Sino-Nasal Outcome Test Research Articles

Impact of nasal modifications on sinonasal function after maxillomandibular advancement for obstructive sleep apnea

PurposeTo assess sinonasal function after preservation maxillomandibular advancement (MMA), as initial reports have shown it may decrease postoperatively.MethodsThis prospective study was performed at a tertiary referral center starting January 2023. MMA was performed with previously published nasal modifications to help mitigate negative sinonasal outcomes. Sino-nasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Survey (NOSE) were collected preoperatively, and one and three months postoperatively. Repeated measures ANOVAs with a Bonferroni adjustment were performed for total score, total sinonasal score (sum of questions 1–12), and each symptom. Both p-values and partial eta squared (np2) were reported.ResultsTwenty patients were included. Median age was 50.7 years (range 31–65), with 20.0% being female. Preoperative AHI (65.1 ± 28.9) and SpO2 Nadir (78.0% [69.0–82.0]) improved to 12.1 ± 12.1 and 86.0 ± 3.2%. NOSE significantly decreased at one month (55.9 ± 28.4 vs. 8.11 ± 12.0, p < 0.001). Total score and total sinonasal scores significantly decreased postoperatively (49.0 ± 21.6 vs. 18.1 ± 17.4 vs. 12.5 ± 14.1, p < 0.001; 17.3 ± 12.5 vs. 9.2 ± 9.3 vs. 6.3 ± 7.3, p = 0.003) with MMA having large effects on both variables (np2=0.72 and 0.35, respectively). MMA had large significant effects on improvement in need to blow nose, nasal blockage, sneezing, runny nose, cough, post-nasal discharge, dizziness, and ear pain at one and three months postoperatively. Facial pain/pressure significantly worsened at one-month but then improved to baseline at three months postoperatively ((1.2 ± 1.4 vs. 1.9 ± 1.5 vs. 1.2 ± 1.4, p = 0.026).ConclusionPatients who underwent preservation MMA did not show evidence of worsening sinonasal function, with some evidence that sinonasal function may improve after MMA at three months postoperatively. Long-term follow-up with more patients is needed to support these findings.

Septoplasty versus non-surgical management for deviated nasal septum: a systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of septoplasty versus non-surgical management for patients experiencing nasal obstruction due to deviated nasal septum (DNS). We conducted a comprehensive search of PubMed, Scopus, Embase, Web of Science, Cochrane Library, Clinicaltrials.gov, ICTRP, and ISRCTN for relevant RCTs. The primary outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-22), Peak Nasal Inspiratory Flow (PNIF), surgical complications, and quality of life. Data were synthesized using RevMan 5.4 and STATA 18, with effect estimates presented as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). The study protocol was registered with PROSPERO (ID: CRD42024538373). Our search identified 537 studies, of which 3 RCTs involving 721 participants met the inclusion criteria. The meta-analysis revealed that septoplasty significantly improved NOSE and SNOT-22 scores compared to non-surgical interventions at 6 and 12 months of follow-up, despite no notable differences at 3 months post-treatment. No significant difference was observed regarding nasal flow assessed by PNIF. The rate of complications was low, ranging from 0.31% (revision rate) to 4.12% (bleeding and infection rates). Additionally, our qualitative synthesis showed an improvement in the quality of life at 6 and 12 months in the septoplasty group compared with the non-surgical group. This systematic review and meta-analysis of 721 patients revealed the efficacy of septoplasty, with or without turbinate surgery, in improving nasal obstruction symptoms at 6 and 12 months. Additionally, septoplasty consists of a relatively low rate of complications such as bleeding, infection, and septal perforation. Furthermore, a low revision rate was found. Septoplasty improved the quality of life, especially after 6 and 12 months. However, our findings should be interpreted with caution, and further research is needed to consolidate our results.

