Quality of life assesment in persons with chronic active otitis media

U poslednjih dvadesetak godina, publikovan je ogroman broj radova koji se bave razvojem, validacijom i upotrebom specifičnih upitnika kratke forme, u cilju procene kvaliteta života pacijenata sa određenom vrstom oboljenja. Ciljevi. Naš cilj je bio da specifičan upitnik za procenu kvaliteta života pacijenata sa aktivnim hroničnim zapaljenjem srednjeg uva prevedemo, kulturološki adaptiramo na srpski jezik i validiramo, kao i da izvršimo procenu kvaliteta života tih pacijenata pre i posle izvedene hirurške intervencije na obolelom uvu. U istraživanju je korišćen opšti i specifični upitnik i identifikovani su prediktori kvaliteta života ovih pacijenata. Materijal i metode. U okviru ove panel studije bilo je uključeno 246 pacijenata sa dijagnozom hroničnog zapaljenja srednjeg uva. Dijagnoza bolesti je postavljena na Klinici za otorinolaringologiju i maksilofacijalnu hirurgiju, Kliničkog centra Srbije, u periodu od oktobra 2014. do novembra 2015. godine. Svi pacijenti su tokom prve posete specijalisti popunili dva upitnika, generički upitnik za procenu kvaliteta života povezanog sa zdravljem i specifični upitnik o hroničnom zapaljenju uva. Od 246 ispitanika, 203 je dobilo preporuku za hirurško lečenje, a 167 je operisano i praćeno 12 meseci nakon operacije. Ispitanici su upitnike ponovo popunjavali nakon 6 i 12 meseci od izvedene operacije. Podaci su statistički analizirani metodama deskriptivne i inferencijalne statistike, a za statistički značajnu razliku je uzimana vrednost od 0,05. Za pronađenu statistički značajnu razliku, određivali smo i veličinu efekta za varijable od značaja. Rezultati. Validacija upitnika je sprovedena na 60 pacijenta sa hroničnim zapaljenjem srednjeg uva i na 60 zdravih dobrovoljaca. Kronbah alfa koeficijent, konvencionalni indeks konzistencije, iznosio je 0,821, dok je pri ponovljenom merenju nakon 4 nedelje bio neznatno viši, iznoseći 0,840. Što se tiče test-retest pouzdanosti, dobijena vrednost intraklasnog korelacionog koeficijenta između obe posete je iznosila 0,985 (95% interval poverenja: 0,975 do 0,991). Na 167 operisanih pacijenata dobijena je visoko statistički značajna razlika u poboljšanju sluha nakon izvedene operacije. Takođe, dobijeno je visoko statistički značajno smanjenje u ukupnom skoru specifičnog upitnika posle hirurške intervencije, kao i u svakom od njegova tri subskora...In the past 20 years, a large number of publications were dedicated to development, validation and use of short-form specific questionnaires in assessment of quality of life of the patients with particular diseases. Aims. Our primary goal was to contribute to this trend, by choosing a questionnaire that is in its early phase of development, translating and adapting it into Serbian language, and using it for assessment of quality of life improvement in patients with chronic otitis media after surgical intervention on the affected ear. Material and methods. This study included 246 patients diagnosed with chronic otitis media at the Clinic for Otorhinolaryngology and Maxillofacial Surgery of the Clinical Centre of Serbia from October 2014 to November 2015. All patients filled two questionnaires during their first visit, one specific and one generic used to asses general health-related quality of life. Surgical treatment has been recommended to 203 patients, out of whom 167 underwent surgery during the following year. Patients completed questionnaires again, 6 and 12 months after the surgery. Statistical analysis included descriptive and analytical statistical methods, and the value of 0.05 was considered as statistically significant. Effect size in standard deviations was reported for all statistically significant results. Results. The specific questionnaire was validated on 60 patients with chronic otitis media and 60 healthy volunteers. Cronbach alpha coefficient, the conventional index of consistency, was 0.821, while on repeated measurement after 4 weeks, was slightly higher − 0.840. In assessment of test-retest reliability, the value of interclass correlation coefficient between two visits was 0.985 (95% confidence interval: 0.975 to 0.991). There was a significant improvement in the area of ear symptoms and in hearing level on 167 operated patients. Furthermore, there was highly significant improvement in quality of life, represented by lower postoperative scores, both overall and for each of subscores of the specific questionnaire. For overall health-related quality of life, significant improvement was found both in physical and mental score of the questionnaire..

