Pediatric Orbital Fractures: Outcomes in Relation to Time of Surgery.

INTRODUCTION: Orbital trapdoor fractures in children and adolescents can cause persistent problems with vision and appearance. Early surgery is recommended, although, because of the rarity of these fractures, there is a lack of evidence regarding the optimal timing of surgery.The objective of this study was to examine the effect of the time from trauma to surgery on the recovery time and severity of diplopia in children and adolescents with orbital trapdoor fractures. MATERIALS AND METHODS: A retrospective cohort study was performed of all orbital fractures in children and adolescents aged 0 to 20 years, treated at a tertiary referral center in 2005-2017. Data relating to demographics, cause of injury, surgery, time of follow-up, and final outcomes were extracted. The cases of trapdoor fracture were specifically examined with regard to the time from trauma to surgery and diplopia at last follow-up, which was the primary outcome. RESULTS: One hundred thirty-five patients, aged 2.4 to 20 years (mean 17.0), were treated for orbital fractures during the period; 37 (27%) had an isolated orbital floor fracture and 12 (9%) had a trapdoor fracture. All patients with trapdoor fractures underwent surgery; the mean time to surgery was 11.9 days in 2007-2011 and 1.1 days in 2012-2017. Although statistical significance cannot be proven in this small and retrospective study, a shorter time from trauma to surgery seems to lead to fewer problems with diplopia and 2 patient cases that highlight this are presented. CONCLUSIONS: Delayed surgical intervention in pediatric orbital trapdoor fractures increases the risk of delayed recovery and persistent diplopia. Other factors, such as the degree of muscle incarceration and necrosis and the surgeon's experience and skill, may, however, also influence the outcomes.

Chronic rhinosinusitis associated with chronic bronchitis in a five-year follow-up: the Telemark study.

BACKGROUND: Chronic rhinosinusitis (CRS) is associated with generalised airway inflammation. Few studies have addressed the relationship between CRS and chronic bronchitis (CB). METHODS: This prospective study over a five-year period aims to investigate the risk of developing CB in subjects reporting CRS at the beginning of the study. A random sample of 7393 adult subjects from Telemark County, Norway, answered a comprehensive respiratory questionnaire in 2013 and then 5 years later in 2018. Subjects reporting CB in 2013 were excluded from the analyses. New cases of CB in 2018 were analysed in relation to having CRS in 2013 or not. RESULTS: The prevalence of new-onset CB in 2018 in the group that reported CRS in 2013 was 11.8%. There was a significant increase in the odds of having CB in 2018 in subjects who reported CRS in 2013 (OR 3.8, 95% CI 2.65-5.40), adjusted for age, sex, BMI, smoking and asthma. CONCLUSION: In this large population sample, CRS was associated with increased odds of developing CB during a five-year follow-up. Physicians should be aware of chronic bronchitis in patients with CRS.

BMI as a risk factor for the development of chronic rhinosinusitis: a prospective population-based study.

PURPOSE: Obesity is a growing, global health problem and previous cross-sectional studies have demonstrated an association between obesity and chronic rhinosinusitis (CRS). There is, however, a lack of prospective studies regarding the impact of obesity on developing (new-onset) CRS. METHODS: Questionnaire-based data (n = 5769) relating to new-onset CRS and Body Mass Index (BMI) were collected in 2013 and 2018 from the Telemark population study in Telemark, Norway. Odds ratios for the risk of new-onset CRS in 2018 in relation to BMI in 2013 were calculated, adjusted for smoking habits, asthma, gender and age. RESULTS: When comparing the group with normal weight (18.5 ≤ BMI < 25) with the obese group (BMI ≥ 30), the odds of new-onset CRS was 53% higher [OR 1.53 (1.11, 2.10)] in the obese group. CONCLUSION: CRS is a multifactorial disease with different phenotypes and it is important to consider obesity when assessing patients with CRS in a clinical setting.

Nasal symptoms increase the risk of snoring and snoring increases the risk of nasal symptoms. A longitudinal population study.

PURPOSE: Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms. METHODS: In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999-2001 (RHINE II, baseline) and in 2010-2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112). RESULTS: Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22-1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02-1.47). CONCLUSION: Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.

Caregivers' absence from work before and after tonsil surgery in children with sleep-disordered breathing.

