Assessment Of Chronic Rhinosinusitis Research Articles

Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool.

Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment. The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Oxford Level 3.

Rhinosinusitis Quality-of-Life Assessment: A Persian Adaptation and Validation.

Rhinosinusitis involves inflammation within the paranasal sinuses and the nasal mucosa. It is a very common chronic health condition. This paper performs a validation process on the Persian translation of the rhinosinusitis quality-of-life questionnaire (RhinoQOL), for use in clinical assessment of chronic rhinosinusitis (CRS) patients. The Lund-Mackay score is also used widely in assessing CRS, and this study aims to describe its relationship to RhinoQOL. The Persian RhinoQOL adaptation was carried out on 110 CRS patients. A follow-up questionnaire was completed two weeks later. Psychometric properties were determined by statistical analysis (reliability, reproducibility, validity, responsiveness). A total of 45 patients were included for radiologic score calculation. The Spearman's test was used for assessing the correlation between the RhinoQOL scores and Lund-Mackay score. Internal reliability was excellent for the impact scale (Cronbach's alpha=0.92). Cronbach's alpha was 0.63 and 0.55 for frequency and irritation scales, which reflects lower internal consistency values. Temporal stability or Test-retest reliability was excellent across all three scales. ICC was 0.96, 0.97, and 0.99 for RhinoQOL frequency, irritation, and impact scales. No significant correlation was observed between the Lund-Mackay score and RhinoQOL scores in terms of frequency, irritation and impact scales. The Persian version of RhinoQOL appears to be as reliable, valid, and sensitive to change as the English version.

The Role of Diagnostic Nasal Endoscopy and a Computed Tomography Scan (Nose and PNS) in the Assessment of Chronic Rhinosinusitis: A Comparative Evaluation of the Two Techniques

Introduction: The objective components of chronic rhinosinusitis (CRS) diagnosis require confirmatory findings from either diagnostic nasal endoscopy (DNE) or a computed tomography (CT) scan. Chronic rhinosinusitis affects a significant population worldwide, imposing a huge toll on the human economy as well as on quality of life. Thus, it is particularly important to define a cost-effective and easily available diagnostic tool for it. Hence, we have conducted this study with the aim of assessing the effectiveness of DNE in comparison with CT for evaluating CRS. Material and Methods: Eighty participants fulfilling the diagnostic symptom criteria of CRS underwent CTs of their noses and paranasal sinuses (PNS) and DNE. Standard Lund–Mackay and Lund–Kennedy scores were awarded to all participants based on the CT and DNE. A comparative analysis was done. Results: DNE in comparison to CT had 92.31% sensitivity, 73.33% specificity, 93.75% positive predictive value, 68.75% negative predictive value, and 88.75% diagnostic accuracy. Conclusion: We suggest that nasal endoscopy be used as an early diagnostic tool in the clinical assessment of suspected CRS patients (based on the diagnostic symptom criteria). DNE helps to decrease the usage of CT, thereby decreasing cost and radiation exposure. Computed tomography may be added for patients having anatomical defects (affecting endoscopic visualization) or refractory disease, and where surgery has been planned.

A survey on chronic rhinosinusitis: opinions from experts of 50 countries.

Chronic rhinosinusitis (CRS) is a very prevalent inflammatory disease. Treatments vary in different countries. In the present study, we explored the approaches of physicians in 50 countries. In this cross-sectional study, a rhinosinusitis survey (RSS) was completed by Honorary and Corresponding Members (otorhinolaryngologists) of the Italian Society of Rhinology. In 79.1% of the 50 countries, the proportion of patients suffering from CRS was 15%. Nasal symptoms were more intense in winter (46% of countries), and spring and autumn (22%). The most common symptoms were nasal obstruction (86%), postnasal drip (82%) and headache (52%). The most common investigative modalities in the assessment of CRS are paranasal sinus CT, fiberoptic endoscopy, and anterior rhinoscopy. CRS patients were principally treated by otorhinolaryngologists (70%). Medical treatments included nasal corticosteroids (90%), nasal washes (68%), and nasal decongestants (32%). In 88% of countries, more than 50%, or "about 50%", of all patients reported subjective symptom improvement after treatment. In most of the countries, surgery was required by 20-35% of all CRS patients. During post-surgery follow-up, nasal washes (90%), nasal corticosteroids (76%), and systemic antibiotics (32%) were prescribed. In 20-40% of all patients, CRS was associated with nasal polyps. In such patients, the medical treatment options were nasal corticosteroids (90%), systemic corticosteroids (50%), nasal washes (46%), and systemic antibiotics (34%). Treatment of CRS patients varies in different countries. Paranasal sinus CT is the most common investigative modality in the assessment of CRS, and nasal corticosteroids are the first-line treatment, in the absence or presence of nasal polyps.

