Impact of rhinosinusitis in health care delivery: the Quebec experience.

OBJECTIVE: Rhinosinusitis is a common disease affecting 135 per 1,000 population. The cost and the impact on quality of life of this disease are considerable. Health care delivery for a particular disease is evaluated through the health impact of the disease, outcomes of treatments, and their costs. This article reviews our experience with rhinosinusitis and its impact on health, as measured using a generic quality of life instrument, the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36), in a selected patient population. Outcomes of treatments will be introduced, and the economic impact of chronic rhinosinusitis based on a U.S. study will be discussed. MATERIAL AND METHODS: One hundred and ten patients (divided into three subgroups: recurrent acute rhinosinusitis, chronic rhinosinusitis, and nasal polyposis) completed the SF-36 survey on the day of the diagnostic visit in the outpatient sinus clinics of two hospitals. RESULTS: The scores of the SF-36, in chronic rhinosinusitis, are compared with the normative values of a healthy U.S. population showing statistically significant differences in seven of eight domains. A comparison of the scores of chronic rhinosinusitis with a U.S. study on chronic rhinosinusitis shows statistically significant differences in five of eight domains. A comparison of the scores in the three diagnostic subgroups shows a statistical significance in two domains: bodily pain and vitality are more affected in recurrent acute and chronic rhinosinusitis. CONCLUSIONS: Chronic rhinosinusitis affects the quality of life of patients with rhinosinusitis and represents an important health burden. Some differences are noted with the U.S. chronic rhinosinusitis population. Recurrent acute and chronic rhinosinusitis seem to have more impact on vitality and bodily pain than nasal polyposis.

Otologic manifestations in congenital velopharyngeal insufficiency.

A study of ear disease in children with congenital velopharyngeal insufficiency (VPI) was undertaken. A retrospective chart analysis of 80 cases of VPI formed the basis of this review. Thirty-seven percent of the children had evidence of middle ear disease, with middle ear effusion and recurrent otitis media being the most frequent findings. Thirty-one percent had abnormal audiograms, with 20% having a conductive or mixed hearing loss. Overall, 46% of the children had otologic manifestations, indicating the need for the pediatrician and the otolaryngologist together to be actively involved in the evaluation and treatment of this group of children, starting in early infancy.