PURPOSE: Sleep-disordered breathing, SDB, in children is associated with morbidity that can result in caregivers having to stay at home from work. The aim of this study was to investigate whether the number of days when caregivers are reimbursed, temporary parental benefit (TPB) to stay at home from work to care for their sick child is increased among children with SDB before and after tonsil surgery. METHODS: This is a retrospective, cross-sectional study of children (n = 440), aged 2-11 years, that underwent tonsil surgery for SDB in day surgery at Sahlgrenska University Hospital in 2014 and 2015. TPB, was provided by the Swedish Social Insurance Agency. The expected days of TPB in the general population of the region were calculated. The number of days with TPB was compared 2 years before and 2 years after surgery and compared with the expected days of TPB. RESULTS: Two years before surgery, the children had no more days of TPB than expected. Two years after surgery, the children with SDB had 4.8 more days with TPB (p < 0.001) than expected, but, when the 1st month after surgery was excluded from the analysis, there was no difference in days of TPB compared with the general population. CONCLUSION: Children with SDB who had tonsil surgery had no more days of parental benefits 2 years before and 2 years after surgery than expected. SDB is associated with increased morbidity, but it does not appear to cause caregivers to stay at home in the majority of children.

Rituximab in multiple sclerosis at general hospital level.

OBJECTIVES: The use of rituximab (RTX) in multiple sclerosis (MS) is a rapidly increasing choice of disease-modifying therapy. Efficacy outside specialized university hospital-based care is not yet systematically investigated. Our aim was to evaluate off-label RTX treatment for MS at a general hospital in Sweden. MATERIALS AND METHODS: Subjects with definite MS with at least one rituximab infusion were eligible for inclusion in this retrospective, observational study. Effect was evaluated by monitoring clinical disability, annual relapse rate, new lesions on MRI, and safety by the incidence and severity of adverse events. RESULTS: Among the 83 included subjects, 15 had clinical worsening of disease during the median 23.5 (1-76) months of follow-up after RTX initiation: 7/66 with relapsing-remitting multiple sclerosis (RRMS) and 8/17 with progressive subtypes (PMS). Cumulative survival without worsening was 86% in RRMS and 30% in PMS. The annual relapse rate before RTX vs follow-up dropped from 0.38 to 0.05 (P < .00001). Subjects with new enhancing lesions on MRI during the first year before RTX initiation vs the year after dropped from 0.94 to 0.024 (P < .00001) and was only seen in RRMS (1.05-0.31, P = .00003). Adverse events were mainly mild. Thirty-six out of 53 non-infusion-related adverse events were infections, of which four were serious, including a case of pneumonia with concomitant late-onset neutropenia. CONCLUSIONS: Rituximab was as effective and safe when given at a general hospital outpatient clinic compared with results from previous university hospital-based studies. Vigilance is required concerning severe adverse events.

Non-infectious rhinitis is more strongly associated with early-rather than late-onset of COPD: data from the European Community Respiratory Health Survey (ECRHS).

PURPOSE: Chronic obstructive pulmonary disease (COPD) is associated with several co-morbidities and non-infectious rhinitis (NIR) has emerged as a new possible co-morbidity. The primary aim of this study is to confirm a previously reported association between NIR and COPD in a multicentre population over time. The secondary aim is to investigate the course over time of such an association through a comparison between early- and late-onset COPD. METHODS: This study is part of the European Community Respiratory Health Survey (ECRHS). A random adult population from 25 centres in Europe and one in Australia was examined with spirometry and answered a respiratory questionnaire in 1998-2002 (ECRHS II) and in 2008-2013 (ECRHS III). Symptoms of non-infectious rhinitis, hay fever and asthma, and smoking habits were reported. Subjects reporting asthma were excluded. COPD was defined as a spirometry ratio of FEV1/FVC < 0.7. A total of 5901 subjects were included. RESULTS: Non-infectious rhinitis was significantly more prevalent in subjects with COPD compared with no COPD (48.9% vs 37.1%, p < 0.001) in ECRHS II (mean age 43) but not in ECHRS III (mean age 54). In the multivariable regression model adjusted for COPD, smoking, age, BMI, and gender, non-infectious rhinitis was associated with COPD in both ECRHS II and III. CONCLUSION: Non-infectious rhinitis was significantly more common in subjects with COPD at a mean age of 43. Ten years later, the association was weaker. The findings indicate that NIR could be associated with the early onset of COPD.

