Jose L. Mattos

Trends in common rhinologic illnesses: Analysis of U.S. healthcare surveys 1995–2007†

Up to date information on the epidemiology of, and recent changes in, allergic rhinitis (AR), acute sinusitis (AS), and chronic sinusitis (CS) office and emergency department (ED) visits and prevalence is sparse. Current studies may quote data that is outdated or based solely on patient self‐report. The purpose of this work was to describe basic epidemiologic measures of office and ED visits for AR, AS, and CS between 1995 and 2007, and to analyze trends over time for each of these diseases.

Rhinology-specific priority setting for quality improvement: a modified Delphi study from the Quality Improvement Committee of the American Rhinologic Society

Improving the quality of healthcare is a complex and resource intensive process. To optimize the allocation of scarce resources, quality improvement (QI) should focus on high‐value diseases that will produce the largest improvement in health system performance. Given the breadth and multidisciplinary nature of sinonasal disease management, the purpose of this study was to transparently develop a prioritized list of sinonasal diseases for QI from the perspective of the specialty of rhinology and the American Rhinologic Society (ARS).

Taste impairment in chronic rhinosinusitis

Though many patients with chronic rhinosinusitis (CRS) describe disturbances in smell and taste, there have been no studies specifically assessing taste impairment in CRS. This study sought to objectively assess taste dysfunction in CRS patients and determine whether taste impairment correlates with olfactory dysfunction. Additionally, this investigation sought to determine the impact of taste dysfunction on quality of life (QOL) in CRS and identify the clinical factors that influence taste.

Systematic Review and Meta-analysis of SNOT-22 Outcomes after Surgery for Chronic Rhinosinusitis with Nasal Polyposis

Objective Wide variation exists regarding reported outcomes after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). This study seeks to combine data across studies to generate a summary measure and explore factors that might lead to variation. Data Sources OVID Medline, Scopus, EbscoHost, Database of Abstracts and Reviews of Effects, Health Technology Assessment, and National Health Service Economic Evaluation Database. Review Methods A search was performed following the PRISMA guidelines. Two independent researchers conducted a search using the mentioned data sources. Studies published before August 29, 2016, that involved ESS to treat CRSwNP were included. Mean changes in Sinonasal Outcome Test–22 (SNOT-22) scores were determined through metaregression of the following independent variables: publication year, sex, age, allergy status, asthma, tobacco use, prior surgery, follow-up length, and preoperative SNOT-22. Results Fifteen articles with 3048 patients treated with ESS met inclusion criteria. Pooled analyses of SNOT-22 scores revealed a mean change of 23.0 points (95% CI, 20.2-25.8; P < .001). A metaregression of patient factor effects on the mean change of SNOT-22 scores demonstrated that age (r = 0.71, P = .01), asthma (r = 0.21, P = .01), prior ESS (r = 0.29, P = .01), and preoperative SNOT-22 score (r = 0.4, P < .01) correlated with greater improvement in SNOT-22 scores. Tobacco use (r = −0.91, P = .01) and longer lengths of follow-up (r = −0.45, P < .01) were associated with less improvement in SNOT-22 scores. Conclusions Quality-of-life outcomes are significantly improved after ESS among patients with CRSwNP. Patient-specific factors may affect the degree of SNOT-22 change after surgery.

A framework for quality measurement in the presurgical care of chronic rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society: A framework for quality measurement in the presurgical care in CRS

Quality improvement (QI) in the management of chronic rhinosinusitis (CRS) is garnering increasing attention. Defining frameworks and metrics to assess the quality of key components in CRS management could assist in reducing unwarranted practice variation and increase high‐quality care.

Establishing the minimal clinically important difference for the Questionnaire of Olfactory Disorders.

Olfactory‐specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders Negative Statements (QOD‐NS). Changes in the QOD‐NS after treatment can be difficult to interpret since there is no standardized definition of clinically meaningful improvement.

Novel Radiographic Assessment of the Cribriform Plate

Background The cribriform plate (CP) is a common site of spontaneous cerebrospinal fluid (SCSF) leaks. Radiographic assessment of the anterior and lateral skull base has shown thinner bone in patients with SCSFs; however, prior assessment of the CP has required postmortem cadaver dissection. Objective To develop novel radiographic techniques to assess the anatomy of the CP. Methods Computed tomography (CT) scans were performed on cadaveric specimens. Bone density and anatomy of a predefined volume of interest of the posterior CP were assessed by two independent reviewers. CT assessment of olfactory foramina was also performed and validated using anatomic dissection of cadaver specimens. Results Interclass correlation coefficients (ICCs) for measuring the same volume of each CP was 0.96, confirming reproducible anatomic localization. Cadaver CPs had a mean Hounsfield units of 263, indicating a mix of bone and soft tissue, and ICC was 0.98, confirming reproducible radiographic measurements. Optimal CT estimates of bone composition of CPs averaged 85% (range 76% to 96%) compared to actual anatomic dissection which averaged 84% bone (range 74% to 91%, r = .690, P = .026). Conclusion Our novel, noninvasive CT method for assessing CP anatomy is reproducible and correlates with anatomic dissection assessing bone composition. The clinical implications of anatomic changes in the CP are an area for further study.

Gene Markers as Predictors of Nodal Metastasis and Outcome

Objective: 1) Investigate the correlation between percentage of metastatic tumor in lymph nodes from patients with squamous cell carcinoma (SCC) of the head and neck and level of expression of 3 marker genes: pemphigus vulgaris antigen (PVA), parathyroid hormone related peptide (PTHrP), and tumor-associated calcium signal transducer (TACSTD1). 2.) Understand the relation of these markers and clinical outcomes. Method: Four hundred forty-eight grossly negative lymph nodes from 92 patients with SCC were evaluated for expression of the gene markers PVA, PTHrP, and TACSTD1 using real-time PCR. Confirmation of metastasis was determined by histological examination. The expression of these markers was analyzed versus tumor percentage using correlation and linear regression. Results: All 3 markers were studied independently and were statistically significant predictors of tumor percentage in the lymph nodes at a significance level of 0.05. PVA had the strongest correlation with tumor percent with a correlation coefficient of 0.68, an r squared of 0.46, and a P value <.001. PTHrP had a correlation coefficient of 0.39, r squared of 0.16, and a P value of .003. TACSTD1 had a correlation coefficient of 0.38, r squared of 0.15, and a P value of .004. Conclusion: All 3 markers are statistically significant predictors of percent tumor in grossly negative lymph nodes. PVA had the strongest correlation. Further analysis will include a multivariate regression to account for possible confounding. Since expression correlates with tumor percent, we expect that expression levels will also correlate with clinical outcomes.