Development and Validation of the Sinonasal Outcome Test-12.

OBJECTIVES: Quality of life (QoL) questionnaires are widely used in clinical interviews to assess the impact of medical interventions or measure the outcomes of healthcare services. The main aim of such questionnaires is the subjective assessment of health status and its impact on QoL. This study aimed to develop an efficient, short sinonasal disease assessment instrument, the sinonasal outcomes test-12 (SNOT-12), and to compare it with the preexisting SNOT-22. METHODS: This was a two-phase cross-sectional study. The study was performed between June 2019 and February 2020 using the electronic files of the ORL department outpatient clinics at King Fahd University Hospital, affiliated with Imam Abdulrahman Bin Faisal University. The study was performed in 2 phases: an item reduction phase, which resulted in an initial SNOT-12 scale, and a validation phase, using a comparative analysis of the initial SNOT-12 and the SNOT-22. RESULTS: The developed short-form SNOT-12 maintained the 4 latent factors extracted in EFA (nasal, Sleep/extra nasal, psychological, ear/facial). It strongly correlated with SNOT-22 (r = 0.973). It had good construct reliability (0.705-0.901) and validity and a higher discrimination power than the SNOT-22. CONCLUSIONS: The SNOT-12 is a short, valid, and reliable instrument that may prove useful for the initial screening and monitoring of patients with chronic rhinosinusitis.

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.

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.

Cryosurgical Ablation for Treatment of Rhinitis: Two-Year Results of a Prospective Multicenter Study.

OBJECTIVES/HYPOTHESIS: To assess the long-term (12-24 months) safety and effectiveness of cryoablation of the posterior nasal nerve as treatment for chronic rhinitis. STUDY DESIGN: A multicenter, prospective, single-arm clinical study. METHODS: The study was conducted from February 2017 to April 2020. Study endpoints included change from baseline in the reflective Total Nasal Symptom Score (rTNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), physician assessment of improvement using the Clinical Global Impression-Improvement (CGI-I), and the incidence of treatment-related adverse events. RESULTS: Ninety-one participants completed the study through the initial 12-month study period. Sixty-two participants consented to the long-term follow-up with 57 completing the 24-month follow-up. Significant improvements in the total rTNSS were reflected in a median change from baseline of -3.0 or -4.0 at all timepoints (P < .001). Greater than 80.0% of participants achieved the minimum clinically important difference (MCID) of improvement by ≥1 point on the rTNSS at all follow-ups. Total RQLQ scores indicated significant improvement (P < .0001) in quality of life. Over 77% of participants achieved the MCID (≥0.5 points) for the total RQLQ score. According to the CGI-I, ≥83.0% experienced improvement at all but the 12-month visit (61.9%). One participant experienced two treatment-related serious adverse events (epistaxis and retained pledget). A total of 29 nonserious treatment-related AEs were reported in 23 participants; most events were transient and resolved with little to no intervention. CONCLUSIONS: Cryotherapy significantly and clinically improves rhinitis symptoms and quality of life with outcomes that are durable through 24 months after treatment. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1952-1957, 2021.

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.

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.

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.

The impact of bilateral endoscopic inferior turbinoplasty with or without adenoidectomy on the quality of life of children: a retrospective case series study.

BACKGROUND: Inferior turbinoplasty (IT) and adenoidectomy (Ad) are frequently resorted to in children with chronic rhinitis (CR) refractory to medical therapy. The aim of this study is to document the long-term improvement in quality of life (QOL) in children with CR following endoscopic IT with or without Ad. METHODS: A retrospective case series study was conducted. We searched a prospectively kept surgical database for children ≤18 years old who had CR who underwent endoscopic IT with or without Ad between 2009 and 2016 at a tertiary care children's center. Patients with sinonasal pathologies other than CR, had craniofacial syndromes or dysmorphism and had other sinonasal procedures or trauma were excluded. Collected data included demographics, secondary diagnoses, duration of follow-up, and complications of procedures. The Glasgow Children's Benefit Inventory (GCBI) was administered by phone to assess QOL improvement. RESULTS: One hundred sixty-five eligible subjects were identified. Eighty-nine subjects met the inclusion criteria. Data was collected for the 60 subjects that were reached. Forty-two patients had IT only while 18 had IT and Ad. The mean age was 10.7 ± 2.7 years, with 31 males and 29 females. The median duration of follow-up (25th, 75th percentile) was 38.1 months (24.6, 55.8). The median GCBI score (25th, 75th percentile) was 22.9 (6.3, 39.6) revealing an overall positive benefit in all domains. There was only one complication. CONCLUSIONS: This study validates prior findings regarding improvement of QOL and safety of IT with or without Ad for children with CR and indicates it is maintained in the long term.

