David S. Caradonna

Association between Symptoms of Allergic Rhinitis with Decreased General Health–Related Quality of Life

Background The impact of specific allergic rhinitis symptoms on patient quality of life (QOL) is currently unknown. Objective In this study, we sought to determine the association between nasal and extranasal symptoms of allergic rhinitis with general health–related QOL. Methods A total of 150 participants with ages > 18 years and persistent allergic rhinitis were prospectively recruited for this cross-sectional study. General health–related QOL was measured by using the visual analog scale (VAS) from the five-dimension EuroQol QOL survey (EQ-5D). The severity of nasal and extranasal symptoms was measured by using the 22-item Sino-Nasal Outcome Test (SNOT-22). The severity of nasal obstruction was measured by using the Nasal Obstruction Severity Evaluation (NOSE) scale. Each participant also completed a Rhinitis Control Assessment Test (RCAT). Results The total SNOT-22 score was significantly correlated with RCAT (r = -0.68 [95% confidence interval {CI}, -0.75 to -0.58]; p < 0.001) and EQ-5D VAS (r = -0.44 [95% CI, -0.56 to -0.30]; p < 0.001). Of the 22 symptoms assessed on the SNOT-22, sleep-related symptoms, and otologic symptoms were associated with the greatest decrease in general health–related QOL. Nasal symptoms were least associated with general health–related QOL. The symptom of nasal obstruction was not at all associated with general health–related QOL (p = 0.267). We confirmed this finding by showing no significant correlation between the NOSE score and EQ-5D VAS (r = -0.05 [95% CI, -0.21 to 0.12]; p = 0.582). Conclusion Sleep and otologic symptoms were associated with the greatest negative impact on QOL in adults with persistent allergic rhinitis and should be routinely assessed in their clinical evaluation.

A validated model for the 22-item Sino-Nasal Outcome Test subdomain structure in chronic rhinosinusitis

Previous studies have identified subdomains of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), reflecting distinct and largely independent categories of chronic rhinosinusitis (CRS) symptoms. However, no study has validated the subdomain structure of the SNOT‐22. This study aims to validate the existence of underlying symptom subdomains of the SNOT‐22 using confirmatory factor analysis (CFA) and to develop a subdomain model that practitioners and researchers can use to describe CRS symptomatology.

Association between systemic antibiotic and corticosteroid use for chronic rhinosinusitis and quality of life

We sought to establish the significance of querying chronic rhinosinusitis (CRS) patients about their past CRS‐related oral antibiotic and corticosteroid usage by determining the association between these metrics and patients’ quality of life (QoL).

The 22-item Sino-Nasal Outcome Test accurately reflects patient-reported control of chronic rhinosinusitis symptomatology

Patient‐reported control of chronic rhinosinusitis (CRS) symptoms is associated with the quality of life impact of CRS. We sought to determine if 22‐item Sino‐Nasal Outcome Test (SNOT‐22) score is predictive of patient‐perceived CRS symptom control.

Patient-reported control of chronic rhinosinusitis symptoms is positively associated with general health-related quality of life

In chronic rhinosinusitis (CRS), although patient‐reported severity of sinonasal symptoms is significantly associated with diminishment of patients’ general health‐related quality of life (QOL), it remains unclear whether patient‐perceived control of CRS symptomatology is associated with patients’ QOL. In this study, we sought to determine the association between patient‐perceived control of CRS symptomatology and QOL.

Massive, destructive, dentigerous cyst: A case report☆☆☆★

Dentigerous cysts are relatively common odontogenic abnormalities that develop around unerupted maxillary or mandibular teeth. These are often asymptomatic and found incidentally on dental radiographs. Occasionally, they can be large and cause symptoms related to expansion and impingement on contiguous structures. Herein we present the first reported case to our knowledge of a maxillary dentigerous cyst presenting as a bleeding intraoral mass with associated extensive maxillary destruction.

Relationship between chronic rhinosinusitis exacerbation frequency and asthma control

To determine the association between the frequency of acute chronic rhinosinusitis (CRS) exacerbations (AECRS) and the degree of asthma control in asthmatic CRS patients.

Reversal of Smoking Effects on Chronic Rhinosinusitis after Smoking Cessation

Objective To understand whether the impact of smoking on chronic rhinosinusitis (CRS) is reversible after smoking cessation. Study Design Cross-sectional study. Setting Academic tertiary care rhinology clinic. Subjects and Methods A total of 103 former-smoker CRS patients and 103 nonsmoker CRS patients were prospectively recruited. The primary outcome measure was sinonasal symptom severity measured with the 22-item Sinonasal Outcomes Test (SNOT-22), and secondary outcome measures were general health-related quality of life (QOL) measured with the 5-dimensional EuroQol visual analog scale (EQ-5D VAS) and patient-reported CRS-related antibiotic and oral corticosteroid usage in the past year. Outcome measures were compared between cohorts and checked for association with time since cessation of smoking for former smokers. Results Compared with nonsmokers, former smokers had worse SNOT-22 score (P = .019) and EQ-5D VAS score (P = .001) and reported using more CRS-related antibiotics (P = .003) and oral corticosteroids in the past year (P = .013). In former smokers, every year was associated with a statistically significant improvement in SNOT-22 score (β = −0.48; 95% CI, −0.91 to −0.05; P = .032), EQ-5D VAS score (β = 0.46; 95% CI, 0.02-0.91; P = .046), and CRS-related oral corticosteroid use (relative risk = 0.95; 95% CI, 0.91-0.98; P = .001). Given the differences in our study outcome measures between former smokers and nonsmokers, we estimate that the reversible impacts of smoking on CRS may resolve after 10 to 20 years. Conclusions CRS patients who are former smokers have worse sinonasal symptomatology, QOL, and CRS-related medication usage than nonsmokers. Every year since cessation of smoking is associated improvements in sinonasal symptomatology, QOL, and CRS-related oral corticosteroid use, potentially reaching nonsmoker levels after 10 to 20 years.

Aeroallergen sensitivities and development of chronic rhinosinusitis in 13 adults who initially had allergic rhinitis.

• Post-thyroidectomy haemorrhage is an uncommon, but potentially lethal complication of thyroid surgery. The 4th BAETS audit data suggest a slightly higher rate of haemorrhage in those patients with Graves’ thyrotoxicosis, although this is statistically insignificant. • During the time period analysed, 1280 thyroid operations were performed; 532 (42%) were total thyroidectomies, of which 244 (45.9%) were for Graves’ disease. • Pooled local data showed a postoperative haemorrhage rateof 2.11%(Twenty sevenpatients). Subgroupanalysis showed preponderance towards haemorrhage in those with Graves’ disease compared to those with nonGraves’ disease (OR 3.95, 95%CI 1.83–8.50,P < 0.001). • Theaverage time todiagnosis of significanthaemorrhage was 9.7 hours, with one-third of diagnoses occurring after 24 h. Local haemorrhage rates differed significantly from those of the BAETS audit (v P < 0.001). • Patients with Graves’ disease are significantly more likely to bleed postoperatively than those without Graves’ disease. In almost one half of all cases of haemorrhage, no specific bleeding point can be found upon return to theatre. Conflict of interest

Smoking: An independent risk factor for lost productivity in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is associated with a significant loss of patient productivity that costs billions of dollars every year. Smoking is associated with worsening sinonasal symptoms, but its effect on lost productivity in CRS patients has yet to be described. Therefore, we sought to determine the association between smoking and productivity in patients with CRS.