Real-world effectiveness of dupilumab in a European cohort of CRSwNP (CHRINOSOR)

Pivotal studies with dupilumab demonstrated clinically relevant improvements in nasal polyp score, symptom score, and quality-of-life score in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). We evaluated the effectiveness of dupilumab in a large-scale CRSwNP cohort from 6 European tertiary-care centers. Nasal polyp score, Sinonasal Outcome Test 22 score, visual analog scale for total sinus symptoms, loss of smell, and nasal blockage, and Asthma Control Test (ACT) score were collected from hospital records and assessed at baseline and again at 24 and 52 weeks' treatment with dupilumab in CRSwNP patients. Treatment effectiveness was evaluated in relation to demographic and lifestyle factors, sinus surgery history, presence of comorbidities, and blood eosinophil counts (BEC). Treatment response was evaluated according to European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) 2021 criteria. All patient outcomes improved at 24 and 52 weeks' treatment compared to baseline. Dupilumab showed effectiveness independent of age, sex, body mass index, smoking status, prior sinus surgery, presence of asthma, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, allergy, or baseline BEC. Atotal of 92.5% and 94.4% showed an improvement in at least 1 EUFOREA criterion at 24 and 52 weeks, respectively; 54.4% and 68.2% metall 4 of the more stringent EUFOREA criteria at 24 and 52 weeks, respectively. Real-world evaluation of dupilumab effectiveness demonstrates a robust and sustained response in at least two thirds of patients at 52 weeks' treatment. Favorable treatment response was independent of the number of sinus surgery procedures, major comorbidities, or baseline systemic levels of type 2 inflammation.

Multi-Institutional Comparison of Quality of Life Between Open Versus Endoscopic Skull Base Approaches.

The primary objective of this prospective review was to compare quality of life between patients undergoing endoscopic and open skull base approaches. Prospective Review. Five centers recruited consecutive patients treated surgically for skull base neoplasms between 2012 to 2018. The Skull Base Inventory (SBI), Anterior Skull Base (ASB), and Sinonasal Outcome Test (SNOT-22) were administered up to 12 months post-operatively. Mean change from baseline scores were compared with univariable and multivariable analyses. A total of 180 patients were included: 108 (60%) F and 72 (40%) M, of whom 126 (70%) underwent endoscopic and 54 (30%) underwent open approaches. Patients undergoing endoscopic approaches were more likely to have sellar or clival pathology (68 vs. 15%, p < 0.001). Those undergoing endoscopic approaches had better disease-specific quality of life at one year using the SBI and ASB (mean change from baseline = 7.2 vs. 0.69, p = 0.004; 5.8 vs. -1.1, p = 0.002), respectively. On multivariable analysis, endoscopic approach was associated with greater improvement in overall quality of life (mean difference in change scores from baseline = 6.5, p = 0.009), as well as endocrine (mean difference = 8.3, p = 0.011), neurologic (mean difference = 8.3, p = 0.012), visual (mean difference = 7.9; p = 0.032), financial (mean difference = 9.7, p = 0.03), and spiritual domain scores (mean difference = 4.0, p = 0.035). Subgroup analyses of pituitary and non-pituitary histopathologies demonstrated trends towards greater quality of life at 1-year compared to baseline in the endoscopic approach compared to the open group. Endoscopic approaches are associated with better quality of life compared to open approaches. However, baseline differences in histopathology between the group limit the direct comparison of the open and endoscopic approaches. Future studies with larger and more homogenous samples are required. Level IV evidence.

Long-term effects of dupilumab on chronic rhinosinusitis with nasal polyps: A step towards clinical remission.

Clinical remission, defined as the absence of disease activity and symptoms, is an emerging goal in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). This study aimed to evaluate the long-term effects of dupilumab on patients with CRSwNP, with or without asthma, and explore the potential for achieving clinical remission. A two-year prospective study was conducted on 109 patients with CRSwNP, with or without asthma, who were eligible for dupilumab as an add-on therapy. Comprehensive assessments, including clinical, laboratory, and radiological evaluations, were performed before and after treatment. Clinical remission of CRSwNP was defined as 12 months of dupilumab treatment, no exacerbations requiring oral corticosteroids (OCS), no need for nasal sinus operation, no anosmia or hyposmia, a Sino-Nasal Outcome Test (SNOT-22) score under 20, and a Lund-Mackay score (LMS) below 10. For those with comorbid asthma, clinical remission was defined as an asthma control test (ACT) score of 19 or higher, no asthma exacerbations, and no need for OCS. Dupilumab significantly improved CRSwNP outcomes in both groups, including SNOT-22 scores, nasal polyp size (LMS), and anosmia/hyposmia. Comorbid asthma was highly prevalent (79.8%), and patients with asthma had significantly larger nasal polyps, both before and after dupilumab therapy, despite similar symptom improvement. Higher fractional exhaled nitric oxide (FeNO) and blood eosinophil count (BEC) levels, along with anosmia/hyposmia, predicted larger polyp size. Dupilumab also significantly improved asthma outcomes, increasing forced expiratory volume in 1s (FEV1) and decreasing FeNO. Clinical remission was achieved in 11% of patients, with a slightly lower rate in those with asthma (7.3%). Dupilumab treatment can achieve clinical remission in CRSwNP. However, comorbid asthma appears to reduce the likelihood of remission and is associated with larger nasal polyps, even with similar symptom improvement. Asthma may independently influence polyp development, potentially impacting long-term outcomes in CRSwNP.

