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Background: Real-world evidence (RWE) is a valuable instrument to better understand the patient journey and effectiveness of therapies. RWE on the prevalence of uncontrolled chronic rhinosinusitis (CRS) and CRS natural course of disease across Europe is scarce. In addition, there is limited RWE that enables comparison of the effectiveness of marketed therapies including topical or systemic corticosteroids, sinus surgery, or biologics., Objective: To establish an international CHRonic rhINOSinusitis Outcome Registry (CHRINOSOR) based on real-world data collection enabled by mobile health technology., Methodology: A digital platform, Galenus Health, supporting patients and physicians in the management of chronic respiratory diseases, is used to collect data on patient profile, disease history, patient outcomes, and a set of relevant clinical outcomes. Adult patients with a diagnosis of CRS are eligible for inclusion., Results: A collaborative scientific network of 17 university ear-nose-throat (ENT) clinics from 10 European countries has been established with the aim to collect real-world data in a longitudinal and standardized manner. The Galenus Health digital platform is currently being implemented in these ENT clinics taking into account legal, privacy, and data security aspects. Up to 300 patients have already been included., Conclusions: CHRINOSOR is a collaborative effort that aims at improving our understanding of CRS, its comorbidities, and the effectiveness of its treatments. Ultimately, these insights will guide us as scientific community to develop future care pathways informed by RWE., (Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Objectives: Nasal endoscopy is a cornerstone in diagnosing sinonasal disease, but different raters might generate different results using the technique. Our study aims to evaluate the agreement between multiple raters to assess the validity of nasal endoscopy., Design/participants: Three independent and blinded raters evaluated 28 patients (56 nasal cavities) diagnosed with chronic rhinosinusitis according to the European Position Paper on Rhinosinusitis and Nasal Polyps. The ratings were compared using unweighted Fleiss' kappa coefficients (K f ) for each objective parameter., Setting: The department of Otorhinolaryngology, Odense University Hospital, Denmark., Main Outcome Measures: The ratings were quantified in a modified Lund-Kennedy endoscopy score and focused on the objective parameters specified in the diagnostic criteria: polyps, oedema and discharge., Results: The raters agreed on the findings concerning polyps and discharge but not regarding oedema with the inter-rater agreement for the different parameters being: polyps K f =.66 (SE .07, P<.001), oedema K f =.05 (SE .07, P=.21), discharge K f =.35 (SE .08, P<.001), oedema exclusively in middle meatus K f =-.07 (SE .04, P=.8) and discharge exclusively in middle meatus K f =.16 (SE .07, P=.01)., Conclusion: Using nasal endoscopy, the evaluation of polyps by multiple raters showed sufficient reliability indicating an acceptable objective evaluation. The evaluation of discharge achieved a fair level of agreement while the assessment of oedema could not achieve a sufficient reliability questioning the inclusion of oedema in the criteria for diagnosing sinonasal disease., (© 2017 John Wiley & Sons Ltd.)

The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.

Endoscopic sinus surgery (ESS) for patients with severe chronic rhinosinusitis (CRS) has become a well-established treatment in cases where medical therapy fails. Even though CRS patients are divided into two subgroups, CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP), most studies present only results for the total cohort. This prospective cohort study evaluated the efficacy of ESS on both quality of life and olfactory function measures, in a cohort of Danish CRS patients diagnosed according to the EPOS criteria, with results analysed separately for the CRSwNP and CRSsNP subgroups. All 97 CRS patients who underwent ESS over an 18-month trial period were evaluated preoperative by SNOT-22 score, Sniffin' Sticks score, modified Lund-Kennedy endoscopic score and Lund-Mackay CT score. Patient outcomes were reevaluated at clinical follow-up 1 and 6 months postoperative. ESS efficiently and immediately improved quality of life for both CRSwNP and CRSsNP patients, with over 50 % reduction in SNOT-22 score 1 month after surgery, which sustained 6 months postoperative. Olfactory function measured by Sniffin' Sticks score showed overall improvement in both groups. ESS efficiently improved quality of life in both CRSwNP and CRSsNP patients, and surgery lead to an overall improvement in olfactory function. However, a minor proportion of patients experienced deterioration in olfactory function after ESS.

