. Initially, the EES-Q is validated to evaluate the impact of endoscopic endonasal surgery (EES) on HRQoL. The aim of this study is to assess whether EES-Q outcomes differ in patients with CRS compared with healthy individuals. Therefore, extending the use of the EES-Q for all CRS patients. DESIGN: Cross-sectional study. SETTING: Tertiary referral hospital. PARTICIPANTS: One hundred patients with uncontrolled CRS (50% with nasal polyps) scheduled to receive EES. The questionnaire was completed preoperatively. Healthy control subjects (n = 100) without any history of sinusitis or a known current medical treatment at a hospital were included. MAIN OUTCOME MEASURES: Mann-Whitney U test was performed to identify differences in EES-Q scores (domain scores and EES-Q score). RESULTS: The median EES-Q score in CRS patients (33.8) was significantly higher (p < 0.001) than in the control group (10.4). As well as the physical (52.5 vs. 16.4, p < 0.001), psychological (13.8 vs. 5.0, p < 0.001) and social (37.5 vs. 2.5, p < 0.001) domain scores. CONCLUSIONS: With this study, we are extending the use of the EES-Q. It indicates that the EES-Q can be a valuable clinical tool to assess multidimensional HRQoL in all patients with CRS.

Clinical potential of pupillary light reflex parameters as objective indicators reflecting chronic rhinosinusitis-specific quality of life: a 12-month prospective longitudinal study.

Pupillary light reflex (PLR) and heart rate variability (HRV) parameters can be objective indicators of chronic rhinosinusitis (CRS) status from the viewpoint of autonomic nervous system activity. This study aimed to establish objective indicators for CRS using the 22-item Sino-Nasal Outcome Test (SNOT-22) and PLR/HRV parameters. Sixty-seven patients were prospectively and longitudinally followed up after surgical treatment. We investigated changes in SNOT-22 scores, representing CRS-specific quality of life (QOL). We prepared two models: linear regression model adjusting clinical factors as predictor variables (model 1) and linear mixed-effects model adjusting clinical factors and among-individual variability (model 2). We compared Akaike's information criterion (AIC) values and regression coefficients. The model with lower AIC values was defined as the better-fit model. Model 2 showed lower AIC values in all parameters (better-fit model). Three parameters showed opposite results between the two models. The better-fit models showed significances in the five PLR parameters but not in any HRV parameters. Among these PLR parameters, constriction latency can be the most robust indicator because of the narrowest 95% confidence intervals. Adjusting the among-individual variability while investigating clinical potential of PLR/HRV parameters to reflect CRS-specific QOL can improve the model fit, thereby reaching robust conclusions from obtained data.

Perceived Financial Insecurity Impacts Healthcare Decision-Making Among Patients With Sinusitis.

OBJECTIVES/HYPOTHESIS: The economic burden of sinusitis is significant, and socioeconomic factors can impact patient decision-making. The purpose of this study was to examine the impact of perceived financial insecurity on healthcare decision-making and treatment compliance among sinusitis patients. STUDY DESIGN: Cross-sectional study using the 2018 National Health Interview Survey. METHODS: Survey responses to nine questions regarding financial stressors and nine questions regarding cost-saving healthcare actions were recorded, which included seeking lower cost medication, medication noncompliance, and avoiding care visits due to costs. RESULTS: There was a total weighted sample size of 28.9 million patients who self-reported a diagnosis of sinusitis (12% of the U.S. population). Sinusitis patients who reported cost-saving actions had an increased severity of perceived financial insecurity than those without cost-saving actions (P < .001). Sinusitis patients with perceived financial insecurity had the highest odds of at least one cost-saving action (odds ratio [OR] = 5.94, 95% CI = 5.911-5.970, P < .001), followed by lack of health insurance (OR = 5.13, 95% CI = 5.107-5.159, P < .001), and poor self-reported health status (OR = 2.81, 95% CI = 2.792-2.822, P < .001). Increasing the number of financial stressors increased the odds of at least one cost-saving action (P < .001). Across all financial stressors, the most commonly performed cost-saving action was asking for lower cost medication. CONCLUSIONS: Perceived financial insecurity is associated with cost-saving healthcare actions among sinusitis patients, including treatment noncompliance. Interventions to assess financial insecurity among sinusitis patients may facilitate shared decision-making for optimal, individualized treatment plans that may lead to improved outcomes and quality of life. LEVEL OF EVIDENCE: NA Laryngoscope, 131:2403-2412, 2021.