The effect of allergen immunotherapy in patients with central compartment atopic disease post-surgery.

To assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post-surgery. A retrospective cohort of surgically treated, HDM-sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22-item sino-nasal outcome test (SNOT-22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin-exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell×109/L), tissue eosinophilia (%>100/HPF), and serum IgE (kU/L) were also recorded. Eighty-six CCAD patients were assessed (41±14yrs, 64% female). AIT was applied in 37% (n=32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p=0.02) in the AIT group. At 12 months post-surgery, the AIT group has less MT edema (%≥diffuse 15.6 vs. 52.9, p<0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (%≥4/week, 37.5 vs. 79.6%, p<0.01). The rhinologic symptoms were similar (21.1±17.1 vs. 20.1±21.6, p=0.83). Surgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de-escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation.

Psychological burden in patients with sellar masses under conservative and surgical management

The aim of this study was to investigate the level of distress and the quality of life of operated and non-operated patients with pituitary tumors. Patients who presented to a neurosurgical center and two endocrinological services for outpatient follow-up after surgical treatment, as well as those under medical therapy or radiological follow-up without treatment, were invited to participate in the study. Sociodemographic, health-related quality of life and clinical data were assessed. Psychosocial factors were measured using the Distress Thermometer (DT), the Hospital Anxiety and Depression Scale (HADS), the Short Form (SF-36), and the Sino-nasal outcome test (SNOT). Thirty-two postoperative patients and thirty conservatively managed patients (n = 21 under medical treatment, n = 9 watch and wait), mean age 53, SD 19; 56% female participated in the study. Prolactinomas (35%) and non-functioning pituitary adenomas (21%) were the most common findings. There were no significant differences between conservative and operative groups in mean DT score (4.7 (SD 2.45) vs. 4.9 (SD 3.0), p = 0.61), HADS anxiety score (6.4 (SD 3.9) vs. 6.0 (SD 4.3), p = 0.76) or depression score (5.7 (SD 4.8) vs. 4.6 (SD 3.6), p = 0.50). For patients with ACTH-producing adenomas, the mean anxiety score was significantly higher (10.3 (SD 1.9) vs. 5.9 (SD 4.0), p = 0.03). The SNOT score correlated significantly with the DT, HADS-A, and HADS-D scores and therefore was associated with higher psychological distress. The level of self-reported distress in patients with sellar processes was not associated with a specific treatment strategy. ACTH-producing adenomas and manifest nasal symptoms were associated with higher psychological distress.

Exploring the Link Between Resilience and Disease Severity in Chronic Rhinosinusitis With Nasal Polyps.

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly affects patients' quality of life, impacting both physical and psychological well-being. This study investigated the potential role of resilience in coping with CRSwNP and its relationship to disease severity and cellular proliferation. Methodology Between July 1, 2021, and June 30, 2022, 30 patients diagnosed with CRSwNP were enrolled in a study at Cardiomed Hospital in Cluj-Napoca, Romania. Resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC), while disease severity was evaluated through patient-reported outcomes (Sino-Nasal Outcome Test (SNOT-22)) and objective measures (Lund-Mackay score). Ki-67 expression was analyzed as a marker of cellular proliferation within nasal polyps. Results No significant correlation was observed between resilience and either SNOT-22 scores or Ki-67 expression. However, a strong positive correlation was found between SNOT-22 scores and Lund-Mackay scores, indicating that patients with more severe symptoms also exhibited greater objective disease burden. In addition, a moderate positive correlation was identified between Ki-67 expression and Lund-Mackay scores, suggesting a potential link between cellular proliferation and disease severity. Conclusion These findings suggest that resilience may not directly influence symptom severity or cellular proliferation in CRSwNP. Further research with larger sample sizes and longitudinal designs is needed to elucidate the complex interplay between resilience, disease pathophysiology, and patient outcomes in CRSwNP. This will ultimately inform the development of more targeted and effective interventions to improve the quality of life for individuals with this chronic condition.