Objectives: To determine the Sinonasal Outcome Test 22 (SNOT 22) score in persons without chronic rhinosinusitis., Design and Setting: As part of a trans-European study selected, respondents to a survey questionnaire were invited for a clinical visit. Subjective symptoms and rhinoscopy were used for the clinical diagnosis of chronic rhinosinusitis according to EPOS., Participants: A total of 366 persons participated at the clinical visit and of these 268 did not have chronic rhinosinusitis. All participants completed the SNOT 22., Main Outcome Measures: The SNOT 22., Results: The SNOT 22 score ranged from 0 to 67 with a mean score of 10.5 (CI: 9.1-11.9) and the median score was 7. Persons with allergic rhinitis and blue-collar workers had a significant higher score., Conclusion: The median value of 7 is taken as the normal SNOT 22 score in persons without CRS and can be used as a reference in clinical settings and research. Allergic rhinitis and occupation affect SNOT 22 in persons without CRS., (© 2015 John Wiley & Sons Ltd.)

Conclusion: By consulting an ENT-doctor, patients with chronic rhinosinusitis (CRS), in the general population, receive disease information and adjustment of treatment which can improve disease-specific Quality-of-Life and may improve objective measurements., Objectives: This study aims to follow persons with clinical diagnosed CRS from the general population, to evaluate their benefit from consultation with an ENT-doctor in terms of severity of symptoms and Quality-of-Life., Methods: As part of a trans-European study, selected respondents to a survey questionnaire were invited for a clinical visit. Based on the European Position Paper on Rhinosinusitis and Nasal Polyps, persons were diagnosed with CRS and followed for 2 years. Quality-of-Life was measured using the Sino Nasal Outcome Test 22 and European Quality-of-Life - 5 Dimensions. Clinical examination included rhinoscopy, acoustic rhinometry, peak nasal inspiratory flow, smell test, and skin prick test., Results: Out of 91 persons with CRS, only 42% had previously consulted an ENT-doctor, and 51% were in current treatment for CRS. Most patients were advised medical treatment and 20% underwent surgery. Disease-specific Quality-of-Life, peak nasal inspiratory flow, olfactory function, and the nasal volume significantly increased over the 2-year period.

Background: An increased coexistence of gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) has been reported in epidemiologic and register studies, and reflux has been shown more frequently in patients with CRS in studies using esophagus pH manometry compared to participants without CRS. A discussion is ongoing about whether there might be an association between these two diseases and, if so, whether the association is causal., Objective: The purpose of this study was to clinically investigate the prevalence and symptom severity scores of CRS among patients with GERD. The results were compared with those of a randomly assigned control group from the general Danish population., Method: In this case-control study, 82 patients with GERD were examined for CRS using the European Position Paper on Rhinosinusitis and Nasal Polyps criteria, which combine patient history and anterior/posterior rhinoscopy results. Sinonasal-related quality of life was assessed by using the Sino-Nasal Outcome Test 22 (SNOT-22). These results were compared with those of a population-based control group examined for CRS in the same way., Results: The prevalence of CRS among patients with GERD was 20.7% (95% confidence interval [CI], 12.0%-29.5%), significantly higher than the CRS prevalence of 8.5% (95% CI, 6.8%-10.2%) in the background population. Patients with GERD and CRS had an average SNOT-22 score of 43.8, whereas patients with CRS from the background population scored, on average, 28.1. Having GERD increased the mean SNOT-22 score in patients with CRS by 15.7 (95% CI, 6.5-24.9)., Conclusion: The results of this study provide additional evidence of an association between GERD and CRS and indicate that GERD may play a role in the development of CRS. The results also show that sinonasal-related quality of life is decreased in patients with CRS who also suffer from GERD.

Chronic rhinosinusitis (CRS) is a disease related to the nose and the paranasal sinus as defined by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria. The criteria include subjective symptoms, such as nasal obstruction, and objective findings by endoscopy. Acoustic rhinometry (AR) is an objective method to determine nasal cavity geometry. The technique is based on a sound pulse reflection analysis in the nasal cavity and determines cross-sectional areas as a function of distance as well as volume. AR measurements in persons recruited from the general population, with and without CRS based on the clinical EPOS criteria, were investigated. As part of a trans-European study, 362 persons, comprising 91 persons with CRS and 271 persons without CRS, were examined by an otolaryngologist including rhinoscopy. Minimum cross-sectional area, distance to minimum cross-sectional area, and volume in the nasal cavity were measured by acoustic rhinometry and all participants underwent Peak Nasal Inspiratory Flow (PNIF) and allergy test. A difference in AR was found before and after decongestion, but no difference was seen between CRS patients and controls. Positive correlation between AR and PNIF was found and AR was capable of identifying mucosal oedema and septum deviation visualised by rhinoscopy. In conclusion, AR, as a single instrument, was not capable of discriminating persons with CRS from persons without CRS in the general population. However, AR correlates well with PNIF and was capable of identifying septum deviation and mucosal oedema.

