A systematic review to examine the relationship between objective and patient‐reported outcome measures in sinonasal disorders: recommendations for use in research and clinical practice (original) (raw)
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Criteria To Screen for Chronic Sinonasal Disease
Chest, 2009
Background: Sinusitis and rhinitis are associated with uncontrolled asthma. There are no simple, validated tools to screen for these diseases. The objective of this study was to assess instruments to assist in the diagnosis of chronic sinonasal disease. Methods: Participants without acute sinonasal symptoms underwent an extensive evaluation. The results were submitted to an expert panel that used the Delphi method to achieve consensus. Using the consensus diagnosis of the panel, we determined the sensitivity and specificity of test procedures to diagnose chronic sinonasal disease. We determined the reproducibility of the most sensitive and specific instrument in a separate cohort. Results: Fifty-nine participants were evaluated, and the expert panel reached consensus for all (42 participants with chronic sinonasal disease, 17 participants without chronic sinonasal disease). A six-item questionnaire based on the frequency of nasal symptoms was the most sensitive tool used to diagnose sinonasal disease (minimum specificity, 0.90). Reproducibility testing in a separate cohort of 63 participants (41 chronic sinonasal disease with asthma, 22 chronic sinonasal disease without asthma) showed a concordance correlation coefficient of 0.91 (95% CI, 0.85 to 0.94) when this questionnaire was limited to five items (ie, excluding a question on smell). This five-item questionnaire had a sensitivity of 0.90 (95% CI, 0.77 to 0.97), a specificity of 0.94 (95% CI, 0.71 to 1.00), and an area under the receiver operating characteristic curve of 0.97 (95% CI, 0.93 to 1.0). Sinus CT scans and nasal endoscopy lacked sensitivity for use in the diagnosis of chronic sinonasal disease. Conclusions: We have developed a sensitive, specific, and reproducible instrument to screen for chronic sinonasal disease. Validation studies of this five-item questionnaire are needed, including in patients with asthma.
Response to medical or surgical therapy in chronic rhinosinusitis: A one year prospective analysis
Allergologia et Immunopathologia, 2009
Introduction: Chronic rhinosinusitis (CRS) is treated with both surgical and medication options. However, long term data on patient outcomes is rare. In a real world clinical environment, our objective was to identify CRS patients, gather patient characteristics, and follow symptoms over one year. Patients and methods: This observational study enrolled patients with CRS. Primary clinical markers included atopy testing, serum IgE, and complete blood counts. A sinus computerized tomography (CT) scan was performed serially. Patients were enrolled into medical treatment Arm A and into surgical treatment Arm B. Symptom scores were calculated using the chronic sinusitis survey (CSS). Results: Atopy testing was positive in 67%. IgE levels or atopy did not correlate with CSS scores. A 23% decrease in total CSS scores was noted in Arm A at one year (P ¼.01). Arm B demonstrated a 38% reduction in total CSS scores at 3 months (P ¼.02) only. CT evidence of CRS was found in 74% of patients. However, CT scores did not change significantly over 12 months. Conclusions: No correlation was found between serum IgE levels or atopy versus CSS scores. CT scan scores did not change significantly over 12 months in either treatment group. A reduction of CSS scores was seen in both treatment groups; however a rebound effect was suggested in the surgical arm. Our study demonstrates the disconnection between clinical markers, radiographic evidence and response to therapy in CRS in a common clinical setting. It exemplifies the need for controlled studies with years of chronic rhinosinusitis outcome analysis.
The Role of Allergy Therapy in Chronic Rhinosinusitis: A Systematic Review
Current Otorhinolaryngology Reports, 2012
The role of allergy in chronic rhinosinusitis (CRS) remains controversial. The objectives of the review were to determine if atopy plays a role in CRS, and to determine if allergy treatment impacts patient outcome. We screened 1,755 articles, resulting in 37 studies, of which 7 were prospective. No randomized controlled trials examining the benefit of immunotherapy in CRS were found in the literature. The study populations for the majority of the studies available were highly selected, evaluating patients failing medical therapy and often requiring endoscopic sinus surgery (ESS). Evidence from these studies suggests a high prevalence of atopy in CRS patients with a possible role of food allergy in CRS pathophysiology. Five of the 7 cohort studies in this review did not show a correlation between atopy and post-surgical outcome in CRS patients requiring ESS.
Update on evidence-based reviews with recommendations in adult chronic rhinosinusitis
International forum of allergy & rhinology, 2014
Chronic rhinosinusitis (CRS) has a significant impact not only on individuals who are afflicted but also on society as a whole. An increasing emphasis is being placed on incorporating the best available evidence into the care of patients, in association with an individual clinician's expertise and the patient's values. Recent evidence-based reviews with recommendations (EBRRs) have distilled our knowledge of CRS treatment options and have also pointed out continued gaps in this knowledge. This review synthesizes the findings of 8 EBRRs regarding CRS published in the International Forum of Allergy and Rhinology between 2011 and 2014. The recommendations in this review are based on the best available evidence and are meant to be incorporated into each…
BMC ear, nose, and throat disorders, 2017
Chronic rhinosinusitis (CRS) is one of common health conditions that affects patients' health-related quality of life. Our purpose is to assess the reliability and validity of Thai-version of Sino-Nasal Outcome Test 22 in chronic rhinosinusitis. Permission for translation of SNOT-22 from English language to Thai language was obtained from the developer. The translation process was done based on the international standard of translation method. A total of 80 subjects were recruited into the study and divided into two groups comprising of 50 patients with chronic rhinosinusitis and 30 healthy volunteers. Cronbach's α and Intraclass correlation coefficient were evaluated for its reliability. Validity test was evaluated against VAS score, SF-36 (Thai version) questionnaire and CT scan (based on Lund-Mackay score). Responsiveness was assessed between pre-operative and post-operative scores in 34 patients. The Thai version of SNOT-22 showed good reliability according to high value...