The proof of the pudding is in the eating: real-life intra- and extrapulmonary impact of elexacaftor/tezacaftor/ivacaftor.

Elexacaftor/tezacaftor/ivacaftor (ETI) has shown significant improvements in pulmonary and nutritional status in persons with cystic fibrosis (pwCF). Less is known about the extrapulmonary impact of ETI and effects on airway microbiology, lung clearance index (LCI) and fraction of exhaled nitric oxide (FeNO). A multicentre prospective observational trial, including 79 pwCF ≥ 18 years eligible for ETI. Assessments were done at the initiation of, and 3 and 6 months into treatment with ETI. Outcomes included forced expiratory volume in 1 second (FEV1), LCI, FeNO, sputum or cough swab culture, body mass index (BMI), cystic fibrosis questionnaire-revised respiratory domain (CFQ-R RD), sinonasal outcome test-22 (SNOT-22), general anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), fecal elastase-1 (FE-1), adherence to baseline therapies, exacerbation rate and adverse events. Our cohort included 79 pwCF (31±11(SD) years) with a baseline ppFEV1 of 68±23. Forty-two (53%) pwCF were previously treated with a CFTR modulator. In the entire study group, there were significant improvements from baseline in ppFEV1, LCI, FeNO, annualized exacerbation rate, BMI, CFQ-R RD and SNOT-22 (p<0.05 for all). Airway culture positivity for methicillin-susceptible Staphylococcus aureus and Pseudomonas aeruginosa also decreased during the study period. There was no significant change in FE-1, GAD-7 or PHQ-9. Adherence to dornase alfa and hypertonic saline decreased. ETI treatment led to significant improvements in respiratory and nutritional status, alongside a decrease in adherence to chronic supportive therapies. We did not observe any significant changes in exocrine pancreas function or in questionnaire scores for depression and anxiety.

Added Sinonasal Morbidity of Transpterygoid Approach versus Transsphenoidal Approach: A Case-Controlled Analysis

Abstract Background The transpterygoid approach is often used alongside the transsphenoidal approach in endoscopic endonasal skull base surgery to access lateral skull base regions. This study investigates the sinonasal morbidity associated with this combined approach. Methods We conducted a retrospective analysis of 70 adult patients who underwent either transsphenoidal (TS) or transsphenoidal plus transpterygoid (TS + TP) approaches at a tertiary academic hospital from 2018 to 2023. Sinonasal quality of life was measured using the Sinonasal Outcome Test (SNOT-22) at preoperative, 2-week, 6-week, and 12-week postoperative evaluations. Results Both cohorts exhibited a significant increase in SNOT-22 scores at 2 weeks postoperatively (TS: mean increase of 8.5, p = 0.020; TS + TP: mean increase of 12.3, p &lt; 0.001), which normalized by 6 and 12 weeks (TS: p = 0.587 and p = 0.987, respectively; TS + TP: p = 0.378 and p = 0.220, respectively). There were no statistically significant differences in sinonasal morbidity between the TS and TS + TP cohorts at any time point. Middle turbinate (MT) sacrifice was associated with higher SNOT-22 scores (B = 12.559, p = 0.035), indicating worsened sinonasal outcomes. Conclusion The transpterygoid approach, when added to the transsphenoidal approach, does not increase long-term sinonasal morbidity. This suggests that the combined approach is a viable option for achieving broader surgical exposure without compromising sinonasal quality of life in the long term. Further studies with extended follow-up are needed to confirm these findings and explore additional quality of life metrics.

