A detection dog for obstructive sleep apnea : could it work in diagnostics?

Purpose We have previously demonstrated that dogs can be trained to distinguish the urine of patients with obstructive sleep apnea (OSA) from that of healthy controls based on olfaction. Encouraged by these promising results, we wanted to investigate if a detection dog could work as a screening tool for OSA. The objective of this study was to prospectively assess the dogs' ability to identify sleep apnea in patients with OSA suspicion. Methods Urine samples were collected from 50 patients suspected of having OSA. The urine sample was classified as positive for OSA when the patient had a respiratory event index of 5/h or more. The accuracy of two trained dogs in identifying OSA was tested in a prospective blinded setting. Results Both of the dogs correctly detected approximately half of the positive and negative samples. There were no statistically significant differences in the dogs' ability to recognize more severe cases of OSA, as compared to milder cases. Conclusion According to our study, dogs cannot be used to screen for OSA in clinical settings, most likely due to the heterogenic nature of OSA.Peer reviewe

Long-Term Follow-Up After Maxillary Sinus Balloon Sinuplasty and ESS

Objectives: The aim of this controlled follow-up study was to compare the need for revision surgery, long-term efficacy, and satisfaction in chronic rhinosinusitis patients who had undergone maxillary sinus operation with either balloon sinuplasty or traditional endoscopic sinus surgery (ESS) technique. Methods: Thirty-nine ESS patients and 36 balloon patients of our previously described cohort, who had been primarily operated in 2008 to 2010, were contacted by phone. Symptoms, satisfaction, and need for revision surgery were asked. In addition, we collected data of patients who had undergone primary maxillary sinus balloon sinuplasty in the Helsinki University Hospital during the years 2005 to 2019. As a control group, we collected data of patients who had undergone primary maxillary sinus ESS at 3 Finnish University Hospitals, and 1 Central Hospital in years 2005, 2008, and 2011. Results: Altogether, 77 balloon patients and 82 ESS patients were included. The mean follow-up time was 5.3 years in balloon group and 9.8 years in ESS group. Revision surgery was performed on 17 balloon patients and 6 ESS patients. In the survival analysis, the balloon sinuplasty associated significantly with a higher risk of revision surgery compared to ESS. According to the phone interviews, 82% of ESS patients and 75% of balloon patients were very satisfied with the primary operation. Conclusion: Although the patient groups expressed equal satisfaction and change in symptoms after the operations, the need for revision surgery was higher after balloon sinuplasty than after ESS. This should be emphasized when counselling patients regarding surgical options.Peer reviewe

Factors Affecting Revision Rate of Chronic Rhinosinusitis

Peer reviewe

Translation, cross-cultural adaptation, and validation of the sino-nasal outcome test (snot)-22 for Finnish patients

Purpose The Sino-Nasal Outcome Test-22 (SNOT-22) is the most commonly used disease-specific quality of life questionnaire in rhinology. The purpose of this prospective study was to translate and validate SNOT-22 into Finnish. Methods The validation process followed the guidelines proposed for cross-cultural adaptation of health-related measures of quality of life. The study consisted of three groups: rhinologic out-patients (N = 96), FESS patients (N = 49) and healthy controls (N = 79). Out-patient and FESS groups completed the questionnaire twice (answers A and B), out-patients after two weeks and FESS patients after 3 months. Validity, reliability and responsiveness were evaluated. Results The mean SNOT-22 sum score of the out-patient questionnaires were 35.3 points (answer A) and 32.4 points (answer B). ICC in out-patient group was 0.879. For the FESS patients, the mean pre- and postoperative (answer A and B) SNOT-22 sum scores were 46.8 and 21.9 points, respectively (p <0.0001). The mean SNOT-22 of healthy controls was 8.9 points. The out-patients (answer A) and healthy controls had statistically significant difference in SNOT-22 scores (p <0.0001). Conclusions The results of our study show that the validated Finnish version of the SNOT-22 questionnaire demonstrates good validity, reliability and responsiveness.Peer reviewe

