The use of the 4-subdomain structure for SNOT-22 (reflecting sleep, nasal, otologic/facial pain, and emotional symptoms of CRS) was validated as the most appropriate to calculate SNOT-22 subdomain scores for patients from different geographic regions using CFA.

No abstract

Based on our results, we propose a SNOT-22 MCID of 12 in medically managed patients with CRS. The MCID, while specific, was not sensitive for identifying patients with CRS experiencing a noticeable improvement in sinus symptoms or general health.

Different types of CRS symptoms - most prominently otologic/facial pain and sleep-related symptoms - and their underlying pathophysiologic mechanisms may differentially affect the general health-related QOL detriment associated with CRS. These findings raise the possibility that treatment of the various symptoms associated with CRS may lead to differential improvement in general-health related QOL.

ObjectivesThe concept of disease control incorporates independent disease characteristics that are longitudinally reflective of disease status and which can be used to make treatment decisions. Chronic rhinosinusitis (CRS) is a chronic condition for which the determination of disease control by both the patient and the treating physician is important. Our objectives were to determine CRS disease characteristics that are associated with patient‐reported and physician‐rated CRS disease control.Study TypeCross‐sectional.MethodsA total of 209 participants were prospectively recruited. Participants were asked to rate their global level of CRS control as “not at all,” “a little,” “somewhat,” “very,” and “completely.” All participants completed a 22‐item Sinonasal Outcome Test (SNOT‐22) and also reported the number of sinus infections, CRS‐related antibiotic courses taken, CRS‐related oral corticosteroid courses taken, and missed days of work or school due to CRS, all in the last 3 months. Clinical and demographic characteristics were also collected from each participant. A Lund‐Kennedy endoscopy score was calculated for each participant from nasal endoscopy. Two rhinologists were then given each participant's SNOT‐22 score (as well as SNOT‐22 nasal, sleep, otologic/facial pain, and emotional subdomain scores), endoscopy score, and the number of sinus infections, CRS‐related antibiotics, CRS‐related oral corticosteroid courses and missed days of work or school due to CRS in the preceding 3 months as reported by the patient. The two rhinologists were blinded to all other participant characteristics and each rhinologist independently rated every participant's global control level as “not at all,” “a little,” “somewhat,” “very,” and “completely.” Associations were sought between CRS disease characteristics (SNOT‐22 score, endoscopy score, sinus infections, CRS‐related antibiotic usage, CRS‐related oral corticosteroid usage, and lost productivity due to CRS) and patient‐reported CRS control as well as mean physician‐rated CRS control.ResultsPatient‐reported global CRS control was associated only with SNOT‐22 (adjusted relative risk [RR] = 0.99, 95% CI: 0.98–0.99, P < .001) but no other CRS disease characteristic. Patient‐reported CRS control was specifically associated only with nasal symptoms and not extra‐nasal symptoms of CRS. Physician‐rated CRS control was associated with SNOT‐22 score (adjusted RR [for each 1‐unit increase of SNOT‐22] = 0.99, 95% CI: 0.98–0.99, P < .001), number of acute bacterial CRS exacerbations—reflected by number of antibiotic courses taken (or sinus infections)—in the last 3 months (adjusted RR = 0.89, 95% CI: 0.82–0.98, P = .014) and the number of CRS‐related oral corticosteroid courses taken in the last 3 months (adjusted RR = 0.87, 95% CI: 0.78–0.97, P = .012). Nasal, sleep, and otologic/facial pain symptoms were all associated with physician‐rated CRS control. Having used at least one course of antibiotics or oral corticosteroids in the last 3 months was the optimal threshold for detecting po...

2c. Laryngoscope, 128:1033-1038, 2018.

Background: The degree to which different sinonasal symptoms contribute to the overall quality of life (QOL) detriment in chronic rhinosinusitis (CRS) patients remains unknown. In this study we sought to characterize the effect of different CRS symptoms on the general health-related QOL in patients. Methodology: We performed a prospective cross-sectional study of 131 adult patients with CRS. Sinonasal symptoms were evaluated using the 22-item Sinonasal Outcomes Test (SNOT-22) and general health-related QOL was evaluated using the EuroQol 5-Dimensional general health-related QOL survey (EQ5D) and visual analog scale (EQ5D-VAS). Health utility values (HUV) were determined using responses to the EQ5D. SNOT-22 scores were broken down into subdomain scores for sleep, nasal, otologic/facial pain and emotional function symptoms. Results: The otologic/facial pain subdomain score consistently had the largest impact on EQ5D-VAS and HUV. After otologic/facial pain, the sleep subdomain score had the second largest effect while the nasal subdomain score had the least impact on general health-related QOL. Conclusions: Different types of CRS symptoms - most prominently otologic/facial pain and sleep-related symptoms - and their underlying pathophysiologic mechanisms may differentially affect the general health-related QOL detriment associated with CRS. These findings raise the possibility that treatment of the various symptoms associated with CRS may lead to differential improvement in general-health related QOL.

Responsiveness and minimal clinically important difference for the EQ-5D in chronic rhinosinusitis* Background: The 5-dimensional EuroQol questionnaire (EQ-5D) is validated to measure general health-related quality of life (QOL). Our objective was to determine the responsiveness and minimal clinically important difference (MCID) of the EQ-5D health utility value (EQ-5D HUV) and visual analog scale (EQ-5D VAS) in chronic rhinosinusitis (CRS).Methods: 203 adults undergoing medical management for CRS were prospectively recruited. General health-related QOL (using EQ-5D HUV and EQ-5D VAS) and CRS-specific QOL (using the 22-item Sinonasal Outcome Test ) were measured at enrollment and a subsequent follow-up time point 2-12 months later. At follow-up, participants also rated change in general health as "Much worse", "A little worse", "About the same", "A little better" or "Much better" compared to enrollment. The EQ-5D HUV and EQ-5D VAS MCIDs were calculated using distribution-based, anchor-based, and receiver operator characteristic (ROC) curve-based methods.Results: Change in SNOT-22 score was correlated with EQ-5D HUV and EQ-5D VAS change. Using the different methods of calculating MCID, we find the EQ-5D HUV MCID to be 0.04 and EQ-5D VAS MCID to be 8.0. The calculated EQ-5D MCIDs had approximately a sensitivity of 40-50% and specificity of 80% in detecting patients experiencing noticeable improvement in general health. Conclusions:The EQ-5D responds well to changing CRS symptomatology. We propose MCIDs for EQ-5D HUV of 0.04 and EQ-5D VAS of 8 in CRS patients, which although specific, are not sensitive for detecting patients experiencing improvement in general health.