Neck pain associated with headache attributed to rhinosinusitis: an observational study

ABSTRACT Background Neck pain is common among people with headache, including migraines, tension headache, and cervicogenic headache. Neck pain has also been associated with self-reported sinus headache in individuals who were not formally diagnosed with headache attributed to rhinosinusitis (HAR). Neck pain, in individuals diagnosed with HAR according to the International Classification of Headache Disorders, has not been investigated. Objective The primary objective of this study was to compare the report of neck pain in people with and without HAR. A secondary purpose was to compare measures of cervical musculoskeletal dysfunction between groups. Methods This was an observational study. There were 80 total participants, age and sex-matched with 40 per group. HAR group participants completed the Headache Impact Test, Sino-Nasal Outcome Test-22, Neck Disability Index (NDI), and Visual Analog Scale Score (VASS) to rate headache. All participants underwent examination of neck range of motion, neck muscle endurance, and segmental examination. Results There were significant between-group differences for reported neck pain (82.5% in HAR group; 22.5% in control group, p < .001) and NDI score (mean difference [95% CI] = 15.7 [11.1, 20.2], p < .001). There was a moderate and significant positive correlation between HAR and segmental dysfunction in the upper cervical spine (O-C3) (0.425, p < .001) but not the lower cervical spine. Conclusion Neck pain may be associated with HAR, and patients perceive this neck pain as impacting their quality of life. Upper cervical segmental dysfunction was common and significantly different in the HAR group. Causation of both the subjective and objective findings remains unclear.

Persistent Eosinophilic Inflammation Is Not a Feature of Type 2 CRS Patients Failing Anti-IL-5R Therapy and Requiring Class Switching to Anti-IL-4/13.

Type 2 inflammation dominates eosinophilic chronic rhinosinusitis (eCRS) and adult onset asthma. IL-4, -5, and -13 are prominent disease mediators. Disease control can be achieved with biologic therapies. However, despite some patients entering remission, others experience poor control. We aimed to describe eCRS patients treated with anti-IL-5R antibody (benralizumab) and assess characteristics between responders and those requiring class switching to anti-IL-4/13R (dupilumab). A retrospective cohort study was performed on consecutive adult patients with eCRS and asthma who had commenced benralizumab. Disease control was defined as controlled or poorly controlled (EPOS2020 partly control/uncontrolled). Poorly controlled patients were switched to dupilumab. Baseline and post-IL-5R characteristics including age, sex, 22-item Sinonasal Outcome Test (SNOT-22), Asthma Control Questionnaire (ACQ) score, and serum/tissue eosinophilia were assessed. Disease control post-class switching was reassessed. Factors predicting poorly controlled disease on anti-IL-5R therapy were sought. Fifty patients were assessed (51.44 ± 12.73 years, 56% female). Poorly controlled disease on anti-IL-5R requiring class switch to dupilumab was seen in 42%. Poorly controlled patients were younger (46.14 ± 10.76 vs. 55.28 ± 12.83 years, p = 0.01) with higher baseline SNOT-22 (61.42 ± 19.19 vs. 42.32 ± 21.55, p < 0.01). Baseline ACQ scores and eosinophil count (0.78 ± 0.49 vs. 0.62 ± 0.34×109cells/L, p = 0.23) and were similar between groups. In the poorly controlled patients on anti-IL-5R therapy, eosinophilia had reduced in both serum (0.78 ± 0.5 vs. 0.02 ± 0.1×109cells/L, p < 0.01) and tissue (>100 cells/HPF: 100% vs. 29%, p = 0.01). Class switching resulted in disease control for 65%. Neither eosinophilia nor its reduction predicted a non-responder group to anti-IL-5R therapy. While the eosinophil population may be a good marker for the CRS phenotype seen in nasal polyps, it is unlikely to be the cell population driving the disease process.

Deep Learning-Derived Quantitative Scores for Chronic Rhinosinusitis Assessment: Correlation With Quality of Life Outcomes.