Long-term follow-up after ESS and balloon sinuplasty : Comparison of symptom reduction and patient satisfaction

Conclusion This is the first controlled study of balloon sinuplasty's long-term efficacy with the follow-up time over 5 years. The results are in accordance with a previous 2-year-follow-up study. Both techniques retained the efficacy and patient satisfaction on average 6 years after the surgery. Background Endoscopic sinus surgery (ESS) and balloon sinuplasty are considered as a treatment for chronic rhinosinusitis (CRS) after a failure of conservative therapy. High cost and lack of long-term follow-up studies restrain the use of balloon sinuplasty. Objective The aim of this study was to compare long-term efficacy and satisfaction in CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique. Previous or additional sinonasal operations were exclusion criteria. Materials and methods Study patients were recruited from 208 CRS-patients who underwent either ESS or balloon sinuplasty. Patients with nasal polyposis (gradus >= 2), previous sinonasal surgery, unilateral disease, or immune deficiency were excluded. Altogether 45 patients in the ESS group and 40 patients in the balloon group were included. Of these, 30 and 28, respectively, answered to a phone interview held on average 6 years after primary surgery. Symptom reduction and long-term satisfaction were evaluated by using symptom scores of 19 parameters altogether. Results Both groups experienced improvement in symptoms and were equally satisfied with the operation. The number of patient-reported acute exacerbations was higher among the balloon dilated patients. Also, the reduction of thick nasal discharge was less evident in the balloon sinuplasty group. Four patients in the balloon sinuplasty group underwent revision surgery. There were no revisions in the ESS group.Peer reviewe

Radiological score of computed tomography scans predicts revision surgery for chronic rhinosinusitis

Objective. Evaluate computed tomography (CT) signs that predict need for revision endoscopic sinus surgery (ESS) of chronic rhinosinusitis (CRS). Methods. CRS patients (n = 48) underwent routine sinus CT scans and baseline ESS in 2006-2011. Lund-Mackay (LM) scores and 43 other CT signs were analysed blinded from both sides. Patients filled in a questionnaire during the day of CT scanning. Follow-up data were collected from hospital records until January 2018. Associations were analysed by Fisher's exact, Mann Whitney U, Kaplan-Meier method with logrank test and Cox's proportional hazard model. Results. Total LM score was not significantly associated with the need for revision ESS. The best predictive model was a sum of CT signs of non-detectable anatomy of inferior/middle turbinates, obstructed frontal recess, and previous sinus surgery. Using these CT findings, we formed a Radiological Score (RS) (min-max, 0-3 points). Having at least one RS point was significantly associated with the need for revision ESS during the average follow-up of 10.7 years (p = 0.008, Logrank test). Conclusion. We identified a radiologic score that was able to predict the need for revision ESS, which is probably useful in predicting CRS outcomes.Peer reviewe

Factors Affecting the Control of Chronic Rhinosinusitis With Nasal Polyps : A Comparison in Patients With or Without NERD

Objectives: The aim was to compare the control of chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), in patients with/without nonsteroidal anti-inflammatory drug exacerbated respiratory disease (NERD). Study Desing: A retrospective hospital-based sample of CRSwNP patients with/without NERD with follow-up. Setting: Tertiary rhinology centers. Methods: Electronic patient record data from 116 CRSwNP patients (46 with NERD and 70 without NERD) undergoing ESS during 2001-17 were studied. Mean follow-up time was 9.9 years (range 1.1-15.3). Endpoints reflecting uncontrolled CRSwNP were revision ESS, and need for rescue/advanced therapy (e.g. antibiotics, oral corticosteroids and/or biological therapy) during follow-up. NERD was variable of interest and gender, age, asthma, allergic rhinitis (AR), smoking, Lund-Mackay (LM) score of sinus computed tomography scans previous ESS and baseline total ethmoidectomy were used as covariates. Results: Twenty-one (49.7%) NERD patients and 18 (25.7%) non-NERD patients underwent revision ESS within a mean +/- SD of 4.3 +/- 2.8 and 3.7 +/- 2.6 years, respectively (p = .013, by Logrank test). In Cox ' s regression models, NERD, female gender, young age, asthma, AR, previous ESS, and lack of total ethmoidectomy were associated with revision-ESS. In adjusted model, only the total ethmoidectomy predicted revision-free survival. In adjusted logistic regression model, there was an insignificant trend that NERD and LM score were associated with the need for rescue/advanced therapy in the follow-up. Conclusions: Patients with NERD had higher risk of uncontrolled CRSwNP than patient group without NERD, as measured by revision ESS and/or need for rescue/advanced therapy in the follow-up. In addition, baseline total ethmoidectomy was associated with revision-free survival.Peer reviewe

