Sino‐Nasal outcome test‐22 outcomes after sinus surgery: A systematic review and meta‐analysis

Soler, Zachary M.; Jones, Rabun; Le, Phong T.; Rudmik, Luke; Mattos, José L.; Nguyen, Shaun A.; Schlosser, Rodney J.

doi:10.1002/lary.27008

Cited by 95 publications

(98 citation statements)

References 94 publications

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“…found durable improvement in SNOT‐22 following FESS for CRS. Prior studies have found that patients with higher preoperative SNOT‐22 scores and a history of asthma demonstrate more improvement in their quality of life following surgery . This relationship of improvement to asthma did not reach statistical significance in our study.…”

Section: Discussioncontrasting

confidence: 90%

Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery

Khanwalkar

Shen

Kern

et al. 2018

Int Forum Allergy Rhinol

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Background Whether for research or quality improvement, assessment of postoperative quality of life outcomes faces a challenge in reliable data collection. Typical coordinator‐led studies cite response rates from 35% to 70%. This study evaluates the utility of a digital patient engagement platform to track patient‐reported outcome measures (PROMs) following septoplasty and functional endoscopic sinus surgery (FESS). Methods A prospective cohort was recruited at a tertiary care center from January 2017 to March 2018. A mobile phone application relayed PROMs, including pain (assessed on a 0 to 10 visual analogue scale [VAS] every other day for 2 weeks, as well as the patient‐reported outcome measure information system [PROMIS] pain interference short form 4a at baseline, 2 weeks, and 3 months) and timing of return to work. Results Of 288 patients enrolled, 249 (86.5%) provided clinical data, including 208 who underwent septoplasty or FESS. Granular VAS scores, submitted by 195 patients, demonstrated 80% of these patients achieved minimal pain by postoperative day 8. A nonsignificant trend of increased days to pain relief by procedure emerged: septoplasty (mean ± standard deviation [SD], 3.60 ± 2.44), FESS (3.96 ± 3.25), FESS with septoplasty (4.40 ± 3.04), and FESS with drilling (4.86 ± 3.68). Across procedures, PROMIS pain interference increased at 2 weeks (9.17 ± 4.15) and decreased at 3 months (5.32 ± 2.61) compared with baseline (7.09 ± 4.63), with greater improvement noted in the FESS subgroup at 3 months. Patients returned to work at mean 7.1 days regardless of procedure. Conclusions With its high response rate, mobile digital patient engagement platforms may effectively track postoperative outcomes with the potential for reduced sample bias.

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Section: Discussioncontrasting

confidence: 90%

Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery

Khanwalkar

Shen

Kern

et al. 2018

Int Forum Allergy Rhinol

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“…Although the questionnaire may be a good resource for evaluating QOL in CF patients, it has not been validated for this purpose . As alluded to in the opening paragraph of the discussion, baseline SNOT‐20 scores in this cohort of patients are much lower than what is typically observed in standard CRS patients, in which average baseline SNOT‐22 scores are generally greater than 40 . This, in addition to the lack of a validated questionnaire to specifically target sinonasal QOL in the CF population, makes assessment of this patient population difficult, and highlights the importance of development of a sinus‐specific QOL instrument for use in the CF population.…”

Section: Discussionmentioning

confidence: 93%

Ivacaftor improves rhinologic, psychologic, and sleep‐related quality of life in G551D cystic fibrosis patients