Computed tomography (CT) plays a crucial role in assessing chronic rhinosinusitis, but lacks objective quantifiable indicators. This study aimed to use deep learning for automated sinus segmentation to generate distinct quantitative scores and explore their correlations with disease-specific quality of life. From July 2021 to August 2022, 445 CT data were collected from 2 medical centers. A deep learning model based on nnU-Net was trained for automatic sinus segmentation and internally validated using 300 cases. The remaining 145 cases were split into an external testing set (74 cases) and an independent testing set (71 cases). Two quantitative scores, the quantitative Lund-MacKay score and the quantitative opacification score (QOS), were derived from the segmentation results. The quantitative scores' efficacy was assessed by comparing them with the Lund-MacKay score (LMS), the 22-item Sinonasal Outcome Test score (SNOT-22), and other clinical variables through correlation analyses. Furthermore, the relationship between quantitative scores and postoperative quality of life improvement was explored using single-factor logistic regression. The segmentation model achieved average Dice similarity coefficients of 0.993, 0.978, 0.958, and 0.871 for the training, validation, external testing, and independent testing sets, respectively. Both quantitative scores significantly correlated with the LMS (rho = 0.87 and rho = 0.70, P < .001). Neither score correlated with the total SNOT-22 score, although the modified QOS showed significant correlations with the nasal and sleep subdomains (rho = 0.26 and rho = 0.27, P < .05). No significant association was found between quantitative score and postoperative improvement in quality of life. Deep learning enables the automated segmentation of sinuses on CT scans, producing quantitative scores of sinus opacification. These automatic quantitative scores may serve as tools for chronic rhinosinusitis assessment.

Long-Term Effectiveness of Dupilumab in Severe Uncontrolled Chronic Rhinosinusitis with Nasal Polyps: A Multicenter Retrospective Study.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex immunological disease associated with significant morbidity and reduced health-related quality of life. Dupilumab is an anti-T2-inflammatory biological drug registered for chronic rhinosinusitis with nasal polyps, indicated by integrated care pathways when optimal medico-surgical treatment yields insufficient control of sinonasal symptoms. The purpose of this study was to confirm the long-term efficacy of dupilumab in the treatment of severe uncontrolled CRSwNP. Multicentric data collection of patients with severe uncontrolled CRSwNP treated with Dupilumab was retrospectively performed. Mixed Model Anova test was used to evaluate the effect of the biological therapy in the improvement of nasal polyp score and quality of life measured with Sinonasal Outcome Test-22 (SNOT-22) and visual analog scale (VAS) scores. The study showed a statistically significant and progressive improvement in the Nasal Polyp Score with a decrease from a median baseline value of 6 (IQR 5-6) to 0 (IQR 0-2) at 24 months. Furtherly, optimal results were found for SNOT-22 scores from baseline (62 ± 19) to 6 months (15± 11), with further variations on each successive timepoint remaining below the minimal clinically important difference. VAS scores of nasal obstruction, rhinorrhea, sleep disorders, and craniofacial pain, demonstrated consistent and significant improvements over time until one year of treatment, confirming substantial relief for the most pertinent symptoms of the condition. The results of this study show high therapeutic efficacy and safety of dupilumab for severe CRswNP particularly in the first 6-12 months, with sustained benefits up to 24 months.

Evaluation of the Patient Global Impression of Symptom Severity (PGISS) Score as a Subjective and Objective Measure of Disease Activity in Chronic Rhinosinusitis.

The Sino-nasal Outcome Test (SNOT-22) is a 22-question survey that is utilized to evaluate health-related quality of life of patients with chronic rhinosinusitis (CRS). The Patient Global Impression Symptom Severity (PGISS) is a similar yet versatile instrument that combines features of both a Likert scale and a visual analog to assess symptom severity in CRS patients. While previous studies have evaluated the validity of SNOT-22 as an instrument to measure CRS patients' symptom severity, no studies have evaluated PGISS scale's ability to evaluate and guide treatment plans for CRS patients. The primary objective of this study was to analyze the clinical utility of PGISS in assessing subjective symptom severity and objective disease status in CRS patients. We additionally aimed to investigate if PGISS scores could serve as predictors for treatment strategies in CRS patients. Electronic medical records of CRS patients were retrospectively reviewed between January 2020 and January 2021 from Eastern Virginia Medical School and Sentara Healthcare. Information on demographics, objective disease metrics, treatment, and labs were collected. Statistical analyses were conducted using SAS 9.4 software. A total of 150 patients were included in our study. A statistically significant positive correlation was found between PGISS and SNOT-22 scores (r(131) = 0.701, P < .0001). Patients with moderate to severe PGISS scores had significantly higher odds of changing their treatment course (odds ratio [OR] = 6.813, P = .001, and OR = 5.491, P = .018, respectively). Additionally, patients with severe PGISS scores had decreased odds of receiving biological intervention (OR = 0.048, P = .043), but they had considerably higher odds of pursuing surgery (OR = 15.939, P = .046). No significant associations were seen between PGISS scores and receiving topical steroids, systematic steroids, nonsteroidal medical treatment, or imaging interventions (P > .05). Clinicians may consider using the PGISS scale as an alternative method to the SNOT-22 to evaluate subjective symptom severity and guide treatment plans for patients with CRS.