Tautikohtaisen elämänlaatumittarin validointi - esimerkkinä nenä- ja sivuontelotautikohtainen SNOT-22-mittari

English summar

Translation, cross-cultural adaptation, and validation of the sino-nasal outcome test (snot)-22 for Finnish patients

Purpose The Sino-Nasal Outcome Test-22 (SNOT-22) is the most commonly used disease-specific quality of life questionnaire in rhinology. The purpose of this prospective study was to translate and validate SNOT-22 into Finnish. Methods The validation process followed the guidelines proposed for cross-cultural adaptation of health-related measures of quality of life. The study consisted of three groups: rhinologic out-patients (N = 96), FESS patients (N = 49) and healthy controls (N = 79). Out-patient and FESS groups completed the questionnaire twice (answers A and B), out-patients after two weeks and FESS patients after 3 months. Validity, reliability and responsiveness were evaluated. Results The mean SNOT-22 sum score of the out-patient questionnaires were 35.3 points (answer A) and 32.4 points (answer B). ICC in out-patient group was 0.879. For the FESS patients, the mean pre- and postoperative (answer A and B) SNOT-22 sum scores were 46.8 and 21.9 points, respectively (p p Conclusions The results of our study show that the validated Finnish version of the SNOT-22 questionnaire demonstrates good validity, reliability and responsiveness.</p