Oral Corticosteroids Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis Without Nasal Polyposis: A Randomized Clinical Trial.

Importance: Although oral corticosteroids are commonly prescribed following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) without nasal polyposis, there are little data to suggest that this is a beneficial practice. Objective: To assess the efficacy of oral corticosteroids following ESS in CRS without polyps. Design, Setting, and Participants: This prospective double-blinded, placebo-controlled, randomized noninferiority clinical trial conducted in a single academic tertiary rhinology practice included adults with CRS without polyps undergoing ESS. Of 81 patients recruited, 72 completed the study. Interventions: Patients were randomized into 2 treatment groups: a 12-day postoperative taper of oral prednisone vs matched placebo tablets. All study patients also received a uniform 2-week postoperative regimen of oral antibiotics, fluticasone nasal spray, and saline rinses. Main Outcomes and Measures: The primary outcome measures were Sinonasal Outcome Test-22 (SNOT-22) scores and Lund-Kennedy endoscopy scores, collected preoperatively and postoperatively at 1 week, 1 month, 3 months, and 6 months. Scores were compared between treatment groups at each time point using longitudinal difference between treatment groups and analyzed using 2-way, repeated measures analysis of variance. Secondary outcome measures included treatment-related adverse effects. Results: Overall, 72 patients (mean [SD] age, 49.4 [14.9] years; 36 men, 36 women) completed the study, with 33 in the prednisone arm and 39 in the placebo arm. When comparing longitudinal differences between treatment groups, there was no clinically meaningful difference observed in SNOT-22 total (F[4254] = 1.71, η2 = 0.01 [95% CI, 0.00-0.05]) or Lund-Kennedy scores (F[4247] = 1.23, η2 = 0.02 [95% CI, 0.00-0.50]). In SNOT-22 subdomain analyses, there was no clinically meaningful difference between treatment groups for rhinologic, extranasal rhinologic, ear/facial, or sleep subdomains. However, the prednisone group had worse longitudinal scores for psychological dysfunction compared with the placebo group (F[4254] = 3.18, η2 = 0.05 [95% CI, 0.02-0.09]). Reported adverse effects were similar between the 2 treatment groups. Conclusions and Relevance: In this randomized clinical trial of patients with CRS without polyps, oral prednisone following ESS conferred no additional benefit over placebo in terms of SNOT-22 total scores, SNOT-22 rhinologic subscores, or Lund-Kennedy endoscopy scores up to 6 months after surgery. Patients receiving prednisone, however, did demonstrate worse SNOT-22 psychologic subdomain scores. These results suggest that the risks of oral corticosteroids may outweigh the benefits; thus use of oral corticosteroids after ESS for CRS without polyps should be carefully considered. Trial Registration: ClinicalTrials.gov Identifier: NCT02748070.

The Degree of Stress in Patients With Empty Nose Syndrome, Compared With Chronic Rhinosinusitis and Allergic Rhinitis.

BACKGROUND: Depression is a mental health disease of growing public health concern because depressive mood affects the sufferer's daily life and is also associated with productivity decline. Depression that is caused by other diseases or substances is referred to as secondary depression, which is an important distinction because curing the underlying cause could subsequently regulate depressive mood. Empty nose syndrome (ENS), also known as "paradoxical obstruction of the nose," is a condition in which the major symptom is difficulty breathing, despite having sufficient breathing space in the nose. Empty nose syndrome has been increasing in prevalence in Korea. We found that patients with this ENS have a tendency toward depressive mood, which can escalate so far as to lead to suicide attempts. Thus, herein, we aimed to investigate the psychological burden on patients with ENS. METHODS: We divided patients into 4 groups: ENS (group A), chronic rhinosinusitis with polyp (CRS c polyp, group B), chronic rhinosinusitis without polyp (CRS s polyp, group C), and allergic rhinitis (AR, group D). We estimated and compared Beck Depression Inventory (BDI) scores among the 4 groups, and we investigated the relationship between depression index and nasal cavity area in patients with ENS. RESULTS: The ENS group (A) had depression prevalence of 71% with varying severity, which was much higher than group B (19%), group C (15%), and group D (27%). The correlation between nasal cavity volume and BDI score for the ENS group was not statistically significant. CONCLUSION: The degree and severity of depression in patients with ENS was higher than in patients with CRS or AR. Furthermore, there was no relationship between depression severity and nasal cavity volume in the patients with ENS. Thus, physicians should be careful not to dismiss the accompanying mental health problems of patients with ENS.