Patient Factors Influence Minimal Clinically Important Difference for the SNOT‐22 in Medically Treated Chronic Rhinosinusitis

ABSTRACTBackgroundThe present study explores the effect of sociodemographics and comorbidities on the calculated minimal clinically important difference (MCID) for 22‐item Sinonasal Outcome Test (SNOT‐22) scores in patients with medically treated chronic rhinosinusitis (CRS). The importance of delineating a threshold to indicate clinically meaningful changes perceived by a patient is well acknowledged, yet the influence of patient‐specific factors on MCID has not been fully elucidated.MethodsPatients with CRS (n = 221) presenting to a tertiary care practice reported their change in disease burden with anchor questions following CRS‐directed medical treatment. Baseline sociodemographics, pertinent history, and comorbid conditions, as well as pre‐ and post‐treatment SNOT‐22 scores were also collected. Adjusted logistic regression was utilized to determine the factors influencing MCID.ResultsAmong the 221 patients, 43.9% (n = 97) reported improvement following medical treatment. Gender, education level, depression, and migraine were identified as significant factors influencing perceived improvement. Our predictive model, incorporating these variables, achieved an area under the receiver operating characteristic curve of 0.818 (95% confidence interval [CI] = 0.762, 0.875), with a sensitivity of 74.4% and specificity of 77.9%. Changes in SNOT‐22 scores were not strongly associated with perceived improvement in patients with depression (odds ratio [OR] = 1.06; 95% CI = 0.98, 1.14; p = 0.140). Conversely, patients with migraines perceived more pronounced improvements or deteriorations at the extremes of SNOT‐22 score changes (OR = 0.84; 95% CI = 0.76, 0.93; p = 0.001).ConclusionOur findings underscore the substantial impact of patient‐specific sociodemographics and comorbidities on the calculation of MCID values for the SNOT‐22. This study advances our understanding of variability in MCID and demonstrates the complex milieu of factors affecting patients’ perceived clinical outcomes.

Treatment Decision-Making Among Chinese Americans With Chronic Rhinosinusitis.

There has been limited research on the influence of race and ethnicity on treatment decision-making for chronic rhinosinusitis (CRS). This prospective study aims to investigate potential factors linked to treatment modality choice among patients with medically refractory CRS, distinguishing between Chinese American and non-Chinese American patients. CRS patients with persistent symptoms despite prior medical treatment were prospectively enrolled. These patients chose either to continue medical treatment or to undergo endoscopic sinus surgery (ESS) to alleviate CRS symptoms. Demographic and clinical characteristics were compared using bivariate analysis. The association between ethnicity and treatment modality choice was assessed using multivariable logistic regression. Among the 134 patients (29.1% Chinese Americans) included, 79 patients (59.0%) elected to undergo ESS. No significant differences in demographics, nasal polyp status, comorbidities, Sinonasal Outcome Test (SNOT-22), Lund-Mackay, or modified Lund-Kennedy scores were found between the treatment groups. After adjusting for age, income, and SNOT-22 score, non-Chinese American patients were more inclined to select ESS (OR = 7.92; 95% CI: 2.95-21.28; p < 0.001) as opposed to Chinese American patients. Chinese American patients who underwent ESS had a clinically significant improvement in SNOT-22 scores at 1 month (-11.29 points) and 3 months (-16.29 points) postoperatively. Chinese American patients with refractory CRS are less likely to opt for ESS compared to non-Chinese American patients. Surgical treatment is effective in improving quality of life, as measured by the SNOT-22, among Chinese American CRS patients. Further investigations are warranted to identify factors contributing to surgical hesitancy. 3 Laryngoscope, 2024.

The Quality of Life Assessment With Sinonasal Outcome Test (SNOT-22) in Patients Undergoing Nasal Functional Surgery: Does Turbinate Surgery Influence Outcomes?