Respiratory polygraphy in children with sleep-disordered breathing.

At-home respiratory polygraphy has been shown to be a reliable substitute for in-laboratory polysomnography in adults for diagnosing obstructive sleep apnea, but this is less well studied in children. One aim of this study was to examine the quality of at-home respiratory polygraphy in children with sleep-disordered breathing and to evaluate the interrater reliability of the results. Another aim was to study whether calibrated respiratory inductance plethysmography (RIP) flow can be used for the scoring of respiratory events when the airflow measurements are unreliable. Children aged 4-10 years, with sleep-disordered breathing, underwent at-home respiratory polygraphy. Of 113 polygraphies, only 46% were of acceptable quality, with missing nasal airflow being the most common problem (40%). The median recorded time with artifact-free signal present in three traces simultaneously was 228 min (0-610 min). Seventeen polygraphy studies were selected for further study. Each study was scored by two independent scorers, with and without the nasal airflow signal present, the latter relying on RIP flow for the scoring of respiratory events. The apnea-hypopnea index (AHI) from the four different measurements was compared using intraclass correlation coefficients (ICC). Comparison of the two scorers showed moderate agreement, with (ICC = 0.66) and without (ICC = 0.53) nasal airflow. One scorer had good agreement between AHI with and without nasal airflow (ICC = 0.81), whereas the other had poor agreement (ICC = 0.12). In conclusion, the scoring of respiratory events based on RIP flow is scorer dependent even for experienced scorers. The nasal airflow signal is frequently missing in paediatric respiratory polygraphies, which limits the usefulness of the method.

Is dental evaluation considered in unilateral maxillary sinusitis? A retrospective case series.

OBJECTIVE: Are patients with symptomatic unilateral maxillary sinusitis sent for a dental evaluation of odontogenic maxillary sinusitis (OMS)? PATIENTS AND METHODS: The medical records of all patients diagnosed with sinusitis at a university Ear-nose and throat (ENT) clinic from 2010 to 2015 were scrutinized for symptomatic unilateral maxillary sinusitis verified on CT. Any dental evaluation was recorded, as well as symptoms of OMS, duration to dental evaluation, diagnosis of OMS and dental treatment. RESULTS: A total of 1338 patients diagnosed with sinusitis were screened; 172 had unilateral maxillary sinusitis and 48% (82/172) OMS. 34% did not have any dental evaluation at all. Patients referred to local specialist dental care waited a median of 11 weeks for evaluation and a median of 15 weeks further for dental treatment. Symptoms more frequently reported in OMS patients were foul smell or taste (43.9% vs 11.1%, p < .0001), purulent rhinorrhea (40% vs 19.1%, p = .015) than non-OMS patients. The OMS group also reported more frequently that they were active smokers (31.7% vs 10%, p = .0005). CONCLUSIONS: OMS was found in 48% of unilateral maxillary sinusitis and one-third of the patients with unilateral maxillary sinusitis had no dental evaluation. Low awareness of OMS could delay diagnosis and treatment.

Hearing-related, health-related quality of life in patients who have undergone otosclerosis surgery: a long-term follow-up study.

OBJECTIVES: The aims of the study were to assess health-related quality of life and hearing-related disability in subjects with otosclerosis 30 years after surgery. DESIGN: An observational study was performed. Medical records were reviewed, a clinical examination as well as audiometric assessments were performed. Generic health-related quality of life was assessed by the SF-36v2 and hearing disability by a shortened version of SSQ (speech spatial and qualities of hearing scale). STUDY SAMPLE: Sixty-five individuals, who had undergone stapedectomy in 1977-79 at a tertiary referral center. RESULTS: Generic health-related quality of life according to SF-36 subscale scores was comparable to that of an age- and sex-matched reference population. The SF-36 mental component summary score (MCS) was, however, significantly better than that of the reference population. The mental and physical summary component scores correlated significantly to hearing disability measured by the SSQ but not to hearing impairment. Hearing disability was displayed in all SSQ sub-scores, especially in more complex listening situations and in the localization of sounds. CONCLUSIONS: This study shows that individuals with otosclerosis, 30 years after surgery, have a good generic health-related quality of life, despite moderate to severe hearing loss and significant hearing disabilities.

A comparative study of fatigue and processing speed in patients with multiple sclerosis treated with natalizumab or rituximab.

