Search

Background: A short‐course oral corticosteroid taper and topical intranasal corticosteroids may be used to maximize the success of medical management for chronic rhinosinusitis with nasal polyps (CRSwNP). In this study, we sought to identify characteristics that would be predictive of efficacy for this combination regimen. Methods: Sixty‐four patients with CRS, bilateral polyps, a polyp score of at least 3, and a 22‐item Sino‐Nasal Outcome Test (SNOT‐22) score ≥20 were prospectively enrolled and uniformly treated with a 15‐day prednisone taper and twice daily dilute budesonide irrigations. Participants were assessed at enrollment and at follow up, 2 to 5 months later. Clinical and demographic characteristics were assessed at enrollment. At both time points, CRS symptoms were assessed with SNOT‐22, and polyp score (range, 0 to 6) was assessed endoscopically. Associations were determined with regression. Results: Pretreatment SNOT‐22 score (adjusted β = −0.83; 95% CI, −1.08 to −0.58; p < 0.001) and comorbid asthma (adjusted β = 15.75; 95% CI, 4.74 to 26.75; p = 0.007) were associated with a change in SNOT‐22 experienced over the study period. Achieving a greater‐than‐1 minimal clinically important difference (MCID) improvement in SNOT‐22 score was also associated with pretreatment SNOT‐22 score (adjusted OR = 1.09; 95% CI, 1.04 to 1.14; p < 0.001) and comorbid asthma (adjusted OR = 0.13; 95% CI, 0.03 to 0.72; p = 0.019). SNOT‐22 score ≥47 had 81.5% sensitivity and 78.4% specificity to detect patients experiencing 1 MCID improvement. Pretreatment polyp score was not associated with any outcome metric. Conclusion: In treatment of CRSwNP with prednisone and budesonide irrigations, pretreatment endoscopy was not informative of treatment response. Pretreatment SNOT‐22 and comorbid asthma may be more predictive. [ABSTRACT FROM AUTHOR]

Purpose: The effects of nasal obstruction in patients with chronic rhinosinusitis (CRS) are associated with depressed mood. We sought to validate this finding by determining whether improvement in nasal obstruction would translate to improvement in depressed mood. Methods: This was a prospective observational study of 150 patients undergoing medical management for CRS. Data were collected at two timepoints: enrollment and a subsequent follow-up visit 3–12 months later. Impact of nasal obstruction was measured using the Nasal Obstruction Symptom Evaluation (NOSE) instrument and depressed mood was measured using the 2-item Patient Health Questionnaire (PHQ-2). Sinonasal symptoms associated with CRS were also measured using the 22-item Sinonasal Outcome Test (SNOT-22). Clinical and demographic characteristics were collected. The relationship between changes in PHQ-2 and NOSE scores was determined with correlation and linear regression. Results: Change in PHQ-2 score was significantly correlated with change in NOSE score (ρ = 0.30, p < 0.001). After controlling for covariates, change in PHQ-2 score was associated with change in NOSE score (adjusted linear regression coefficient [β] = 0.014, 95% CI 0.006–0.022, p = 0.001). We confirmed these relationships, finding that change in PHQ-2 was associated (adjusted β = 0.037, 95% CI 0.013–0.061, p = 0.003) with change in the nasal subdomain score of the SNOT-22. Improvement in NOSE score by greater than 22 points was predictive of improvement in PHQ-2 score with sensitivity 54.5% and 83.8% specificity (p < 0.001). Conclusion: These results provide evidence that improvements in nasal manifestations/symptoms of CRS translate to significant improvements in mood. [ABSTRACT FROM AUTHOR]

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 β = 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 β = 0.48, 95% CI 0.14–0.81, p = 0.006) and sleep (adjusted β = 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. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to evaluate the impact of bilateral inferior turbinate reduction (BITR) on patient‐reported quality of life (QOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Methods: This was a prospective cohort study. Patients with CRS, who were recruited from 10 different otolaryngologic practices between 2011 and 2014, completed the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Chronic Sinusitis Survey (CSS), and EuroQol 5 Dimension (EQ‐5D) survey at baseline, and at 12, 24, 36, and 48 months after ESS. A total of 113 patients who underwent ESS with BITR were compared to 788 patients who underwent ESS without BITR. Results: Significant demographic and comorbid differences between BITR and non‐BITR cohorts included age (41 vs 49 years, p < 0.0001), presence of asthma (19% vs 36%, p < 0.0001), prior sinus surgery (22% vs 53%, p < 0.0001), and concurrent septoplasty (80% vs 53%, p < 0.0001), respectively. On univariate analysis, patients who underwent ESS with or without BITR were found to have statistically significant improvement in disease‐specific (SNOT‐22 and CSS) and general (EQ‐5D) QOL scores at years 1 through 4 (p < 0.05). On multivariate regression, however, the performance of BITR was not associated with any improvements in these outcome measures. Conclusion: Patients undergoing ESS achieve similar long‐term improvement in both disease‐specific and general QOL regardless of the performance of concurrent BITR. [ABSTRACT FROM AUTHOR]