Objectives: The European Position Paper on Rhinosinusitis and Nasal Polyps describes methods to perform population-based and clinical studies on chronic rhinosinusitis in a standardised way, and it also describes how to clinical investigate CRS. The aim of this cross-sectional study was to evaluate quality of life and objective findings in persons with chronic rhinosinusitis recruited from the general population., Design: As part of a trans-European study, selected respondents to a survey questionnaire were invited for a clinical visit. Subjective symptoms and rhinoscopy were used for the clinical diagnosis of chronic rhinosinusitis, and persons with and without chronic rhinosinusitis were compared., Setting: This research took place in the department of Otolaryngology, Odense University Hospital., Participants: A total of 366 persons participated at the clinical visit, and of these, 91 were diagnosed with chronic rhinosinusitis, 271 without chronic rhinosinusitis and four persons were excluded., Main Outcome Measures: Severity of symptoms and disease-specific quality of life were measured using the Sino-Nasal Outcome Test 22, and generic quality of life was measured using European quality of life - 5 dimensions including an index score and a visual analogue scale., Results: The prevalence of chronic rhinosinusitis was 9%, and the prevalence of polyps was 4%. Persons with chronic rhinosinusitis had significantly reduced disease-specific quality of life (P = 0.00) and generic quality of life (P = 0.04 and 0.01) compared with persons without chronic rhinosinusitis. Having chronic rhinosinusitis was correlated to age, allergic rhinitis and smell., Conclusion: This study gives insight into health-related quality of life and objective findings in persons with chronic rhinosinusitis recruited from the general population., (© 2013 John Wiley & Sons Ltd.)

Background: The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic and endo- scopic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies the definition is based on symptoms only. The aim of this study was to evaluate the correlation between questionnaire-based and clinical-based CRS., Methods: Based on the GA2LEN postal survey data a total of 366 persons participated at the follow-up at the Danish centre and provided information on questionnaire-based CRS. At the same occasion the 366 participants underwent clinical inter- view and examination by an otorhinolaryngologist to provide information for a clinical-based CRS diagnosis. The association between questionnaire-based and clinical-based CRS diagnosis was determined using logistic regression models and kappa statistics., Results: Mean age of respondents to the postal questionnaire was 45.3 years and 52.9% were female. Persons with asthma were 8.4 % and 26.2 % were actual smokers. There was moderate agreement between questionnaire-based and clinical-based CRS. Sensitivity was [corrected] low comparing questionnaire-based CRS with clinical-based CRS. Incorporation of self reported CRS and medical history in diagnosing CRS by questionnaire increased increased [corrected] the agreement and sensitivity while specificity stayed at a high level. [corrected], Conclusion: Evaluating the correlation between questionnaire-based and clinical-based CRS showed only moderate agree- ment and questions whether they evaluate the same disease. It brings into consideration that adjustments are needed to justify correlation between questionnaire-based and clinical-based diagnosis of CRS.

Background: Very little is known about occupational risk factors for chronic rhinosinusitis (CRS). The aim of this study was to evaluate occupational and other potential risk factors for CRS in a Danish population., Methods: A cross sectional survey study among 4,554 Danes aged 20-75 years evaluated self-reported symptoms of CRS, asthma, and nasal allergy, along with information on smoking habits and occupation., Results: A total of 3,099 returned completed questionnaires (response rate 68.1%). The overall CRS prevalence was 7.8% with no significant differences related to age or gender. Risk ratio estimates revealed an increased risk of CRS among female blue collar workers compared to female white collar workers. Among men the effect of occupation depended on smoking status. Occupational exposure to gasses, fumes, dust, or smoke increased the overall risk of CRS. CRS was reported approximately four times as often in subjects with asthma and in subjects with nasal allergy. Current smoking doubled the CRS prevalence., Conclusions: CRS prevalence was affected by occupation (blue vs. white collar), but the observed effect depended on gender and smoking status. Exposure to airway irritants (occupational or smoking) increased the CRS prevalence. Studies on larger cohorts are needed to fully assess these tendencies, for example, by more extensive use of Job Exposure Matrix models., (Copyright © 2012 Wiley Periodicals, Inc.)

The complement system is an important part of our immune system, and complement defects lead generally to increased susceptibility to infections and autoimmune diseases. We have studied the role of complement activity in relation with chronic rhinosinusitis (CRS), and more specifically studied whether complement defects collectively predispose individuals for CRS or affect CRS severity. The participants comprised 87 CRS patients randomly selected from the general population, and a control group of 150 healthy blood donors. The CRS patients were diagnosed according to the European Position Paper on Rhinosinusitis and nasal Polyps criteria, and severity was evaluated by the Sino-nasal Outcome Test-22. Serum samples were analysed by ELISA for activity of the respective pathways of complement, and subsequently for serum levels of relevant components. We found that the frequency of complement defects was significantly higher among CRS patients than among healthy control subjects. A majority of Mannan-binding lectin deficient CRS patients was observed. The presence of complement defects had no influence on the severity of subjective symptoms. Our studies show that defects in the complement system collectively may play an immunological role related to the development of CRS. However, an association between severity of symptoms and presence of complement defects could not be demonstrated.