Congenital cholesteatoma of the middle ear - uncommon clinical presentation

Introduction. Congenital cholesteatoma of the middle ear is un uncommon and yet not well-defined disease. Only few cases of cholesteatoma in the fossa ovalis with unusual clinical presentation have been reported in medical literature. Case report. We reported a 16-year-old girl with congenital cholesteatoma in the fossa ovalis with minimal clinical presentation. A small mass was found occluding the fossa ovalis and mimicking otosclerotic process within tympanic cavity. The operation started as stapedotomy, and when the process was confirmed it converted to mastoidectomy via the retroauricular approach. Conclusion. The diagnosis of congenital cholesteatoma in children should always be considered, even if the clinical symptoms imitate other ear disorders, in our case otosclerosis. [Projekat Ministarstva nauke Republike Srbije, br. 179055: Cochlear implantation impact on education of deaf and hearing-impaired

Psychometric characteristics of the chronic Otitis media questionnaire 12 (COMQ - 12): stability of factor structure and replicability shown by the Serbian version.

BACKGROUND: Recently, demand for and supply of short-form patient-reported outcome measures (PROMs) have risen throughout the world healthcare. Our contribution to meeting that demand has been translating and culturally adapting the Chronic Otitis Media Questionnaire-12 (COMQ-12) for adults into Serbian and enhancing its psychometric base on the relatively large Serbian COM caseload. Chronic otitis media can seriously affect quality of life progressively and in long-term, and it remains the major source of hearing problems in the developing world. METHODS: The translated questionnaire was given twice to 60 adult patients with chronic otitis media of three types (inactive, active mucosal and active squamous disease) and to 60 healthy volunteers. Both patients and volunteers also filled the generic Short-Form 36 questionnaire (SF-36). Conventional statistical procedures were used in strategically driven development of scoring. Additionally, item responses were scaled by linear mapping against the provisional total score. Generalizability, detailed factor interpretation and supportability of scores were criteria, for the best compromise factor solution. RESULTS: Test-retest reliability was very high (0.924 to 0.989, depending on score). The a priori content dimensions of the questionnaire were strongly supported by 3-factor exploratory and confirmatory factor analyses for content validity, separating (i) ear symptoms from (ii) hearing problems, from (iii) daily activity restriction plus healthcare uptake. The 3-factor structure was furthermore highly stable on replication. The very large effect sizes when contrasting patients with healthy volunteers, and active with inactive disease established construct validity for the total score. A strong association with disease activity and a moderate one with generic health-related quality of life (HRQoL), the SF-36, supported construct validity for two of three factors extracted (ear symptoms, and impact on daily activities plus healthcare uptake). CONCLUSIONS: Given the minimal psychometric work to date on COMQ-12, this interim sample with 120 data points adds materially to knowledge of its reliability, several forms of validity and the feasibility of profile sub-scores to supplement total scores. The good psychometric properties shown for COMQ-12 justify both its routine clinical use and acquisition of the necessarily larger sample for generality, score optimisation and the evaluation of responsiveness

Smartphone addiction, sleep quality, depression, anxiety, and stress among medical students

IntroductionStudies consistently link excessive smartphone use to poor sleep quality, depression, anxiety, and stress. This study specifically aimed to investigate these associations among medical students in Belgrade and Nis (Central Serbia).Materials and methodsThe cross-sectional study included a sample of 761 students, who were selected from both the Faculties of Medicine at the University of Belgrade and the University of Nis. Questionnaires, including the International Physical Activity Questionnaire – Short Form (IPAQ-SF), Smartphone Addiction Scale – Short Version (SAS-SV), the Pittsburgh Sleep Quality Index (PSQI), and the Depression, Anxiety, and Stress Scale – 21 items (DASS-21), were completed by the participants. Statistical analysis techniques, such as the Chi-square test, student’s t-test, and logistic regression, were employed to examine the relationship between smartphone addiction, physical activity, sleep quality, depression, anxiety, and stress.ResultsThe findings indicated a prevalence of smartphone addiction among medical students at 21.7%, with rates of 22.9% among males and 21.1% among females. Females exhibited significantly higher scores on the SAS-SV scale compared to males (p = 0.032). Univariate logistic regression analysis revealed significant associations between smartphone addiction and spending over 4 h daily on smartphones (OR = 2.39; p < 0.001), poor sleep quality (OR = 1.65; p = 0,005), as well as elevated levels of stress (OR = 1.75; p = 0.003), anxiety (OR = 2.04; p < 0.001), and depression (OR = 2.29; p < 0.001). Multivariate regression analysis identified spending more than 4 h daily on smartphones (OR = 2.39; p < 0.001) and increased levels of depression (OR = 2.51; p < 0.001) as independent significant factors associated with smartphone addiction.ConclusionThis study sheds light on the prevalence of smartphone addiction among medical students, with spending excessive time on smartphones and higher levels of depression standing out as significant factors. Future research should delve into the underlying mechanisms and causal relationships between smartphone addiction and these psychosocial factors. Understanding these connections will aid in developing effective interventions and strategies to tackle this growing public health concern