Background: Fatigue is the most debilitating symptom in patients with multiple sclerosis (MS). Natalizumab and rituximab are the most used MS disease modifying therapies in Sweden, but comparative data on the effect on fatigue is sparse. Objective: Primary objective was to compare fatigue levels between patients on natalizumab and rituximab. As secondary objective, we assessed processing speed, an attention domain quality, between treatment groups. Method: In this Swedish multicentre cross-sectional study, patients with relapsing-remitting MS and >24 months treatment duration were identified in the Swedish MS-registry. Fatigue was assessed using the Fatigue Scale for Motor and Cognitive functions (FSMC) and processing speed using Symbol Digit Modalities Test (SDMT). Results: 128 patients were enrolled (natalizumab: 56, rituximab: 72). No significant differences in FSMC were found when adjusting for potential confounders (p = 0.936), with age having the biggest impact, correlating with increased fatigue. Individuals on natalizumab performed significantly better on SDMT at cross-section (natalizumab 64.7, rituximab 56.2; p = 0.003), with an improvement from treatment initiation, compared to rituximab (change: natalizumab 8.9, rituximab -1.0; p = 0.002). Conclusion: We found no difference in fatigue levels between natalizumab and rituximab cohorts. Patients treated with natalizumab showed significantly better results on SDMT than patients on rituximab.

Hearing-aid use and benefit: a long-term follow-up in patients undergoing surgery for otosclerosis.

OBJECTIVES: The aims of the study were to assess hearing-aid uptake in patients with otosclerosis 28-30 years after stapedectomy and to evaluate hearing-aid benefit to users. DESIGN: A retrospective study was performed; it included a review of medical records and follow-up 28-30 years after surgery, including audiometry, clinical examination, structured interview, and a validated questionnaire, IOI-HA. STUDY SAMPLE: Sixty-five patients, who had undergone stapedectomy at a tertiary referral center in 1977-79. RESULTS: In 95% of the subjects there was a theoretical need for hearing-aid amplification at follow-up; 46% of the subjects had no hearing aids, while 26% had unilateral and 28% bilateral hearing aids. Hearing sensitivity in the best ear predicted hearing-aid uptake. Of the subjects with a hearing aid, 94% were everyday users and 54% were full-time users (> 8 hours/day). The subjects reported a high level of satisfaction (mean 4.5) and benefit (mean 4.2), but also residual activity limitations (mean 3.1). CONCLUSIONS: The study shows that there is an unmet need for long-term hearing rehabilitation among patients previously undergoing surgery for otosclerosis. The patients who were using hearing aids were generally very satisfied with their hearing aids, but they still reported residual activity limitations.

A comparison of men and women undergoing septoplasty-the Swedish national septoplasty register.

Objective: Men represent more than two-thirds of septoplasty patients in many studies, but differences between men and women in terms of patient selection or outcome are seldom reported. This study aims to investigate whether women undergoing septoplasty differ from men in critical variables before and after surgery, in a large national sample of septoplasties. Design: Cross-sectional register study. Participants: The study includes 2,532 patients from the National Swedish Septoplasty Register undergoing septoplasty with or without additional turbinoplasty on the indication of nasal obstruction in 2014-2019. Patients in the register have not been preselected. Main outcome measures: Preoperative variables and postoperative outcome were compared between men and women. Results: Men accounted for 1,829 (72%) of the patients. There was no significant difference between men and women in severity of self-reported nasal obstruction or type of surgery performed (septoplasty with or without turbinoplasty). Mean postoperative nasal obstruction 12 months after surgery and overall satisfaction with the result were similar. Women, however, reported more complications 12 months postoperatively, while men reported more problems with snoring and obstructive sleep apnea preoperatively. Conclusion: In this large national patient cohort undergoing septoplasty, we found no differences in preoperative nasal obstruction or postoperative patient-rated outcome in men and women undergoing septoplasty, despite the fact that 72% of the patients were men. It thus remains unclear why women are under-represented in septoplasty surgery in this and many other cohorts.

Nasal steroids improve regulation of nasal patency in asthma and mild rhinitis: a randomised, cross-over trial.