Emotional and Personality Traits are Determinants of Activity Avoidance in Chronic Rhinosinusitis Patients.

OBJECTIVES: Chronic rhinosinusitis (CRS), like other sinonasal diseases, may be associated with avoidance of daily activities. Our goal was to identify characteristics associated with avoidance of activities due to CRS. MATERIALS AND METHODS: A total of 194 CRS patients were recruited. CRS symptom burden was assessed with the 22-item Sinonasal Outcome Test (SNOT-22). SNOT-22 nasal, sleep, ear/facial discomfort and emotional/psychological subdomain scores were calculated. Depressed mood was assessed using the two-item Patient Health Questionnaire (PHQ-2). Personality traits including conscientiousness, neuroticism, agreeableness, openness, and extraversion were assessed using the Big Five Inventory-10 (BFI-10) questionnaire. As the primary outcome, participants rated how often in the prior week that they had avoided any activities in day-to-day life due to their nasal or sinus symptoms on a scale of "never," "rarely," "sometimes," "often," or "extremely often." Ordinal regression models, with bootstrap validation, were used to identify associations between activity avoidance and participants' characteristics. RESULTS: On multivariable analysis, SNOT-22 score (odds ratio [OR] = 1.03, 95% CI, 1.01-1.04, P = .026), and conscientiousness personality trait (OR = 1.38, 95% CI, 1.05-1.81, P = .019) were positively associated with activity avoidance while age (OR = 0.98, 95% CI, 0.96-0.99, P = .049) was negatively associated with activity avoidance. Of CRS symptom burden/SNOT-22 subdomains, only the emotional/psychological subdomain score (OR = 1.28, 95% CI, 1.12-1.46, P < .001) was associated with activity avoidance. CONCLUSION: Younger age and the conscientiousness personality trait were associated with activity avoidance in CRS patients. Of CRS-associated symptomatology, sadness and embarrassment were associated with activity avoidance. Emotional traits and personality most strongly predict avoidance of activities in CRS patients. LEVEL OF EVIDENCE: 2c. Laryngoscope, 131:707-712, 2021.

Unbiased Measure of General Quality of Life in Chronic Rhinosinusitis Reveals Disease Modifiers.

INTRODUCTION: Chronic rhinosinusitis (CRS) is associated with a significant decrease in general health-related quality of life (QOL). The EuroQol 5-dimensional questionnaire measures general health-related quality of life through a health utility value (EQ-5D HUV)-based on five domains reflecting mobility, self-care, activities of daily life, pain/discomfort, and anxiety/depression-and an unbiased visual analog scale (EQ-5D VAS). We sought to identify characteristics of CRS patients with a high EQ-5D HUV but low EQ-5D VAS score. MATERIALS AND METHODS: Retrospective cross-sectional study of 300 CRS patients with EQ-5D HUV equal to 1.0 (reflecting perfect health). All patients completed a 22-item Sinonasal Outcome Test (SNOT-22)-from which nasal, sleep, ear/facial discomfort, and emotional subdomain scores were calculated, as well as the EQ-5D. Low EQ-5D VAS was defined as a score less than 80. RESULTS: On multivariate analysis, low EQ-5D VAS was associated with only the SNOT-22 sleep subdomain score (odds ratio [OR] = 1.07, 95%CI: 1.02-1.12, P = .003). Comorbid asthma was also associated with lower EQ-5D VAS (OR = 2.16, 95%CI: 1.02-4.59, P = .045). In contrast, polyps were negatively associated with having a lower EQ-5D VAS (OR = 0.34, 95%CI: 0.17-0.69, P = .003). CONCLUSION: There are patients with perfect general health-related QOL according to a health utility value-based methodology (like the EQ-5D HUV) who report low general health-related QOL on an unbiased measure like the EQ-5D VAS. In CRS patients with perfect EQ-5D HUV, poor sleep and asthma were associated with low QOL on the EQ-5D VAS, while polyps were negatively associated with low QOL. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1206-1211, 2021.

Long-Term Clinical Follow-Up of Patients With Chronic Rhinosinusitis.

