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

Real-life assessment of chronic rhinosinusitis patients using mobile technology : The mySinusitisCoach project by EUFOREA

Background Chronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socioeconomic burden. Monitoring of patient-reported outcomes by mobile technology offers the possibility to better understand real-life burden of CRS. Methods This study reports on the cross-sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria. Results The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms. Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria. The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well-controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell. Conclusion Real-life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient-reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real-life monitoring, supporting the evolution of care towards precision medicine.Peer reviewe

Low-dose computed tomography of the paranasal sinuses: radiation doses and reliability analysis.

PURPOSE: The study aimed to (1) optimize the radiation doses of computed tomography (CT) of paranasal sinuses, (2) compare the radiation doses of different CT protocols with that of plain radiography, and (3) evaluate the reliability of low-dose CT in the detection of pathology and characterization of the detected pathology. MATERIALS AND METHODS: A head phantom was examined with different scan parameters to define a cutoff value to which the radiation dose can be reduced without negative impact on image quality. Kruskal-Wallis test and Wilcoxon W test were performed to compare the effective doses of the plain radiography in 30 patients with that of 3 different CT protocols in a total of 90 patients. The interobserver and intraobserver agreement in the detection of pathologic findings and in characterization of the pathology was estimated by calculating kappa value. RESULTS: The effective doses of plain radiography and low-dose CT were 0.098 and 0.045 mSv, respectively (P < .001). The effective dose of standard CT of sinuses (0.371 mSv) was 3.8 times higher than that of plain radiography and 8.2 times higher than that of low-dose CT (P < .001). The interobserver and intraobserver agreement on CT with regard to detection of pathology and pathology characterization was almost perfect (kappa values 0.81-1) compared to fair (kappa values 0.38-0.39) in plain radiography. CONCLUSIONS: The here proposed low-dose CT means significant dose reduction and is a reliable method in the investigation of the paranasal sinuses

Pristance-induced arthritis in rats: a new model for rheumatoid arthritis with a chronic disease course influenced by MHC and non-MHC genes

We present a novel animal model for rheumatoid arthritis induced with a well defined synthetic adjuvant oil, pristane. Two weeks after a single intradermal injection of 150 microliters of pristane, the rats developed severe and chronic arthritis. The inflammation was restricted to the joints and involved pannus formation, major histocompatibility complex (MHC) class II expression, and T lymphocyte infiltration. The initial development as well as the chronic stage of pristane-induced arthritis was ameliorated by treatment with antibodies to the alpha beta-T-cell receptor showing that the disease is T cell dependent. Increased levels of interleukin in serum was seen after pristane injection but not during the chronic stage of arthritis. Joint erosions were accompanied by elevated serum levels of cartilage oligomeric matrix protein. Comparison of MHC congenic LEW strains showed that the severity and chronicity of arthritis varied among the different MHC haplotypes. Rats with RT1f haplotype showed a significantly higher susceptibility to pristane-induced arthritis. A strong influence of non-MHC genes was also suggested by the variability of arthritis susceptibility among different strains with the same MHC haplotype; the most susceptible background was the DA and the least susceptible was the E3. Arthritis induced with a well defined nonimmunogenic adjuvant, with a disease course that closely resembles that of rheumatoid arthritis, makes a suitable animal model for future studies of the pathology and genetics of rheumatoid arthriti

Ultrasound Doppler for improved diagnosis of disease in the paranasal sinuses

We propose a method to improve the diagnosis of infection in the paranasal sinuses, distinguishing between mucous and serous cases. The method utilizes a previously published method whereby the viscosity in a sealed container may be measured using an ultrasound Doppler method. As ultrasound propagates in a liquid medium, due to attenuation, the resulting pressure gradient will cause the liquid to move in the propagation direction - the wellknown effect of acoustic streaming. The streaming velocity will, for a given acoustic output, be proportional to the viscosity of the fluid. In this study, we verify that acoustic streaming can be induced in an anthropomorphic sinus phantom cast from a human cranium. The sinus phantom was made from agar with added graphite providing sound attenuation prior to the sinus cavity corresponding to an in vivo situation. A number of water-glycerol solutions with scattering particles, were prepared to mimic a clinically interesting range of viscosities (7-47 mPas). Using a 4.2 MHz continuous wave Doppler probe, clearly detectable mean Doppler shifts in the range of 6.5 to 20 Hz were recorded A linear relationship was found between the Doppler shifts and 1/viscosity (R2=0.94, corrected for the square-law dependence of sound speed variation due to varying glycerol concentration)

Validation and psychometric evaluation of the Swedish version of the Nasal Obstruction Symptom Evaluation scale

Objectives: The Nasal Obstruction Symptom Evaluation (NOSE) scale is a symptom-specific quality-of-life questionnaire for patients suffering from nasal obstruction. The instrument is designed specifically for patients with septal deviation and for the evaluation of the outcome of septoplasty. The aim of this study was to validate a Swedish version of the NOSE instrument for use in clinical practice and research.Methods: A Swedish version of the NOSE was tested in a case group consisting of 125 subjects with nasal obstruction (of which 31 underwent septoplasty) and a control group consisting of 65 healthy subjects. Base line data for the case and control groups were used to evaluate face validity, known groups validity, construct validity, internal consistency and factor structure analysis. Fifty participants in both the case groups and control groups were assessed both at baseline and after 2 weeks to evaluate test-retest reliability. The participants who underwent septoplasty were assessed at baseline and after 3-6 months to evaluate responsiveness.Results: The S-NOSE was found to be reliable, valid, and responsive. Both Cronbachs alpha and McDonald Omega coefficients were &amp;gt; 0.7, and the intra class coefficient was 0.942. The S-NOSE scores were significantly correlated with nasal patency VAS in both the case group and the control group (p &amp;lt; .001 and p = .018, respectively). After septoplasty, the mean S-NOSE score were significantly improved (p &amp;lt; .001). Furthermore, the S-NOSE was shown to have excellent and robust psychometric properties.Conclusion: The S-NOSE can be recommended in both clinical practice and research to evaluate the outcome of septoplasty in Swedish-speaking populations.Funding Agencies|Futurum-The Academy of Health and Care in Region Joenkoeping County, Sweden [FUTURUM-803421]; Swedish government [ALFGBG-715771]</p