An important function of the healthy nose is the ability to adjust nasal patency in response to stimuli such as a change in posture between sitting and supine. We hypothesised that the regulation of nasal patency would be impaired in patients with asthma and mild rhinitis and that it could be improved by reducing nasal inflammation with a topical nasal steroid. This is a randomised, placebo-controlled, double-blind, cross-over study comprising 19 subjects with well-controlled asthma and a history of rhinitis without current treatment. The subjects were randomised to fluticasone propionate aqueous nasal spray (Beconase(®)), 200 µg daily, or placebo (FESS(®) saline nasal spray), for 6 weeks in a cross-over design with a 4-week wash-out between treatments. Nasal patency was measured with acoustic rhinometry, while sitting and supine and with peak nasal inspiratory flow (PNIF). Treatment response was also monitored with spirometry, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Short Form-36 (SF-36), and The Pittsburgh Sleep Quality Index. The minimal cross-sectional area remained unchanged between sitting and supine at baseline and after placebo but after fluticasone propionate there was a significant decrease. PNIF, RQLQ and SF-36 improved after fluticasone propionate, whereas sleep quality did not change. In well-controlled asthma and mild rhinitis, nasal steroid treatment normalised the neurovascular response to posture in the nasal mucosa and improved health-related quality of life. An impaired ability to regulate nasal patency could be a marker of upper airway inflammation in patients with asthma that can be measured non-invasively.

Eosinophilic airway diseases: basic science, clinical manifestations and future challenges.

Eosinophils have a broad range of functions, both homeostatic and pathological, mediated through an array of cell surface receptors and specific secretory granules that promote interactions with their microenvironment. Eosinophil development, differentiation, activation, survival and recruitment are closely regulated by a number of type 2 cytokines, including interleukin (IL)-5, the key driver of eosinophilopoiesis. Evidence shows that type 2 inflammation, driven mainly by interleukin (IL)-4, IL-5 and IL-13, plays an important role in the pathophysiology of eosinophilic airway diseases, including asthma, chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. Several biologic therapies have been developed to suppress type 2 inflammation, namely mepolizumab, reslizumab, benralizumab, dupilumab, omalizumab and tezepelumab. While these therapies have been associated with clinical benefits in a range of eosinophilic diseases, their development has highlighted several challenges and directions for future research. These include the need for further information on disease progression and identification of treatable traits, including clinical characteristics or biomarkers that will improve the prediction of treatment response. The Nordic countries have a long tradition of collaboration using patient registries and Nordic asthma registries provide unique opportunities to address these research questions. One example of such a registry is the NORdic Dataset for aSThmA Research (NORDSTAR), a longitudinal population-based dataset containing all 3.3 million individuals with asthma from four Nordic countries (Denmark, Finland, Norway and Sweden). Large-scale, real-world registry data such as those from Nordic countries may provide important information regarding the progression of eosinophilic asthma, in addition to clinical characteristics or biomarkers that could allow targeted treatment and ensure optimal patient outcomes.

[National recommendations for tracheotomy and tracheostomy care. Consensus for safe tracheostomy care of adult patients]. / Nationella rekommendationer för trakeotomi och trakeostomivård.

This article describes new Swedish guidelines for the care of adult patients having a tracheostomy. A national expert panel of ENT and anaesthesiology specialists appointed by each national specialist association reviewed fatal patient cases involving tracheostomy failure as well as national and international guidelines to produce a "best of practice" document. The main recommendation is that the health care provider has the full responsibility to ensure that the combined surgical competence at the hospital can handle acute airway problems also under difficult anatomical conditions. The distribution of percutaneous and surgical tracheotomy should be weighted to ensure the competence in both.

Altered positional regulation of nasal patency in patients with obstructive sleep apnoea syndrome.

We assessed the regulation of nasal patency supine in subjects with obstructive sleep apnoea syndrome (OSAS) compared to healthy controls. Healthy subjects increase nasal obstruction when changing body position from sitting to supine, possibly due to increased hydrostatic pressure in the head supine. Limited data indicate that this response is altered in patients with OSAS, suggesting that supine nasal patency is actively regulated. This study examined the nasal response to recumbent body position using acoustic rhinometry in OSAS patients and healthy controls. Twenty subjects (16 men and 4 women, mean age 55 +/- 16 years), with diagnosed OSAS [mean apnoea hypopnoea index (AHI) 46 +/- 22 events/h] without nasal obstruction and continuous positive airway pressure (CPAP)-naive, underwent measurement of intra-nasal cross sectional area by acoustic rhinometry at sitting and after 5 min supine. Twenty healthy controls (13 men, 7 women, mean age 35 +/- 9 years) were also included in the study. In the patients with OSAS, the mean minimal cross sectional area (MCA, left + right nasal cavity) was unchanged between sitting (1.18 +/- 0.41 cm(2)) and supine (1.21 +/- 0.35 cm(2), P = 0.5). In the healthy controls, the mean MCA decreased from 1.06 +/- 0.18 to 0.94 +/- 0.21 cm(2) supine, P = 0.01. This study showed that the normal decrease in nasal patency following a change in body position from sitting to supine is absent in patients with OSAS. The results indicate that there is an active regulation of supine nasal patency.