OBJECTIVE: This study comprised a long-term follow-up of a cohort of patients with chronic rhinosinusitis (CRS) regarding clinical features and symptomatology. METHODS: Data from 42 patients with CRS were available from a previous study. Forty of these patients were alive and were contacted for inclusion after approximately 10 years. Patients completed a questionnaire about disease and symptoms, and underwent a clinical examination. RESULTS: Thirty-four patients (85%) responded and could be included and evaluated. For the participants in this follow-up study median length of time between initial inclusion (C1) and follow-up (C2) was 11 years (range: 8-15). In some patients the CRS shifted phenotype over time, from CRS with nasal polyposis to CRS without nasal polyposis or vice versa. The median total visual analogue score for combined sinonasal symptoms for all patients was statistically significantly reduced at follow-up. For individual patients, scores for nasal congestion, nasal discharge, facial pressure, and hyposmia were also statistically significantly reduced. The most frequently reported symptom-relieving treatments were nasal steroids and saline rinsing of the nose. Self-reported general quality of life was statistically significantly improved at C2 compared to C1. CONCLUSION: At long-term follow-up, symptoms were generally reduced and patients reported an improved quality of life. Patients can be given hope for eventual symptom relief. CRS is a chronic condition that seems to harbor the ability to alter its phenotype after several years. Topical corticosteroids and saline rinsing of the nose should be emphasized, since patients consider these treatments to be of high value.

Assessment of health-related quality-of-life in patients with chronic Rhinosinusitis - Validation of the German Sino-Nasal Outcome Test-22 (German-SNOT-22).

PURPOSE: The Sino-Nasal-Outcome-Test-22 (SNOT-22) represents the reference questionnaire to assess symptoms, health-related quality-of-life (HRQOL) and treatment-response in patients with chronic rhinosinusitis (CRS). The SNOT-22 has been validated for various languages, yet no validation is available for the German version. Thus, we provide a validation of the SNOT-22 for German. METHODS: In this prospective observational study 139 CRS-patients and 36 control-participants were included. CRS-patients completed the German-SNOT-22 before treatment (T0) and four (T1), twelve (T2) and 48 weeks after inclusion (T3). At T0, Mackay-Naclerio-, Lund-Mackay- and Brief-Symptom-Inventory-18 (BSI-18) scores were collected as external reference for the German-SNOT-22 and its subscales. At T1, T2, and T3 health-transition-items (HTIs) were raised to explore responsivity. Control-participants completed the German-SNOT-22 at T0. Reliability (internal consistency, item-total correlation), validity (concurrent validity, discriminatory validity) and responsiveness (distribution- and anchor-based) were explored for the German-SNOT-22. RESULTS: At T0, the mean German-SNOT-22 total-score for CRS patients was 38.0 (± 20.9) and responded to treatment (T1 = 26.3 ± 19.1; T2 = 25.8 ± 20.6; T3 = 20.5 ± 16.3). For control-participants, the mean total-score at T0 was 15.1 (±10.9). The German-SNOT-22 was reliable (excellent internal consistency α = 0.93; good overall item-total correlations r = 0.39-0.85), valid (significant correlations between Mackay-Naclerio-, Lund-Mackay- and BSI-18 scores, all r > 0.39, p < 0.01) and responsive (significant correlations between HTIs and mean change in German-SNOT-22 total-score F = 9.57, p < 0.001). CONCLUSION: The German-SNOT-22 validated here matches the original SNOT-22. It is a reliable, valid and responsive questionnaire to assess symptoms, HRQOL and treatment-response in CRS-patients. Good psychometric properties were observed.

[The correlation between the degree of anxiety/depression and the improvement of subjective and objective symptoms after functional endoscopic sinus surgery in chronic sinusitis].

Objective: To explore whether the improvement of subjective symptoms and objective grades after endoscopic sinus surgery in patients with chronic sinusitis (CRS) are related to the degree of preoperative anxiety or depression and to provide reference for improving the effects of clinical treatment. Methods: The clinical data of one hundred and sixty patients with CRS treated by endoscopic sinus surgery in the First Affiliated Hospital of Chongqing Medical University from April 2018 to August 2019 were collected prospectively. The visual analogue scale (VAS) scores, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, Lund-Kennedy scores of nasal endoscopy and the Lund-Mackay scores of CT before and 6 months after surgery were used to analyse the correlation between the scores of anxiety or depression and the subjective and objective scores of patients before and after operation by grouping and layering. One hundred and one males (63.1%) and 59 females (36.9%) with an average age of 47.3 years (18-75 years) were included. Single-sample, independent or paired t-test, one-way ANOVA and rank-sum test were used for comparison and Pearson correlation analysis was used for the correlation between groups. Results: There was no statistical difference of anxiety or depression between different groups in terms of age, gender and course in the 160 effective patients (t values were -0.151, -0.487, -0.846, all P values>0.05; t values were -0.473, -1.302, -1.069, all P values>0.05). And the degree of preoperative anxiety or depression was positively correlated with the subjective scores, including overall discomfort, nasal obstruction, runny nose and olfactory decline (r values were 0.515, 0.606, 0.424, 0.306, all P values<0.01; r values were: 0.518, 0.584, 0.448, 0.308, all P values<0.01), but not significantly correlated with objective scores of Lund-Mackay and Lund-Kennedy (all P value>0.05). Moreover, as far as the symptoms of overall discomfort, nasal obstruction, headache and runny nose, the results of one-way ANOVA showed that the improvement of symptoms in patients with serious anxiety or depression was worse than that of the normal, mild and moderate patients (all P values<0.05). However, there was no significant difference in the scores of Lund-Kennedy 6 months after surgery between them (both P values>0.05). Conclusion: The state of anxiety or depression affects the improvement of symptoms after endoscopic sinus surgery for CRS patients. Compared with the patients with normal and mild to moderate anxiety or depression, the improvement of symptoms in patients with severe anxiety and depression is worse. It is necessary to evaluate the anxiety or depression of the patients with CRS who are going to undergo endoscopic sinus surgery.

