Claire Hopkins

Psychometric validity of the 22‐item Sinonasal Outcome Test

Objectives:  We set out to determine the psychometric validation of a disease‐specific health related quality of life instrument for use in chronic rhinosinusitis, the 22 item Sinonasal Outcome Test (SNOT‐22), a modification of a pre‐existing instrument, the SNOT‐20.

The Lund-Mackay staging system for chronic rhinosinusitis: How is it used and what does it predict?

Objectives The Lund-Mackay score is widely used in assessment of chronic rhinosinusitis. We aimed to describe its relationship to other measures of pre- and post-treatment health status. Study Design Multicenter prospective study of 1840 patients undergoing surgery for chronic rhinosinusitis in the UK. Results There was no absolute threshold for surgery, but patients with higher Lund-Mackay scores underwent more extensive surgery. There was no correlation between Lund-Mackay and SNOT-22 scores. The Lund-Mackay increased with increasing grade of polyposis. The Lund-Mackay score was associated with symptom reduction (coefficient = 0.24, P = 0.02) complication rates (odds ratio, 1.08, 95%CI 1.06 to 1.1), and revision rates (odds ratio, 1.03, 95% CI 1.001 to 1.06). Conclusions The Lund-Mackay score measures a different aspect of disease to “subjective” symptom scores. However, it correlates well with other markers of disease severity, the nature of surgery offered, and its outcome. Significance This demonstrates the strengths and limitations of a commonly used staging system.

The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis

Objectives: This study summarises the results of a National Audit of sino‐nasal surgery carried out in England and Wales. It describes patient and operative characteristics as well as patient outcomes up to 36 months after surgery.

Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis

We present a large, prospective cohort study following patients who underwent surgery for chronic rhinosinusitis (CRS), with or without nasal polyps, in hospitals in England and Wales. Five‐year outcomes will be reported, and we will revisit a previous analysis of the effectiveness of extensive surgery in the treatment of nasal polyposis.

Complications of surgery for nasal polyposis and chronic rhinosinusitis : The results of a national audit in England and Wales

Objective: The objective of this study was to determine the rate of complications of surgery for nasal polyposis and chronic rhinosinusitis as well as their risk factors.

The Sino-Nasal Outcome Test (SNOT) : Can we make it more clinically meaningful?

OBJECTIVE: To test whether subscales should be used when analyzing the Sino-Nasal Outcome Test (SNOT). STUDY DESIGN AND SETTING: Prospective cohort study involved 87 acute NHS hospitals in England and Wales. RESULTS: With the use of exploratory factor analysis we found evidence for the existence of four unique constructs within the SNOT. Two constructs address symptoms (rhinologic and ear/facial) and two address aspects of health-related quality of life (psychological issues and sleep function). Subscales of the SNOT that correspond to these constructs provided clinically meaningful information over and above that provided by the SNOT total score on the type of surgical benefits gained by patients with different sino-nasal conditions. CONCLUSION: The SNOT is not unidimensional and a SNOT total score will mask variation in the true underlying constructs. SIGNIFICANCE: The SNOT would have greatly improved clinical use if it was scored with appropriate subscales. Such a measure would allow us to tease out the differential impact of sino-nasal conditions, in addition to allowing greater understanding of treatment effects.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Isam Alobid, MD, PhD1, Nithin D. Adappa, MD2, Henry P. Barham, MD3, Thiago Bezerra, MD4, Nadieska Caballero, MD5, Eugene G. Chang, MD6, Gaurav Chawdhary, MD7, Philip Chen, MD8, John P. Dahl, MD, PhD9, Anthony Del Signore, MD10, Carrie Flanagan, MD11, Daniel N. Frank, PhD12, Kai Fruth, MD, PhD13, Anne Getz, MD14, Samuel Greig, MD15, Elisa A. Illing, MD16, David W. Jang, MD17, Yong Gi Jung, MD18, Sammy Khalili, MD, MSc19, Cristobal Langdon, MD20, Kent Lam, MD21, Stella Lee, MD22, Seth Lieberman, MD23, Patricia Loftus, MD24, Luis Macias‐Valle, MD25, R. Peter Manes, MD26, Jill Mazza, MD27, Leandra Mfuna, MD28, David Morrissey, MD29, Sue Jean Mun, MD30, Jonathan B. Overdevest, MD, PhD31, Jayant M. Pinto, MD32, Jain Ravi, MD33, Douglas Reh, MD34, Peta L. Sacks, MD35, Michael H. Saste, MD36, John Schneider, MD, MA37, Ahmad R. Sedaghat, MD, PhD38, Zachary M. Soler, MD39, Neville Teo, MD40, Kota Wada, MD41, Kevin Welch, MD42, Troy D. Woodard, MD43, Alan Workman44, Yi Chen Zhao, MD45, David Zopf, MD46

Acid reflux treatment for hoarseness

Objectives The aim of the review was to assess the effectiveness of anti-reflux therapy for patients with hoarseness, in the absence of other identifiable causes, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made. This was assessed by evaluation of prospective randomised controlled studies that were identified by a systematic review of the literature. Both medical and surgical treatments were evaluated. Method The Cochrane ENT Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 3, 2005), MEDLINE (1966 to 2005), EMBASE (1974 to 2005) and conference proceedings were searched with prespecified terms. The date of the last search was September 2005.Randomised controlled trials recruiting patients with hoarseness in the absence of other identifiable causes, such as malignancy, cord palsy or nodules, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made. Data collection and analysis Three reviewers examined the search results and identified studies before deciding which would be included in the review . Results 302 potential studies were identified by the search strategy. No trials were identified which met our inclusion criteria. Six randomised controlled trials were identified in which some, but not all patients presented with hoarseness, and were treated with proton pump inhibition. As we could not determine with certainty whether all these patients had hoarseness among the other laryngeal symptoms, these were excluded. However, these studies suggest a significant placebo response, which is comparable to the benefit derived from anti-reflux therapy in some studies. As no trials met our criteria, we are unable to reach any firm conclusions regarding the effectiveness of anti-reflux treatment for hoarseness. Conclusions There is a need for high quality randomised controlled trials to evaluate the effectiveness of anti-reflux therapy for patients with hoarseness which may be due to laryngopharyngeal and gastro-oesophageal reflux.

A pilot study of the SNOT 22 score in adults with no sinonasal disease

Objective:  To determine the SNOT 22 score in a normal population.

Health-related quality of life after polypectomy with and without additional surgery

Objective: The objective of this study was to compare the health‐related quality of life of patients undergoing simple polypectomy with that of patients undergoing polypectomy with additional surgery.