Nasal nitric oxide in relation to psychiatric status of patients with empty nose syndrome.

BACKGROUND: Although cases of empty nose syndrome (ENS) are not very common, the suffering that ENS causes patient is immense and could be very difficult to imagine. Nasal nitric oxide (nNO) is an airway disease biomarker, and its levels increase after endoscopic sinus surgery. The trend of nNO levels in ENS before and after surgical treatment remains unknown. This study aimed to evaluate the role of nNO in ENS. METHODS: Patients with ENS who received surgical implantation and with chronic hypertrophic rhinitis (CHR) who underwent turbinoplasty and completed at least 1 year of follow-up were prospectively enrolled. nNO measurements and subjective assessments [SinoNasal Outcome Test (SNOT)-22, Beck Depression Inventory (BDI)-II, and Beck Anxiety Inventory (BAI)] were performed preoperatively and at 3, 6, and 12 months postoperatively. RESULTS: We enrolled 19 ENS and 12 CHR patients. nNO levels were significantly lower in the ENS than in the CHR patients before surgical treatment (p < 0.001). nNO levels in the ENS patients significantly increased 3 months after implantation and remained plateaued (p = 0.015). BDI-II and BAI scores significantly improved after surgical treatment for the ENS patients but not for the CHR patients; changes in nNO levels correlated well with improvements in BDI-II and BAI scores (p = 0.025 and 0.035, respectively). CONCLUSIONS: nNO significantly increased at third month after surgical treatment and remained plateaued in ENS patients. This increase correlated with improvements in BDI-II and BAI scores. Therefore, nNO may be important in assessing the psychiatric status of empty nose syndrome.

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.

Seasonal variations in chronic rhinosinusitis symptom burden may be explained by changes in mood.

PURPOSE: There are many year-round modifiers of chronic rhinosinusitis (CRS). However, it is unknown whether there are seasonal variations in the sinonasal symptom burden of CRS. METHODS: This was a retrospective cross-sectional study of sinonasal symptom burden measured using the 22-item Sinonasal Outcome Test (SNOT-22) and its four associated nasal, sleep, ear/facial discomfort and emotional subdomains in 1028 individuals with CRS. The season (winter, spring, summer or fall) when the SNOT-22 was completed was recorded. Regressions, controlling for clinical and demographic characteristics, were performed to seek association between season of the year and SNOT-22 total and subdomain scores. RESULTS: The mean SNOT-22 scores were 37.4 for those individuals completing their SNOT-22 in the fall, 40.5 in the winter, 37.4 in the spring and 36.0 in the summer. There was a statistically significant association between higher SNOT-22 scores and completing the SNOT-22 in the wintertime (adjusted ß = 4.08, 95% CI 0.74-7.42, p = 0.017). When seeking association between season and SNOT-22 subdomain scores, wintertime was associated only with higher emotional (adjusted ß = 0.48, 95% CI 0.14-0.81, p = 0.006) and sleep (adjusted ß = 2.23, 95% CI 0.54-3.91, p = 0.010) subdomain scores. Examining individual SNOT-22 items, these associations were due to more symptoms related to depressed mood ("sad") and psychomotor retardation. CONCLUSION: There are seasonal variations in symptom burden of CRS patients, independent of aeroallergen hypersensitivity, with the greatest increase in baseline CRS symptomatology during the winter. This finding was most strongly associated with increased emotional symptomatology and depressed mood.