Background: Chronic rhinosinusitis (CRS) is a common health problem, with significant medical costs and impact on general health. Even so, prevalence figures for Europe are unavailable. In this study, conducted by the GA²LEN network of excellence, the European Position Paper on Rhinosinusitis and nasal Polyps (EP³OS) diagnostic criteria are applied to estimate variation in the prevalence of Chronic rhinosinusitis (CRS) for Europe., Method: A postal questionnaire was sent to a random sample of adults aged 15-75 years in 19 centres in Europe. Participants reported symptoms of CRS, and doctor diagnosed CRS, allergic rhinitis, age, gender and smoking history. Definition of CRS was based on the EP³OS diagnostic criteria: the presence of more than two of the symptoms: (i) nasal blockage, (ii) nasal discharge, (iii) facial pain/pressure or (iv) reduction in sense of smell, for >12 weeks in the past year--with at least one symptom being nasal blockage or discharge., Results: Information was obtained from 57,128 responders living in 19 centres in 12 countries. The overall prevalence of CRS by EP³OS criteria was 10.9% (range 6.9-27.1). CRS was more common in smokers than in nonsmokers (OR 1.7: 95% CI 1.6-1.9). The prevalence of self-reported physician-diagnosed CRS within centres was highly correlated with the prevalence of EP³OS-diagnosed CRS., Conclusion: This is the first European international multicentre prevalence study of CRS. In this multicentre survey of adults in Europe, about one in ten participants had CRS with marked geographical variation. Smoking was associated with having CRS in all parts of Europe., (© 2011 John Wiley & Sons A/S.)

Introduction: Chronic rhinosinusitis (CRS) is a significant health problem whose incidence and prevalence is rising. It calls into attention consensus about diagnosing, assessing symptoms and treatment of patients with CRS. Therefore, a validated Danish measure of health-related quality of life in sinonasal disease is needed., Material and Methods: The Sino-Nasal Outcome Test 22 (SNOT-22) was translated into Danish and its reproducibility was evaluated by test-retesting 40 patients with CRS. The statistical analyses used were Pearson's correlation coefficient, Cronbach's alpha, kappa and Bland-Altman's plot. Reproducibility was also tested for SNOT-22 subscales., Results: The results show good internal correlation with a Cronbach's alpha of 0.83 in the initial test and one of 0.92 in the retest. Pearson's correlation coefficient was 0.70 (p < 0.001), revealing good correlation between the initial scores and the retests scores. Kappa was calculated for each item with a mean value of 0.61 showing substantial agreement. The paired t-test revealed no significant difference between the subscales., Conclusion: The Danish version of SNOT-22 is recommended for Danish clinicians and researchers as a patient-reported measure of outcome in sinonasal disorders such as rhinosinusitis and nasal polyposis.

Chronic rhinosinusitis (CRS) is a common health problem, with significant medical costs and impact on general health. Even so, prevalence figures for Europe are unavailable. In this study, conducted by the GA2LEN network of excellence, the European Position Paper on Rhinosinusitis and nasal Polyps (EP3OS) diagnostic criteria are applied to estimate variation in the prevalence of Chronic rhinosinusitis (CRS) for Europe. Method: A postal questionnaire was sent to a random sample of adults aged 15-75 years in 19 centres in Europe. Participants reported symptoms of CRS, and doctor diagnosed CRS, allergic rhinitis, age, gender and smoking history. Definition of CRS was based on the EP3OS diagnostic criteria: the presence of more than two of the symptoms: (i) nasal blockage, (ii) nasal discharge, (iii) facial pain/pressure or (iv) reduction in sense of smell, for >12 weeks in the past year - with at least one symptom being nasal blockage or discharge. Results: Information was obtained from 57 128 responders living in 19 centres in 12 countries. The overall prevalence of CRS by EP3OS criteria was 10.9% (range 6.9-27.1). CRS was more common in smokers than in nonsmokers (OR 1.7: 95% CI 1.6-1.9). The prevalence of self-reported physician-diagnosed CRS within centres was highly correlated with the prevalence of EP3OS-diagnosed CRS. Conclusion: This is the first European international multicentre prevalence study of CRS. In this multicentre survey of adults in Europe, about one in ten participants had CRS with marked geographical variation. Smoking was associated with having CRS in all parts of Europe. [ABSTRACT FROM AUTHOR]