Cluster analysis in 975 patients with current cough identifies a phenotype with several cough triggers, many background disorders, and low quality of life.

BACKGROUND: Recognition of disorder phenotypes may help to estimate prognosis and to guide the clinical management. Current cough management guidelines classify patients according to the duration of the cough episode. However, this classification is not based on phenotype analyses. The present study aimed to identify cough phenotypes by clustering. METHODS: An email survey among employed, working-age subjects identified 975 patients with current cough. All filled in a comprehensive 80-item questionnaire including the Leicester Cough Questionnaire. Phenotypes were identified utilizing K-means partitional clustering. A subgroup filled in a follow-up questionnaire 12 months later to investigate the possible differences in the prognosis between the phenotypes. RESULTS: Two clusters were found. The cluster A included 608 patients (62.4% of the population) and the cluster B 367 patients (37.6%). The three most important variables to separate the clusters were the number of the triggers of cough (mean 2.63 (SD 2.22) vs. 6.95 (2.30), respectively, p < 0.001), the number of the cough background disorders (chronic rhinosinusitis, current asthma, gastroesophageal reflux disease, 0.29 (0.50) vs. 1.28 (0.75), respectively, p < 0.001), and the Leicester Cough Questionnaire physical domain (5.33 (0.76) vs. 4.25 (0.84), respectively, p < 0.001). There were significant interrelationships between these three variables (each p < 0.001). Duration of the episode was not among the most important variables to separate the clusters. At 12 months, 27.0% of the patients of the cluster A and 46.1% of the patients of the cluster B suffered from cough that had continued without interruptions from the first survey (p < 0.001). CONCLUSIONS: Two cough phenotypes could be identified. Cluster A represents phenotype A, which includes the majority of patients and has a tendency to heal by itself. The authors propose that cluster B represents phenotype TBQ (Triggers, Background disorders, Quality of life impairment). Given the poor prognosis of this phenotype, it urges a prompt and comprehensive clinical evaluation regardless of the duration of the cough episode.

Increased the risk of depression in patients with chronic rhinosinusitis without polyp: A longitudinal follow up study using a national sample cohort.

Previous studies have reported that chronic rhinosinusitis (CRS) is closely related to depression. The present study aims to elucidate the association between CRS without nasal polyp and depression using a national sample cohort. Using the national sample cohort from Korean Health Insurance Review and Assessment Service, we matched patients with CRS (n = 21,707) to control participants (n = 86,828), at a ratio of 1:4, according to age, sex, household income, region of residence. The stratified Cox proportional-hazards model was used to evaluate the hazard ratio (HR) between CRS and depression. A subgroup analysis was performed according to age group and gender. The HR for depression was significantly higher in patients with CRS than in control participants (adjusted HR = 1.41, 95% confidence interval = 1.33-1.48) after adjustment for age, sex, household income, region of residence, and medical history. The risk of depression was also elevated in the subgroup analysis, regardless of age or gender. In conclusion, CRS was significantly associated with the increased risk of depression.

Psychological Status as an Effect Modifier of the Association Between Sinonasal Instrument and Imaging Results.