Keskikäytäväantrostomian merkitys endoskooppisessa sivuontelokirurgiassa

Keskikäytäväantrostomian merkitys poskiontelokirurgiassa Pitkäaikaisessa sivuontelotulehduksessa nenän ja sivuonteloiden oireet kestävät yli kolme kuukautta häviämättä välillä täysin. Vastikään julkaistun tutkimuksen mukaan pitkäaikaisen sivuontelotulehduksen esiintyvyys Euroopassa on 10,9%. Endoskooppiavusteista sivuontelokirurgiaa (ESS) harkitaan, jos konservatiivisella hoidolla ei saavuteta riittävää oirelievitystä. Väitöskirjatutkimuksen tarkoituksena oli verrata kahden eri endoskooppiavusteisen leikkausmenetelmän (uncinektomia vs. uncinektomia yhdistettynä keskikäytäväantrostomiaan) välisiä mahdollisia eroja, hyötyjä ja haittavaikutuksia. Ensimmäisen osatyön tavoitteena oli selvittää poskiontelon limakalvon verisuonten seinämässä esiintyvien ja valkosolujen L-selektiiniin sitoutuvien sulfatoitujen Lewis x sokerirakenteiden määrää pitkäaikaisessa sivuontelotulehduksessa. Toisessa osatyössä mitattiin poskionteloiden mukosiliaripuhdistumaa ja sen postoperatiivisesti muutosta. Kolmannessa osatyössä selvitettiin sivuontelokirurgian vaikutusta poskiontelon limakalvon L-selektiinien ja eosinofiilien esiintyvyyteen. Neljännessä osatyössä verrattiin kuvantamispohjaisen Lund-Mckay pisteytyksen muutoksia sivuonteloiden pre- ja postoperatiivisen tilanteen välillä. Viidennessä osatyössä arvioitiin ESS-kirurgian pitkäaikaistuloksia, sekä riskitekijöiden mahdollisia vaikutuksia tyytyväisyydessä leikkaustulokseen. Pystyimme osoittamaan, että pitkäaikaisessa sivuontelotulehduksessa verisuonten seinämässä esiintyvän ja valkosolujen L-selektiiniin sitoutuvien sulfatoitujen Lewis x sokerirakenteiden suhteellinen määrä lisääntyi merkitsevästi. Lisäksi osoitimme, että näiden epitooppien ja limakalvon eosinofiilisten tulehdussolujen esiintyvyys oli verrannollinen tulehduksen vaikeusasteeseen. Potilailla, joilla oli käytössä paikallinen nenäkortikosteroidihoito, L-selektiinin ligandien määrä ja limakalvon eosinofiilisolujen määrä väheni postoperatiivisesti . Oirearvioinnin ja postoperatiivisen poskiontelon limakalvon eosinofiilien välillä esiintyi vastaavuussuhde. Tilastollisesti merkitsevä limakalvon eosinofiilien väheneminen postoperatiivisesti pystyttiin osoittamaan ainoastaan tehdyn keskikäytäväantrostomian puolella. ESS- leikkaus ei parantanut poskiontelon mukosiliaaripuhdistumaa, se pysyi huonona myös 9kk:n kohdalla tehdyssä seurantatutkimuksessa. Ennen leikkausta ja 9kk:a leikkauksen jälkeen tehtyjen tietokonekerroskuvausten perusteella pystyttiin sivuonteloissa osoittamaan molemmilla puolilla selkeä vähentyminen tutkimuksessa käytetyssä kuvantamispohjaisessa Lund-Mackay pisteytyksessä. Tämä vähentyminen oli riippumaton leikkaustekniikasta. Pelkkään uncinatuksen poistoon verrattuna ostiumin koko säilyi merkitsevästi suurempana keskikäytäväantrostomiapuolella. Pitkäaikaisseurannassa saavutettiin merkitsevä oirekuvan vähentyminen molemmilla leikkaustekniikoilla. Leikkaustekniikoiden välillä emme havainneet eroa tyytyväisyydessä leikkauksen tulokseen, kasvokipuun, nenäntukkoisuuteen tai limaisuuteen liittyen. Pitkäaikaisseurannassa keskikäytäväantrostomia osoittautui hieman paremmaksi verrattaessa tarvetta uusintaleikkaukseen. Pitkäaikaisen sivuontelotulehduksen akuuttien pahenemisjaksojen määrä alkoi lisääntyä 9kk:a leikkauksen jälkeen. Potilaat, joilla oli astma ja/tai altistuminen työperäisille hengitysilmaärsykkeille olivat tyytyväisempiä keskikäytäväantrostomiaan, kuin pelkkään uncinektomiaan. Löydös ei kuitenkaan ollut tilastollisesti merkitsevä. Yhteenvetona voidaan todeta, että endoskooppiavusteisella sivuontelokirurgialla (ESS) saavutetaan positiivinen vaikutus potilaan oirekuvaan, kuvantamispohjaiseen Lund-Mackay pisteytykseen, poskiontelon limakalvon L-selektiini ligandeihin ja eosinofiileihin riippumatta leikkaustekniikasta. Mukosiliaaripuhdistuma jäi huonoksi 9kk seurantatukimuksessakin, mikä osoitti värekarvatoiminnan huonoa paranemista. Vaikka tutkimustulokset osoittivat lievää etua tehdystä keskikäytäväantrostomiasta, eri leikkausmenetelmillä saatujen tulosten välillä ei yleisesti ottaen ollut suuria tilastollisesti merkitseviä eroja.Background: Chronic rhinosinusitis (CRS) is an inflammation of the nose and paranasal sinuses lasting more than 12 weeks. It is diagnosed by typical symptoms and/or a computed tomography (CT) scan and/or endoscopic changes. I a recent study the prevalence of CRS in the European population was found to be 10.9%. After failure of maximal conservative therapy, endoscopic sinus surgery (ESS) aims to restore normal sinus function and ventilation through the natural ostia. Traditionally, in maxillary sinus surgery, ESS was initiated with the removal of the uncinate process combined with middle meatal antrostomy. Anterior ethmoidal cells were also