Quality of life assesment in persons with chronic active otitis media

U poslednjih dvadesetak godina, publikovan je ogroman broj radova koji se bave razvojem, validacijom i upotrebom specifičnih upitnika kratke forme, u cilju procene kvaliteta života pacijenata sa određenom vrstom oboljenja. Ciljevi. Naš cilj je bio da specifičan upitnik za procenu kvaliteta života pacijenata sa aktivnim hroničnim zapaljenjem srednjeg uva prevedemo, kulturološki adaptiramo na srpski jezik i validiramo, kao i da izvršimo procenu kvaliteta života tih pacijenata pre i posle izvedene hirurške intervencije na obolelom uvu. U istraživanju je korišćen opšti i specifični upitnik i identifikovani su prediktori kvaliteta života ovih pacijenata. Materijal i metode. U okviru ove panel studije bilo je uključeno 246 pacijenata sa dijagnozom hroničnog zapaljenja srednjeg uva. Dijagnoza bolesti je postavljena na Klinici za otorinolaringologiju i maksilofacijalnu hirurgiju, Kliničkog centra Srbije, u periodu od oktobra 2014. do novembra 2015. godine. Svi pacijenti su tokom prve posete specijalisti popunili dva upitnika, generički upitnik za procenu kvaliteta života povezanog sa zdravljem i specifični upitnik o hroničnom zapaljenju uva. Od 246 ispitanika, 203 je dobilo preporuku za hirurško lečenje, a 167 je operisano i praćeno 12 meseci nakon operacije. Ispitanici su upitnike ponovo popunjavali nakon 6 i 12 meseci od izvedene operacije. Podaci su statistički analizirani metodama deskriptivne i inferencijalne statistike, a za statistički značajnu razliku je uzimana vrednost od 0,05. Za pronađenu statistički značajnu razliku, određivali smo i veličinu efekta za varijable od značaja. Rezultati. Validacija upitnika je sprovedena na 60 pacijenta sa hroničnim zapaljenjem srednjeg uva i na 60 zdravih dobrovoljaca. Kronbah alfa koeficijent, konvencionalni indeks konzistencije, iznosio je 0,821, dok je pri ponovljenom merenju nakon 4 nedelje bio neznatno viši, iznoseći 0,840. Što se tiče test-retest pouzdanosti, dobijena vrednost intraklasnog korelacionog koeficijenta između obe posete je iznosila 0,985 (95% interval poverenja: 0,975 do 0,991). Na 167 operisanih pacijenata dobijena je visoko statistički značajna razlika u poboljšanju sluha nakon izvedene operacije. Takođe, dobijeno je visoko statistički značajno smanjenje u ukupnom skoru specifičnog upitnika posle hirurške intervencije, kao i u svakom od njegova tri subskora...In the past 20 years, a large number of publications were dedicated to development, validation and use of short-form specific questionnaires in assessment of quality of life of the patients with particular diseases. Aims. Our primary goal was to contribute to this trend, by choosing a questionnaire that is in its early phase of development, translating and adapting it into Serbian language, and using it for assessment of quality of life improvement in patients with chronic otitis media after surgical intervention on the affected ear. Material and methods. This study included 246 patients diagnosed with chronic otitis media at the Clinic for Otorhinolaryngology and Maxillofacial Surgery of the Clinical Centre of Serbia from October 2014 to November 2015. All patients filled two questionnaires during their first visit, one specific and one generic used to asses general health-related quality of life. Surgical treatment has been recommended to 203 patients, out of whom 167 underwent surgery during the following year. Patients completed questionnaires again, 6 and 12 months after the surgery. Statistical analysis included descriptive and analytical statistical methods, and the value of 0.05 was considered as statistically significant. Effect size in standard deviations was reported for all statistically significant results. Results. The specific questionnaire was validated on 60 patients with chronic otitis media and 60 healthy volunteers. Cronbach alpha coefficient, the conventional index of consistency, was 0.821, while on repeated measurement after 4 weeks, was slightly higher − 0.840. In assessment of test-retest reliability, the value of interclass correlation coefficient between two visits was 0.985 (95% confidence interval: 0.975 to 0.991). There was a significant improvement in the area of ear symptoms and in hearing level on 167 operated patients. Furthermore, there was highly significant improvement in quality of life, represented by lower postoperative scores, both overall and for each of subscores of the specific questionnaire. For overall health-related quality of life, significant improvement was found both in physical and mental score of the questionnaire..