OBJECTIVE: To determine whether psychological status is an effect modifier of the previously observed low discriminatory capacity of Sinonasal Outcome Test-22 (SNOT-22) scores for Lund-Mackay computed tomography (CT) results. STUDY DESIGN: Observational outcomes study. SETTING: Tertiary care center. SUBJECTS AND METHODS: We assessed patients presenting with chronic sinonasal complaints who underwent CT of the sinuses within 1 month of completing the SNOT-22 instrument. SNOT-22 overall and domain scores were calculated, as were Lund-Mackay CT scores. The discriminatory capacity of SNOT-22 scores for CT results was determined using the receiver-operator characteristic area under the curve (ROC-AUC). Patient-Reported Outcome Measurement Information System (PROMIS) mental health T-scores were assessed, and stratified analyses were used to test for effect modification by psychological status. RESULTS: In stratified analyses, patients with better PROMIS mental health scores had SNOT-22 overall (ROC-AUC 0.96) and nasal domain scores (ROC-AUC 0.97-0.98) that were highly discriminatory for Lund-Mackay scores, while those with worse mental health scores did not (ROC-AUC 0.42-0.55, P < .007). Patients with better SNOT-22 psychological domain scores also had nasal scores that discriminated among CT results significantly better than those with worse psychological domain scores (ROC-AUC 0.65-0.69 and 0.34-0.35, respectively, P < .013). CONCLUSIONS: Psychological status is an effect modifier of the relationship between SNOT-22 and Lund-Mackay scores. SNOT-22 scores were discriminatory for Lund-Mackay CT results in patients with better psychological status, while they were nondiscriminatory in those with worse psychological status. When assessing the relationship between subjective and objective measures of chronic rhinosinusitis, accounting for effect modification may have practical utility.

The impact of asthma on quality of life and symptoms in patients with chronic rhinosinusitis.

Objective: The study aims to evaluate how asthma influences on clinical symptoms, imaging scores and HRQL in CRS patients.Methods: The study enrolled CRS patients and collected data about asthma status, clinical symptoms, allergic sensitization, computed tomography (CT) and 22-item SinoNasal Outcome questionnaire (SNOT-22). Matching pairs of asthmatic and non-asthmatic CRS patients were defined based on age, gender and nasal polyp presence. The difference between pairs in clinical symptoms, CT and SNOT-22 was then analyzed. The study enrolled mild to moderate asthma patients.Results: From 250 CRS patients 65 (26%) had asthma. We found 60 CRS asthma and CRS non-asthma pairs based on age, gender and nasal polyp presence. There was no difference in total SNOT-22 score between asthma (46.5) and non-asthma (43.5) CRS groups (p < .357). There were more patients with allergy positive medical history in asthma group (66.1%) when we stratified for CRS phenotypes, gender and age. Comparing visual analogue scale (VAS) scores for clinical symptoms, smell (p < .013) was the only symptom significantly worse in CRS asthma group. Although there was no difference in Lund-Mackay score, there was a slightly higher osteitis score in CRS asthma group (5.21 vs. 3.45; p = .059).Conclusion: CRS patients with asthma have significantly worse impairment of smell and taste when compared to non-asthmatic CRS patients. This is the only significant difference which is independent of nasal polyp presence, gender, age and allergy.

Evolving Rhinology: Understanding the Burden of Chronic Rhinosinusitis Today, Tomorrow, and Beyond.

PURPOSE OF REVIEW: To improve our appreciation of the burden of chronic rhinosinusitis (CRS) and to understand better how to ease that burden. RECENT FINDINGS: The burden of CRS is high. At an individual level, this burden is due to rhinologic symptoms as well as more systemic symptoms. At a societal level, the indirect costs of CRS, mostly due to reduced productivity, are higher than the direct costs. Surgical treatment has been found to be effective in addressing both the individual and societal burdens. Endotyping is just beginning to usher in the potential for personalized, precision treatments in CRS. We understand much about the burden of CRS but more remains to be learned, especially as newer expensive treatments become available. By appreciating the high burden of CRS, we can fulfill our mission to effectively lift that burden.

[A study on the quality of life and mental health of sinusitis patients with olfactory disorders].

