Robert Slack

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 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.

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.

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.

Three-dimensional structure of the nasal passageway of a hagfish and its implications for olfaction.

From high‐resolution (65 μm) data acquired by magnetic resonance imaging, we have reconstructed the nasal passageway of a single adult hagfish specimen (probably Eptatretus stoutii). We have used this reconstruction to investigate how the anatomy and morphometry of the nasal passageway influence the olfactory ability of the hagfish. We found that the long, broad section of the passageway preceding the nasal chamber will delay the response to an odor by 1–2 s. Diffusion of odorant to the olfactory epithelium, on which the olfactory sensitivity of an animal depends, will be favored by the relatively large surface area of the olfactory epithelium (∼140 mm2) and a modest expansion in the nasal chamber. Oscillating flow (0.3–0.4 Hz) within the narrow (65–130 μm) sensory channels of the nasal chamber is laminar (Reynolds number ∼ 5) and quasi‐steady (Womersley number generally less than one). Distribution of flow over the olfactory epithelium may be aided by: (a) a narrowing before the nasal chamber; (b) partial blockage of the nasal passageway by a protrusion on the central olfactory lamella; and (c) the inward inclination of the olfactory lamellae. Anat Rec,, 2011.

Variation in day‐case nasal surgery – why cannot we improve our day‐case rates?

Objectives:  The NHS plan states that 75% of all elective operations should be performed as day‐cases. We set out to evaluate day surgery rates in sinonasal surgery and to identify factors limiting current practice.

Are men really more full of SNOT

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Patient Outcome after Sino-Nasal Surgery: A Large Prospective Cohort Study

Abstract Problem: This study estimated the safety and effectiveness of surgery to relieve the symptoms associated with rhinosinusitis and nasal polyposis. Methods: For this study 3128 consecutive patients undergoing surgery for nasal polyposis or rhinosinusitis at 87 hospitals were prospectively enrolled. Data on patient prognostic factors were collected at the time of surgery. Outcomes data were collected at 3, 12, and 36 months postsurgery. A patient-centered outcome instrument, the SNOT-22, was used as the main outcome measure. Data on patient satisfaction, revision surgery, and adverse events were also collected. Results: There were no adverse events reported in 93.4% of procedures. The CSF leak rate was 0.064% and the periorbital haematoma rate was 0.2% with no long-term visual problems. There is a statistically significant decrease in patient-reported symptomatology as measured by the SNOT-22 from the preoperative period to both 3 and 12 months. The average effect size at 12 months was 0.7 SD. Asthma, previous surgery, and less extensive polyposis were the strongest independent predictors of higher postoperative symptomatology in a multivariate analysis. Nearly one third of patients undergoing sinus surgery had Lund-Mackay scores less than 4, lower than the normal population. In 3.9% of the patients surgery was performed in the virtual absence of symptoms, and 8.6% of the patients had had or were awaiting revision surgery at 12 months. Full results for the 36-month follow-up period are currently being analyzed and will be presented. Conclusion: Sino-nasal surgery is generally safe and effective. Greatest symptom reduction is seen with primary surgery for patients with extensive nasal polyposis. Greater attention should be paid to patient-reported symptoms when selecting patients for surgery. Significance: This is the largest study of its kind to date and provides a unique estimate of the safety and effectiveness of sino-nasal surgery from the perspective of the patient. Support: The study was funded by a standard contribution from each participating hospital. Funding was also received from the British Association of Otorhinolaryngologists-Head and Neck Surgeons and from GlaxoSmithKline Ltd.