Can short PROMs support valid factor-based sub-scores? Example of COMQ-12 in chronic otitis media.

PURPOSE: Interpretable factor solutions for questionnaire instruments are typically taken as justification for use of factor-based sub-scores. They can indeed articulate content and construct validities of a total and components but do not guarantee criterion validity for clinical application. Our previous documentation of basic psychometric characteristics for a 12-item patient-reported outcome measure in adult chronic otitis media (COMQ-12) justified next appraising criterion validity of sub-scores. METHODS: On 246 cases at 1st clinic visit, we compared various classes of factor solution, concentrating on the best-fitting 3-factor ones as widely supported. Clinical data offered two independent measures as external criteria: binaural hearing (audiometric thresholds measured via audiometry) for evaluating 'Hearing' sub-score, and oto-microscopic findings for the 'Ear discharge symptoms' sub-score. As criterion for the total, and for semi-generic 'Activities/healthcare' sub-score, the generic Short Form-36 item set offered a widely used multi-item criterion measure. RESULTS: Factor model fit and parsimony again favoured a 3-factor solution for COMQ-12; however insufficient item support and the dominant 1st principal component of variation made sub-scoring problematic. The best solution was bi-factor, from which only the weighted total score met the declared convergent validity standard of r = 0.50. Two of the more specific sub-scores ('Ear discharge symptoms' and 'Hearing') correlated poorly with clinical findings and weighted binaural hearing thresholds. CONCLUSION: The COMQ-12 total is acceptably content-valid for general clinical purposes, but the small item set, reflecting excessive pressure for brevity in clinical application, does not well support three criterion-valid factor-based scores. This distinction should be made explicit, and profile sub-scoring discouraged until good convergent and furthermore divergent criterion validities are shown

Long term complications of ventilation tube insertion in children with otitis media with effusion

Background/Aim. Otitis media with effusion (OME) is characterized by the prolonged presence of fluid (longer than 12 weeks) of different viscosity in the middle ear, without perforation of the eardrum or signs of acute inflammation. The conservative treatment does not always provide satisfactory recovery, so surgical treatment may be unavoidable. The aim of the study was to determine the incidence, type and frequency of complications caused by ventilation tube insertion as a part of treatment for OME in children, and specifically, to evaluate the evolution of these changes over the extended period of time. Methods. During a 5-year period (1986-1991), 84 children with chronic bilateral OME, aged from 6 months to 12 years, were enrolled in the study and treated with ventilation tube insertion. All the patients were periodically checked every 6 months over a 3-8 year period following the intervention (otomicroscopic examination, audiometry, tympanometry), and reexamined in 2013 (22-27 years after the primary surgical intervention). Results. The complications observed in this study (51%) were atrophic scarring of the tympanic membrane, myringo- and tympanosclerosis, retraction of the eardrum, persistent perforations, granulation tissue formations, development of chronic otitis and sensorineural hearing loss. Conclusion. The incidence of complications after ventilation tube insertion was 51% in this study. Atrophic scars and myringosclerosis were the most prominent complications. Despite high complications rate ventilation tube insertion still remains the treatment of choice in children with otitis media with effusion

Minimum data set for present analysis.

(SAV)</p

Pearson correlations (with 95% CIs) between external criterion variables and COMQ-12 total and specific factor scores.

Pearson correlations (with 95% CIs) between external criterion variables and COMQ-12 total and specific factor scores.</p

Scoring and handling of missing data.

(DOCX)</p