The accuracy of symptom-based definition of chronic rhinosinusitis
Allergy, 2007
Chronic rhinosinusitis (CRS) is a common prevalent disease in which many factors may contribute. Diagnosing CRS is based primarily on major symptoms and signs of the disease. In primary care centers, CRS is diagnosed primarily using major symptom scales. This symptom-based definition should also be supported by objective signs such as nasal endoscopy and computed tomography (CT) (1). However, there may be a discrepancy between the subjective information and the objective data from nasal endoscopy and CT scans results. The aim of this study was to investigate the diagnostic value of symptom scales (VAS) by examining patients diagnosed as having sinusitis in primary care centers. The association of allergic rhinitis and CRS is well-known. A nasal allergy may block the ostia and delay mucociliary clearance in several ways, thereby increasing CRS pathogenesis (2). We divided patients with CRS into two groups as either allergic or nonallergic and then enrolled them in this study. Patients with allergic rhinitis were included as CRS symptoms in these patients may become considerably more severe than in nonallergic patients.
Rhinology, 2010
To conduct the first prospective randomized controlled trial, evaluating and comparing the effect of medical and surgical treatment of chronic rhinosinusitis (CRS) on quality of life. Ninety patients with CRS, who remained symptomatic after initial medical treatment with Dexarhinaspray duo and nasal douche, were randomized either to medical or surgical therapy. All patients underwent pre- and post-treatment assessments of the Sinonasal Outcome Test-20 (SNOT-20), and the Short Form 36 Health Survey (SF-36). Each patient had three assessments: before starting the randomized treatment, after six months and finally after one year. Both the medical and surgical treatment of CRS significantly improved almost all the parameters of SNOT and SF-36 (p<0.05), with no significant difference being found between the medical and surgical groups (p>0.05). Both maximal medical and surgical therapy of CRS improves the quality of life of CRS patients, providing further evidence that chronic rhin...
Current Allergy and Asthma Reports, 2020
Purpose of Review The objective of this article is to provide a recent update of the association between allergic inflammation and chronic rhinosinusitis. The systematic approach of this review article critically evaluates the literature published over the past few years and summarizes the specific pathophysiologic pathway of chronic sinonasal inflammation that has been postulated. Recent Findings From a systematic search of the Ovid Medline and Embase, 11 studies were included in a qualitative analysis of the association between systemic allergy and chronic rhinosinusitis (CRS). Of the 11 studies, four showed an association, three were inconclusive, and four did not show any association. From the systematic search, 50 studies suggested four possible pathophysiologic pathways that may explain the association of allergic inflammation and CRS, namely, (1) staphylococcal enterotoxin, (2) the innate immunity pathway, (3) mast cell-associated inflammation, and (4) dysbiosis of microbiota. Summary The association of systematic allergy and CRS remains inconclusive. The recent advances in the study of the pathophysiologic pathway of CRS may lead to the possibility of a targeted treatment option for CRS. Keywords Chronic rhinosinusitis. Allergy. Skin prick test. Immunoglobulin E. Sensitization. This article is part of the Topical Collection on Rhinosinusitis. Abbreviations AFRS Allergic fungal rhinosinusitis AIT Allergen immunotherapy AR Allergic rhinitis CCAD Central compartment atopic disease CRS Chronic rhinosinusitis CRSsNP Chronic rhinosinusitis without nasal polyp CRSwNP Chronic rhinosinusitis with nasal polyp ECP Eosinophil cationic protein EDN Eosinophil derived neurotoxin ELISA Enzyme-linked immunosorbent assay EPO Eosinophil peroxidase ICAM1 Intercellular adhesion molecule 1 ILC2 Innate lymphoid cells type 2 LAR Local allergic rhinitis RT-PCR Reverse transcription polymerase chain reaction sIgE Specific IgE SE Staphylococcal enterotoxin SPT Skin prick test TSLP Thymic stromal lymphopoietin VCAM1 Vascular cell adhesion protein 1 This article is part of the Topical Collection on Rhinosinusitis
Trials, 2017
A core outcome set (COS) is an agreed standardised collection of outcomes that should be measured and reported by all trials for a specific clinical area, in this case chronic rhinosinusitis. These are not restrictive and researchers may continue to explore other outcomes alongside these that they feel are relevant to their intervention. The aim of this systematic review was to identify the need for a COS for chronic rhinosinusitis. A sensitive search strategy was used to identify all published Cochrane systematic reviews and randomised control trials of intervention for adult patients with chronic rhinosinusitis. Two independent authors reviewed these to obtain a list of outcomes and outcome measures reported by each clinical trial. Sixty-nine randomised control trials and eight Cochrane systematic reviews were included in this study. They reported 68 individual outcomes and outcome measures, with an average of four to ten outcomes per clinical trial. These outcomes were mapped to ...