McCormick

Cho

Lampkin

et al. 2018

Int Forum Allergy Rhinol

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Background Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator that improves pulmonary function in cystic fibrosis (CF) patients with at least 1 copy of the G551D CFTR mutation. The purpose of this study is to evaluate the impact of ivacaftor on chronic rhinosinusitis (CRS) symptoms in this population. Methods The G551D Observational (GOAL) study was a multicenter prospective cohort study enrolling CF patients ≥6 years with at least 1 G551D mutation. Subjects were provided 20‐item Sino‐Nasal Outcome Test (SNOT‐20) questionnaires prior to ivacaftor therapy and at 1, 3, and 6 months afterward. The impact on rhinologic (R), psychological (P), sleep (S), and ear/facial (E) quality of life (QOL) domains was evaluated separately. Results Of 153 subjects, 129 (84%) completed all questionnaires. Typical baseline symptom burden was low (75% with scores <1) and degree of improvement (ie, reduced scores) was greater with higher baseline scores. SNOT‐20 decreased, reflecting improvement, at all follow‐up intervals (1 month: [mean change ± standard deviation] –0.25 ± 0.53, p < 0.01; 3 months; –0.29 ± 0.58, p < 0.01; 6 months: –0.21 ± 0.58, p = 0.02), but less than the prespecified minimal clinically important difference (0.8). Significant improvement was observed at 1, 3, and 6 months in the R domain (1 month: –0.24, p < 0.01; 3 months: –0.34, p < 0.01; 6 months: –0.25, p < 0.01) and P domain (1 month: –0.25, p < 0.01; 3 months: –0.32, p < 0.01; 6 months: –0.26, p < 0.01), and 1 and 3 months in the S domain (1 months: –0.35, p < 0.01; 3 months: –0.32, p < 0.01; 6 months: –0.18, p = 0.07). There was no improvement in the E domain at any time point. Conclusion Ivacaftor improves QOL in the R, P, and S domains in G551D CF patients, although QOL instruments validated for CRS may not translate well to CF CRS patients because symptom burden was surprisingly low.

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“…Furthermore, patients with eosinophil counts ≤10 per HPF had lower preoperative SNOT‐22 scores, and may have decreased ability for improvement as measured by SNOT‐22 scores. Preoperative SNOT‐22 scores have been recognized as an important factor influencing symptom score change following ESS . The presence of fibrosis, however, remained statistically significant in multivariable analysis, and preoperative SNOT‐22 scores were not different.…”

Section: Discussionmentioning

confidence: 91%

A structured histopathology‐based analysis of surgical outcomes in chronic rhinosinusitis with and without nasal polyps

Marino

García

Zarka

et al. 2019

Laryngoscope Investig Oto

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Objectives Structured histopathology reporting has been recently described for detailing immunopathological characteristics of chronic rhinosinusitis (CRS), and can be utilized for subtyping CRS and personalizing management. This study scrutinized elements of structured histopathology to identify characteristics that prognosticate outcomes following endoscopic sinus surgery (ESS) for CRS patients with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). Methods Outcomes following ESS were measured using the patient‐reported 22‐item sinonasal outcome test (SNOT‐22). Changes in total SNOT‐22 scores at 6 and 12 months postoperatively were analyzed. Thirteen parameters reported in structured histopathology of sinus surgical tissue were studied for association with outcomes postsurgery. The overall cohort of all CRS patients was studied, along with subgroup analyses of CRSwNP and CRSsNP patients. Results In the entire CRS cohort (n = 171), eosinophil count >10 per high power field (HPF) was associated with greater improvement in SNOT‐22 scores at 6 months post‐ESS (P = .039). At 12 months follow‐up, no histopathological characteristic was associated with change in total SNOT‐22 score. In the CRSwNP (n = 66) subgroup, the presence of fibrosis (P = .006) and eosinophil count ≤10 per HPF (P = .025) were associated with less favorable changes in SNOT‐22 scores at 12 months follow‐up. Fibrosis remained statistically significant in multivariable analysis (P = .007). Conclusions At 6 months post‐ESS, tissue eosinophilia is associated with significantly higher improvement in SNOT‐22 scores, but this difference is diluted by 12 months. Fibrosis was associated with less favorable outcomes in SNOT‐22 scores for CRSwNP patients at 12 months and may be a prognosticator for poorer long‐term outcomes. Level of Evidence 4

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Sino‐Nasal outcome test‐22 outcomes after sinus surgery: A systematic review and meta‐analysis

Cited by 95 publications

References 94 publications

Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery

Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery

Ivacaftor improves rhinologic, psychologic, and sleep‐related quality of life in G551D cystic fibrosis patients

A structured histopathology‐based analysis of surgical outcomes in chronic rhinosinusitis with and without nasal polyps

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