Objective:The aim of this study is to investigate the incidence of dysosmia in patients with and without nasal polyps, and the impact of dysosmia on the quality of life and mental health in patients with Sinusitis. Method:A total of 105 randomly selected patients with Sinusitis were divided into two groups based on the results of the Sniffin's Sticks olfactory examination: The dysosmia group and the non dysosmia group, the quality of life （Qol） of olfaction quality of life scale and SCL-90 symptom checklist-90（SCL-90） were scored respectively. Result:The incidence of olfactory disorders in chronic sinusitis patients with nasal polyps was significantly higher than those without nasal polyps（χ²=37.133, P<0.001）. The quality of life score of the olfactory disturbance scale the quality of life score of the olfactory disturbance group（26.5±5.9） was significantly higher than that of the non olfactory disturbance group（11.76±3.58）（t=14.30, P<0.0001）. Life quality score（30.2±4.9） of female patients with olfactory dysfunction was significantly higher than that of male patients（22.3±4.0）（P<0.001）, The score of SCL-90 of chronic sinusitis patients with olfactory dysfunction（n=64） is 6.6（6.0-8.0）, while the score of SCL-90 of chronic sinusitis patients without olfactory dysfunction（n=41） is 7.0（6.2-7.6）, and there was no significant difference between the two groups（P>0.05）. Conclusion:The risk of dysosmia in patients with Sinusitis polyps was significantly higher than that in patients without nasal polyps, and the quality of life in patients with Sinusitis was significantly lower than that in patients without sinusitis, women also had a greater impact on their quality of life than men, and Sinusitis patients with dysosmia had no significant impact on their mental health.

Sino-nasal outcome test-22: Cross-cultural adaptation and validation in Russian speaking patients.

BACKGROUND: Chronic rhinosinusitis (CRS) is a relatively common disease, which significantly affects the patient's quality of life (QoL). Sino-Nasal Outcome Test-22 (SNOT-22) is a QoL questionnaire, which allows quantifying patients' complaints. Our aim was to translate and validated the SNOT-22 into the Russian language. METHODS: Translation and validation of SNOT-22 questionnaire was performed through forward-backward translation technique. After proper translation, the translated questionnaire was completed by CRS patients before and after endoscopic sinus surgery (ESS) and by healthy individuals as controls. RESULTS: Thirty-four native Russian-speaking CRS patients completed the Russian version of the SNOT-22 questionnaire before and after ESS. The internal consistency for reliability assessment was very good (mean Cronbach's alpha = 0.816 for CRS patients). Mean scores for the preoperative, postoperative and control groups were 67.6, 18.1 and 9.2, respectively (P < .001), showing validity and responsiveness of the questionnaire. CONCLUSION: The Russian version of the SNOT-22 questionnaire is a valid outcome measure for patients with CRS.

Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials.

BACKGROUND: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) generally have a high symptom burden and poor health-related quality of life, often requiring recurring systemic corticosteroid use and repeated sinus surgery. Dupilumab is a fully human monoclonal antibody that inhibits signalling of interleukin (IL)-4 and IL-13, key drivers of type 2 inflammation, and has been approved for use in atopic dermatitis and asthma. In these two studies, we aimed to assess efficacy and safety of dupilumab in patients with CRSwNP despite previous treatment with systemic corticosteroids, surgery, or both. METHODS: LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52 were two multinational, multicentre, randomised, double-blind, placebo-controlled, parallel-group studies assessing dupilumab added to standard of care in adults with severe CRSwNP. SINUS-24 was done in 67 centres in 13 countries, and SINUS-52 was done in 117 centres in 14 countries. Eligible patients were 18 years or older with bilateral CRSwNP and symptoms despite intranasal corticosteroid use, receiving systemic corticosteroids in the preceding 2 years, or having had sinonasal surgery. Patients in SINUS-24 were randomly assigned (1:1) to subcutaneous dupilumab 300 mg or placebo every 2 weeks for 24 weeks. Patients in SINUS-52 were randomly assigned (1:1:1) to dupilumab 300 mg every 2 weeks for 52 weeks, dupilumab every 2 weeks for 24 weeks and then every 4 weeks for the remaining 28 weeks, or placebo every 2 weeks for 52 weeks. All patients were randomly assigned centrally with a permuted block randomisation schedule. Randomisation was stratified by asthma or non-steroidal anti-inflammatory drug-exacerbated respiratory disease status at screening, previous surgery at screening, and country. Patients with or without comorbid asthma were included. Coprimary endpoints were changes from baseline to week 24 in nasal polyp score (NPS), nasal congestion or obstruction, and sinus Lund-Mackay CT scores (a coprimary endpoint in Japan), done in an intention-to-treat population. Safety was assessed in a pooled population of both dupilumab groups in SINUS-52 up to week 24 and the dupilumab group in SINUS-24 and the placebo groups in both studies until week 24. The trials are complete and registered at ClinicalTrials.gov, NCT02912468 and NCT02898454. FINDINGS: Between Dec 5, 2016, and Aug 3, 2017, 276 patients were enrolled in SINUS-24, with 143 in the dupilumab group and 133 in the placebo group receiving at least one study drug dose. Between Nov 28, 2016, and Aug 28, 2017, 448 patients were enrolled in SINUS-52, with 150 receiving at least one dose of dupilumab every 2 weeks, 145 receiving at least one dose of dupilumab every 2 weeks for 24 weeks and every 4 weeks until week 52, and 153 receiving at least one dose of placebo. Dupilumab significantly improved the coprimary endpoints in both studies. At 24 weeks, least squares mean difference in NPS of dupilumab treatment versus placebo was -2·06 (95% CI -2·43 to -1·69; p<0·0001) in SINUS-24 and -1·80 (-2·10 to -1·51; p<0·0001) in SINUS-52; difference in nasal congestion or obstruction score was -0·89 (-1·07 to -0·71; p<0·0001) in SINUS-24 and -0·87 (-1·03 to -0·71; p<0·0001) in SINUS-52; and difference in Lund-Mackay CT scores was -7·44 (-8·35 to -6·53; p<0·0001) in SINUS-24 and -5·13 (-5·80 to -4·46; p<0·0001) in SINUS-52. The most common adverse events (nasopharyngitis, worsening of nasal polyps and asthma, headache, epistaxis, and injection-site erythema) were more frequent with placebo. INTERPRETATION: In adult patients with severe CRSwNP, dupilumab reduced polyp size, sinus opacification, and severity of symptoms and was well tolerated. These results support the benefits of adding dupilumab to daily standard of care for patients with severe CRSwNP who otherwise have few therapeutic options. FUNDING: Sanofi and Regeneron Pharmaceuticals.

