On Health-Related Quality of Life and Diagnostic Improvements in Rhinosinusitis

Rhinosinusitis is defined as an inflammatory process involving the mucosa of the nose and one or more of the paranasal sinuses. The aims of the work presented in this thesis were to investigate the degree to which rhinosinusitis affects the health-related quality of life (HRQOL), and to determine whether the diagnosis of this condition can be improved using Doppler ultrasound. The HRQOL of 207 patients divided into three subgroups, one with recurrent acute rhinosinusitis, and two with chronic rhinosinusitis, with or without nasal polyps, was evaluated with the 22 Sinonasal Outcome Test (SNOT-22), the 36-item short-form questionnaire (SF-36), the Hospital Anxiety and Depression (HAD) scale and a total visual analogue scale (VAS). These patients’ HRQOL was significantly decreased compared to normative values. Some significant differences in HRQOL scoring were found between the three subgroups. The study cohort reported 8-14 days of absenteeism per year due to their sinus problems. SNOT-22 and the total VAS appeared to be appropriate outcome measures in cases of rhinosinusitis in the Swedish population. It is not possible to differentiate serous sinus fluid (with a low viscosity) from mucopurulent sinus secretions (with high viscosity) with computed tomography (CT) or ultrasound. A means of determining the properties of sinus secretions non-invasively would, however, be of value, as bacteria are often found in mucopurulent secretions in rhinosinusitis. In order to improve the diagnosis of these patients, the ultrasound technique was further developed. In this thesis, it was demonstrated that it is possible to induce acoustic streaming in a sinus model, and that the acoustic properties of a fluid can be determined with Doppler ultrasound. The appropriate frequency of the ultrasound was found to be ~5 MHz. The anatomical dimensions of the maxillary and frontal sinuses were studied on computed tomography images in order to be able to develop a clinically useful Doppler instrument. It was shown how serous sinus fluid can be distinguished from mucopurulent sinus secretion with Doppler ultrasound, without exposing the patient to a harmful increase in temperature

Computed tomography measurements of different dimensions of maxillary and frontal sinuses

<p>Abstract</p> <p>Background</p> <p>We have previously proposed the use of Doppler ultrasound to non-invasively stage sinus infection, as we showed that acoustic streaming could be generated in nonpurulent sinus secretions and helped to distinguish it from mucopurulent sinus secretions. In order to continue this development of a clinically applicable Doppler equipment, we need to determine different dimensions of the paranasal sinuses, especially the thickness of the anterior wall of the maxillary sinus (at the canine fossa). To the best of our knowledge, this is the first report on the thickness of the canine fossa. This study aimed to (a) estimate different dimensions of the maxillary and frontal sinuses measured on computed tomography (CT) of the head, (b) define cut-off values for the normal upper and lower limits of the different measured structures, (c) determine differences in age, side and gender, (d) compare manually and automatically estimated maxillary sinuses volumes, and (e) present incidental findings in the paranasal sinuses among the study patients.</p> <p>Methods</p> <p>Dimensions of 120 maxillary and frontal sinuses from head CTs were measured independently by two radiologists.</p> <p>Results</p> <p>The mean value of the maxillary sinus volume was 15.7 ± 5.3 cm³and significantly larger in males than in females (P = 0.004). There was no statistically significant correlation between the volume of maxillary sinuses with age or side. The mean value of the bone thickness at the canine fossa was 1.1 ± 0.4 mm. The automatically estimated volume of the maxillary sinuses was 14-17% higher than the calculated volume. There was high interobserver agreement with regard to the different measurements performed in this study. Different types of incidental findings of the paranasal sinuses were found in 35% of the patients.</p> <p>Conclusion</p> <p>We presented different dimensions of the maxillary and frontal sinuses on CTs. We believe that our data are necessary for further development of a clinically applicable Doppler equipment for staging rhinosinusitis.</p

A multicenter international prospective study of the validity and reliability of a COVID-19-specific health-related quality of life questionnaire

Purpose: To develop and validate a health-related quality of life (HRQoL) questionnaire for patients with current or previous coronavirus disease (COVID-19) in an international setting. Methods: This multicenter international methodology study followed standardized guidelines for a four-phase questionnaire development. Here, we report on the pretesting and validation of our international questionnaire. Adults with current or previous COVID-19, in institutions or at home were eligible. In the pretesting, 54 participants completed the questionnaire followed by interviews to identify administration problems and evaluate content validity. Thereafter, 371 participants completed the revised questionnaire and a debriefing form to allow preliminary psychometric analysis. Validity and reliability were assessed (correlation-based methods, Cronbach’s α, and intra-class correlation coefficient). Results: Eleven countries within and outside Europe enrolled patients. From the pretesting, 71 of the 80 original items fulfilled the criteria for item-retention. Most participants (80%) completed the revised 71-item questionnaire within 15 min, on paper (n = 175) or digitally (n = 196). The final questionnaire included 61 items that fulfilled criteria for item retention or were important to subgroups. Item-scale correlations were > 0.7 for all but nine items. Internal consistency (range 0.68–0.92) and test–retest results (all but one scale > 0.7) were acceptable. The instrument consists of 15 multi-item scales and six single items. Conclusion: The Oslo COVID-19 QLQ-W61© is an international, stand-alone, multidimensional HRQoL questionnaire that can assess the symptoms, functioning, and overall quality of life in COVID-19 patients. It is available for use in research and clinical practice. Further psychometric validation in larger patient samples will be performed.publishedVersio

Euforea treatment algorithm for allergic rhinitis

Non peer reviewe