[How to assess the need for new specialists?] / Tjänsteenkät ­ så kan återväxten av specialister i sjukvården säkras - ÖNH-sjukvården visar vägen.

Continuous monitoring of the need to educate specialists is important in the planning of health care resources. In this article, the authors present a questionnaire-based tool that is answered by the heads of Departments of ear, nose and throat (ENT) across Sweden every year. In Stockholm, the movement of patients from university to private ENT has dramatically decreased specialist training in ENT, and this can be seen by the employment survey instrument called ¼Tjänsteenkäten«.

Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study.

STUDY OBJECTIVES: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nasal cavity and paranasal sinuses. Associations between CRS and poor sleep quality have been reported. This 10-year follow-up study investigates possible associations between incident CRS and sleep quality. METHODS: A questionnaire was sent to 16,500 individuals in Sweden, Norway, Denmark, Iceland and Estonia in 2000. It included questions on airway diseases, age, sex, body mass index, smoking habits, comorbidities, education and sleep quality. In 2010, a second questionnaire was sent to the same individuals, with a response rate of 53%. A subgroup of 5,145 individuals without nasal symptoms in 2000 was studied. Multiple logistic regression was performed to examine associations between CRS (defined according to the European position paper on rhinosinusitis and nasal polyps epidemiological criteria) at follow-up and sleep quality, with adjustment for potential confounders. Individuals with the respective sleep problem at baseline were excluded. RESULTS: Over 10 years, 141 (2.7%) of the individuals without nasal symptoms in 2000 had developed CRS. CRS was associated with difficulties inducing sleep (adjusted odds ratio 2.81 [95% CI 1.67-4.70]), difficulties maintaining sleep (2.07 [1.35-3.18]), early morning awakening (3.03 [1.91-4.81]), insomnia (2.21 [1.46-3.35]), excessive daytime sleepiness (2.85 [1.79-4.55]), and snoring (3.31 [2.07-5.31]). Three insomnia symptoms at baseline increased the risk of CRS at follow-up by 5.00 (1.93-12.99). CONCLUSIONS: Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS.

Intranasal Budesonide and Quality of Life in Pediatric Sleep-Disordered Breathing: A Randomized Controlled Trial.

Objective To study the efficacy of budesonide nasal spray on the health-related quality of life and symptoms among children with sleep-disordered breathing. Study Design Randomized, parallel, double-blind, placebo-controlled trial. Setting Tertiary referral center. Subjects and Methods Sixty children (ages, 4-10 years) who were referred because of snoring and/or apneas for >3 months were included between January 2015 and June 2016 and randomized in a double-blind design to treatment with 64 µg/mL of budesonide nasal spray (n = 30) or placebo nasal spray (n = 30) twice daily for 6 weeks. The primary outcome measurement was the change in the mean OSA-18 total score from baseline. Other variables examined were individual OSA-18 domains, a visual analog scale for quality of life, symptoms (snoring, apneas, and nasal obstruction), and adenoid and tonsil size. The trial was investigator initiated and not sponsored by the pharmaceutical industry. Results Fifty-five children completed the trial. An intention-to-treat analysis revealed a significantly greater improvement in the mean OSA-18 total score after treatment with budesonide than placebo (19.5 vs 7.5, P = .0014). Intranasal budesonide also improved 2 OSA-18 domains (sleep disturbance, caregivers' concerns), the visual analog scale score for quality of life, as well as snoring, apneas, and nasal obstruction. No serious adverse events were reported that could be linked to the treatment. Conclusion Among children with sleep-disordered breathing, 6 weeks' treatment with intranasal budesonide significantly improved quality of life and symptoms as compared with placebo nasal spray.