Use of the long-term quality of life assessment in the decision to indicate surgery in patients with chronic rhinosinusitis / Uso da avaliação da qualidade de vida em longo prazo na decisão de indicação cirúrgica em pacientes com rinossinusite crônica

Abstract Introduction: Quality-of-life questionnaires have been used to support decision-making in patients with chronic rhinosinusitis in the past decade. The choice of treatment in practice, however, also considers the patient's decision. Objective: To assess the long-term quality of life of patients with chronic rhinosinusitis who decided to avoid surgery. Methods: This is a prospective longitudinal study with a group of patients with chronic rhinosinusitis, with and without indication for surgery, with application of the questionnaire SNOT-22 in two periods: between 2011 and 2012 and between June and August 2016, via email. Results: Data were collected from 42 patients, of which 13 presented indications for surgery and 29 were not indicated for surgery. The average quality of life score was 42.1 (±16.4) in the group with an indication for surgery and 40.6 (±23.4) in the group without this indication, p = 0.84. All the patients were assessed by a single doctor with blinding in relation to the initial score. No differences were detected between the groups. The impact of the chronic rhinosinusitis was reduced even among the patients with the indication for surgery. Both groups scored over 40. Conclusion: This study can help predict the impact of the chronic rhinosinusitis over time and better adjust expectations with non-surgical treatment.

Resumo Introdução: Questionários de qualidade de vida têm sido usados na última década para apoiar a tomada de decisão em pacientes com rinossinusite crônica. Entretanto, na prática, a escolha do tratamento também considera a decisão do paciente. Objetivo: Avaliar a qualidade de vida em longo prazo de pacientes com rinossinusite crônica que decidiram não se submeter à cirurgia. Método: Estudo longitudinal prospectivo com um grupo de pacientes com rinossinusite crônica, com e sem recomendação de cirurgia, com aplicação do questionário Sino-Nasal Outcome Test 22 (SNOT-22, teste de desfecho sinonasal) em dois períodos: entre 2011 e 2012 e entre junho e agosto de 2016, via e-mail. Resultados: Foram coletados dados de 42 pacientes, dos quais 13 tiveram recomendação para cirurgia e 29 não tiveram. O escore médio de qualidade de vida foi de 42,1 (± 16,4) no grupo com indicação de cirurgia e de 40,6 (± 23,4) no grupo sem essa indicação, p = 0,84. Todos os pacientes foram avaliados por um único médico, cegado para o escore inicial. Não foram detectadas diferenças entre os grupos. O impacto da rinossinusite crônica foi reduzido mesmo entre os pacientes com indicação de cirurgia. Ambos os grupos apresentaram um escore acima de 40. Conclusão: Este estudo pode ajudar a prever o impacto da rinossinusite crônica ao longo do tempo e ajustar de forma mais adequada as expectativas com o tratamento não cirúrgico.