Objective This study aimed to assess the improvement of the quality of life (QoL) through theSinonasal Outcome Test (SNOT-22) questionnaire among patients undergoing septoplasty or septorhinoplasty with and without turbinoplasty and the possible influence of age and sex. Methods We conducted an observational, analytical, prospective cohort study, between 2013 and 2016, involving 99 patients diagnosed with nasal obstruction due to septal deviation and turbinate hypertrophy. The diagnosis, degree of obstruction, sex, and age of the patients were analyzed. Four types of surgery were performed: septoplasty (S), septorhinoplasty (SRP), S plus turbinoplasty (T), and SRP plus T.The QoLwas measured using the SNOT-22 questionnaire, before surgery and four months later.The sum of the scores obtained for each of the 22 indicators was calculated, as well as the differences in these values before and after surgery. Shapiro-Wilk normality tests, boxplot charts, t-tests, paired t-tests, and Kruskal-Wallis tests were used to compare the SNOT-22 parameters and covariables. We applied the Poissonmultiple regression model to adjust for differences linked to patients' age and sex. Results Most of the patients in our cohort were male. The average SNOT-22 score pre and post-test were 53.59 ± 18.58 and 8.46 ± 9.90 (p = 0.00001), respectively; the differences were significant for each studied surgery. The differences in QoL were significant for each studied surgery and the difference between preand post-surgery scores was greater for procedures that included turbinoplasty. The comparison between the procedures involving S aloneversus S+T reached a significance level (p = 0.053). In the analysis of the different subcomponents of QoL in SNOT-22,sleep function showed the greatest improvement after S+T surgery. The multivariable Poisson regression model revealed that the biggest difference before and after surgery was related to female gender vs. males, and S+T surgeries vs. S-only surgery Conclusions The SNOT-22 questionnaire proved to be useful in assessing the improvement in QoL after nasal surgery. Both septoplasty and functional septorhinoplasty enhanceQoL. However, septoplasty combined with turbinoplasty (S+T) results in greater improvements in QoL and sleep functionregardless of age, with the most significant improvement observed in women.

Validation of the Sino-Nasal Outcome Test-25 (SNOT-25) measure for patients with nasal septal perforation.

Nasal septal perforations (NSPs) are a common referral to specialist rhinology practice. A wide range of management options have been described but to be able to offer the most effective treatment modalities to our patients we must be able to capture quantitative data on patient symptom burden accurately and robustly.

Mepolizumab in chronic rhinosinusitis with nasal polyps: Real life data in a multicentric Sicilian experience.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by a type 2 pattern of inflammation. Mepolizumab was approved for the treatment of CRSwNP in 2021. However, there is a lack of real-life studies. This work aimed to evaluate the effectiveness and safety profile of Mepolizumab during the first year of treatment in a real-life setting. A multicentric observational cohort study was carried out. A total of 67 patients were enrolled in the Otorhinolaryngology Unit of the three University Hospitals and considered for Mepolizumab therapy. All recorder characteristics were age (at the first Mepolizumab application visit), sex, smoke habits, previous local and systemic corticosteroid therapy, history of endoscopic sinus surgery, number of previous endoscopic sinus surgery, concomitant asthma, history of an allergic condition, immunoglobulin E (IgE), allergy to nonsteroidal anti-inflammatory drugs (NSAIDs), Aspirin Exacerbated Respiratory Disease (AERD), other comorbidities associated, blood eosinophils, nasal polyp score, sinonasal outcome test 22 (SNOT 22), sniffin' stick test, the start date of Mepolizumab therapy and number of doses of Mepolizumab and eventually, Mepolizumab's adverse events related to administration. The Wilcoxon test for dependent samples was performed to compare variables. Statistical significance was assumed for p values<0.05. A statistically significant reduction in SNOT-22 and NPS was shown in the 6th and 12th month compared to baseline values (p<0.001 for both comparisons). A statistically significant increase value at the Sniffin' sticks test was shown in the 6th and 12th month compared to baseline values (p<0.001 for both comparisons). At the 12-month follow-up, according to EUFOREA indications, all patients were considered to remain in treatment with Mepolizumab and continued the treatment because of a reduced NPS, improved quality of life, and a reduced need for system corticosteroids. This multi-centric real-life study supported the effectiveness of Mepolizumab in patients with severe uncontrolled CRSwNP in the improvement of quality of life, the severity of symptoms, polyp size reduction, and smell function. Our data also support the safety profile of monoclonal therapy with Mepolizumab.