often opened. The minimally invasive technique of maxillary sinus surgery concentrates only on the uncinate process. Since the introduction of this technique, there have been controversial opinions on the advantages of simple uncinectomy over maxillary sinus antrostomy. Subjects and methods: The study group comprised 30 patients (20 women and 10 men) aged between 22 and 66 years, with a mean age of 47 years. They all suffered from chronic maxillary rhinosinusitis with associated mucosal thickening or sinus opacification in the CT scan. There was no difference in the symptoms between each side of the nose, and the preoperative CT scans showed identical moderate findings on both sides. A nasal endoscopy was performed to exclude patients with visible polyposis from the study. The study group underwent ESS under local anaesthesia. Uncinectomy alone was performed on one side. In addition, a middle meatal antrostomy was performed on the contralateral side to duplicate the size of the natural ostium. Ethmoidal bulla was resected bilaterally in 25 patients. Part of the patients in the study group received conservative therapy (intranasal corticosteroid and/or oral antihistamine) both pre- and postoperatively. Nasal endoscopy, a CT scan and measurements of mucociliary clearance (MCC) were performed preoperatively and nine months postoperatively. Maxillary sinus mucosa biopsy specimens were taken for histopathological and immunohistochemical evaluations intraoperatively and 9 months postoperatively from this study group. Patient questionnaires were completed at 1 month preoperatively, and at 1, 3, 9 and 68 months postoperatively. Maxillary sinus specimens were also obtained from an additional subject group that consisted of healthy controls and CRS patients with or without nasal polyposis. Results: We were able to demonstrate that the percentage of vessels expressing endothelial sulphated sialyl-LewisX epitopes (L-selectin ligands) in maxillary sinus biopsies taken intraoperatively increased during CRS compared with uninflamed control tissue. In addition, the expression level of these epitopes and the number of mucosal eosinophils correlated with the inflammation, and they decreased nine months postoperatively compared with intraoperative samples, especially in patients with intranasal corticosteroid treatment. The postoperative reduction of these L-selectin ligands was independent of the operation technique. There was a statistically significant correlation between the postoperative number of mucosal eosinophils and the symptom score, which was also independent of the surgical technique. A statistically significant postoperative decrease of mucosal eosinophils, as well as the correlation of the intraoperative eosinophils with the postoperative symptom score, was found only on the antrostomy side. Surgery did not significantly improve the mucociliary function of the maxillary sinus mucosa; it remained poor even nine months postoperatively. There was no statistical difference between the operative techniques. Comparison of the preoperative and postoperative CT scans revealed that a significant reduction in the radiological Lund-Mackay (LM) score was achieved on both sides, regardless of the procedure performed. The postoperative area of the ostium remained significantly larger on the antrostomy side compared with the uncinectomy side. Comparison of long-term subjective outcomes revealed a significant reduction of symptoms on both sides. There were no significant differences between the uncinectomy with additional antrostomy and the uncinectomy-only sides in terms of satisfaction with the operation, facial pain, nasal obstruction, or discharge values. Additional middle meatal antrostomy seemed to be slightly superior in terms of the need for revision operations. However, this difference was statistically insignificant. The number of prescribed antibiotic courses for acute exacerbations began to increase between the nine- and, on average, 68-month period postoperatively. It seemed that patients with asthma and/or job exposure to irritants might experience less satisfaction with the uncinectomy-only side, whereas patients without these risk factors experienced similar satisfaction after both procedures. This observation did not however reach statistical difference. Conclusion: Endoscopic sinus surgery (ESS) has a positive impact on subjective outcomes, radiological Lund-Mackay scores, sinus mucosa L-selectin ligands and eosinophils regardless of the type of the operation performed. Mucociliary clearance remains poor even after nine months of ESS, indicating poor recovery of the ciliary function. There were no statistically significant differences between the types of operation. However, there is a slight tendency for better results with ostium-enlarging surgery