Diagnostic Accuracy of Cone-Beam Computed Tomography in the Evaluation of Chronic Rhinosinusitis

Introduction: This study assessed the agreement of cone-beam computed tomography (CBCT) scan and sinus endoscopy findings and attempted to find a diagnostic accuracy of CBCT in patients with chronic rhinosinusitis (CRS). Methods: Forty-two patients with CRS referred to the Aria and 22 Bahman Hospitals in Mashhad, Iran, during the year 2011 were included in this cross-sectional study. Paranasal sinus CBCT scanning and endoscopy were performed in all patients. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of CBCT were determined, and the agreement between CBCT and endoscopy findings was evaluated. Results: In most of our findings, except for infundibulum thickening, there was a strong agreement between CBCT and paranasal sinus endoscopy, with a kappa coefficient >0.80 (p < 0.05). The sensitivity, specificity, PPV, NPV, and accuracy of CBCT were >80% for most of the findings, except for infundibulum thickening and septal deviation. Conclusion: CBCT has nearly the same diagnostic accuracy as sinus endoscopy. The accuracy of CBCT scanning is high, and CBCT findings are well correlated with sinus endoscopy findings. Considering its high accuracy and lower costs and radiation doses, CBCT may be a proper alternative method for diagnostic sinus endoscopy in the assessment of CRS in patients with a contraindication for sinus endoscopy.

Correlation between Nasal Symptoms and Nasal Nitric Oxide at Baseline and while Humming.

Background : Chronic rhinosinusitis (CRS) is important in asthma and chronic cough assessment. An accurate diagnosis of CRS based solely on symptoms and nasal endoscopy can be difficult. Sinus CT-imaging is usually recommended in patients with negative rhinoscopy. Nasal nitric oxide (nNO) levels obtained passively and while humming are decreased in sinusitis due to ostiomeatal complex blockage of paranasal sinus gas exchange by inflamed tissue. A nNO measurement is a potential point-of-care test (POCT) for CRS. The SinoNasal Outcome Test (SNOT-20) is a clinical tool to assess symptoms in CRS. Objective : To evaluate if nNO levels provided objective information about CRS that would correlate with individual elements in the SNOT-20 and 6 additional CRS related symptoms. To examine these 26 symptom parameters for related clusters, and test correlation of the clusters with nNO measurements. Methods : In 180 patients, basal and humming nNO level measurements, and 26 symptoms (SNOT-20 plus 6 added items) were collected. Hierarchical cluster analysis was applied to sort the data into clusters. Results : The 26 questions grouped into 5 different clusters. 2 clusters contained questions that were most disease specific for sinonasal diseases in patients referred for subspecialty asthma and chronic cough evaluation. We demonstrated that nNO levels during humming, and the ratio between humming and basal nNO, correlated best with clusters 2 and 4. Conclusion : Baseline and humming nNO measurements provide objective information about CRS. nNO measurements offers the potential of a POCT for objective assessment of CRS in patients presenting to a pulmonary clinic.

Chronic rhinosinusitis: correlation of symptoms with computed tomography scan findings.

IntroductionSymptomatology, nasal endoscopy and Computerised Tomographic (CT) scan have been used to diagnose chronic rhinosinusitis. The value of disease severity score in the assessment of chronic rhinosinusitis has not been well investigated. Hence, this study aims to correlate the pre-operative symptom severity score as well as overall disease severity scoreof patients with chronic rhinosinusitis with CT scan scores.MethodsThis is a prospective study of 60 patients diagnosed clinically with chronic rhinosinusitis. Each patientsubjectively assessed his/her presenting symptoms and severity of disease on a visual analogue scale. The patients had CT scan of the paranasal sinuses which were graded and scored using Lund-Mackay grading system. The correlation study between severity of symptoms/disease severity and CT scores was performed. The level of statistical significance was considered at p < 0.05 and confidence interval at 95%.ResultsAll patients had more than one symptom with mean symptom severity scores highest for nasal discharge and nasal obstruction. There was a significant correlation between CT scores and nasal discharge (r = -0.132; p = 0.03)and nasal obstruction (r = 0.193; p = 0.049). No correlation with other symptoms. There wasno correlation between the overall disease severity scores and the Lund-Mackay CT scores (r = 0.195; p = 0.6).ConclusionThis study showed that CT scan scores can help clinicians to predict severity of symptom for nasal obstruction and discharge but not for other symptoms of chronic rhinosinusitis. However, there was no association of CT score with the overall disease severity score.

Comparison of disease‐specific quality‐of‐life instruments in the assessment of chronic rhinosinusitis

Many disease-specific, quality-of-life (QOL) instruments exist for chronic rhinosinusitis (CRS), resulting in confusion about the best application and use of each instrument. We hypothesized that the most prevalently utilized instruments do not strongly correlate in all domains, but rather act in complementary fashion for QOL assessment. A systematic literature review (MEDLINE) was performed to identify the type and frequency of available CRS-specific QOL instruments. Univariate analyses of the 3 most common instruments (Rhinosinusitis Disability Index [RSDI], Chronic Sinusitis Survey [CSS] and 22-item Sinonasal Outcomes Test [SNOT-22]) were performed using a multi-institutional prospective cohort of sinusitis patients. Systematic literature review found that the SNOT-20 (and its derivatives), RSDI, and CSS are the most commonly utilized CRS-specific QOL instruments. The majority of RSDI domains were weakly or not correlated with the CSS domains (r = 0.097-0.501; p < 0.001). In contrast, the RSDI was highly correlated with the SNOT-22 (r ≥ 0.666; p < 0.001). Patients with asthma and/or allergies reported significantly worse CSS scores (p < 0.001). Comorbidities had no significant impact on RSDI or SNOT-22 responses. Different disease-specific CRS QOL instruments measure different aspects of the patient's experience. The RSDI and SNOT-22 are more sensitive to measuring the emotional impact of CRS, whereas the CSS examines medication use and symptoms. These instruments play complementary roles in the evaluation of CRS treatment outcomes.

Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis – a GA2LEN study

The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic, endoscopic, and radiologic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies, the definition is based on symptoms only. We aimed to assess the reliability and validity of a symptom-based definition of CRS using data from the GA(2) LEN European survey. On two separate occasions, 1700 subjects from 11 centers provided information on symptoms of CRS, allergic rhinitis, and asthma. CRS was defined by the epidemiological EP3OS symptom criteria. The difference in prevalence of CRS between two study points, the standardized absolute repeatability, and the chance-corrected repeatability (kappa) were determined. In two centers, 342 participants underwent nasal endoscopy. The association of symptom-based CRS with endoscopy and self-reported doctor-diagnosed CRS was assessed. There was a decrease in prevalence of CRS between the two study phases, and this was consistent across all centers (-3.0%, 95% CI: -5.0 to -1.0%, I(2) = 0). There was fair to moderate agreement between the two occasions (kappa = 39.6). Symptom-based CRS was significantly associated with positive endoscopy in nonallergic subjects, and with self-reported doctor-diagnosed CRS in all subjects, irrespective of the presence of allergic rhinitis. Our findings suggest that a symptom-based definition of CRS, according to the epidemiological part of the EP3OS criteria, has a moderate reliability over time, is stable between study centers, is not influenced by the presence of allergic rhinitis, and is suitable for the assessment of geographic variation in prevalence of CRS.

The Lund-Mackay staging system for chronic rhinosinusitis: How is it used and what does it predict?

The Lund-Mackay score is widely used in assessment of chronic rhinosinusitis. We aimed to describe its relationship to other measures of pre- and post-treatment health status. Multicenter prospective study of 1840 patients undergoing surgery for chronic rhinosinusitis in the UK. There was no absolute threshold for surgery, but patients with higher Lund-Mackay scores underwent more extensive surgery. There was no correlation between Lund-Mackay and SNOT-22 scores. The Lund-Mackay increased with increasing grade of polyposis. The Lund-Mackay score was associated with symptom reduction (coefficient = 0.24, P = 0.02) complication rates (odds ratio, 1.08, 95%CI 1.06 to 1.1), and revision rates (odds ratio, 1.03, 95% CI 1.001 to 1.06). The Lund-Mackay score measures a different aspect of disease to "subjective" symptom scores. However, it correlates well with other markers of disease severity, the nature of surgery offered, and its outcome. This demonstrates the strengths and limitations of a commonly used staging system.