Evaluation of the Medical and Surgical Treatment Of Chronic Rhinosinusitis: A Prospective, Randomised, Controlled Trial
ABSTRACT Objectives: To conduct the first prospective, randomized, controlled trial evaluating and comparing the medical and surgical treatment of polypoid and nonpolypoid chronic rhinosinusitis (CRS).Materials and Methods: Ninety patients with CRS were equally randomized either to medical or surgical therapy. All patients underwent pre- and posttreatment assessments of visual analogue score (VAS), the Sinonasal Outcome Test-20 (SNOT-20), the Short Form 36 Health Survey (SF-36), nitric oxide (NO), acoustic rhinometry, saccharine clearance time (SCT), and nasal endoscopy. Each patient had three assessments: before starting the treatment, after 6 months, and, finally, after 1 year.Results: Both the medical and surgical treatment of CRS significantly improved almost all the subjective and objective parameters of CRS (P < .01), with no significant difference being found between the medical and surgical groups (P > .05), except for the total nasal volume in CRS (P < .01) and CRS without polyposis (P < .01) groups, in which the surgical treatment demonstrated greater changes.Conclusion: CRS should be initially targeted with maximal medical therapy (e.g., a 3 month course of a macrolide antibiotic, douche, and topical steroid), with surgical treatment being reserved for cases refractory to medical therapy. The presence of nasal polyps is not a poor prognostic factor for the efficacy of CRS therapy, either surgical or medical.
SourceAvailable from: PubMed CentralThe Ulster medical journal 01/2014; 83(3):205.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 10/2014; 113(4):347-85. DOI:10.1016/j.anai.2014.07.025 · 2.75 Impact Factor
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ABSTRACT: ObjectivesENT surgeons are facing an ever-increasing demand to demonstrate their efficacy. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a fully validated and easy-to-use outcome measure in rhinology. Our goal was to translate and validate the SNOT-22 in a cohort of 422 French-speaking subjects.Design, Setting and ParticipantsThe French version of the SNOT-22 was obtained by forward and backward translations by 6 independent interpreters. Five experienced rhinologists compared the translations to each other and a group of 12 naive patients selected the most appropriate translation of each item. To evaluate this questionnaire, we conducted a prospective cohort study on 376 rhinological patients and 46 healthy volunteers in 3 University-affiliated teaching Hospitals.Main outcome measuresreproducibility (test–retest reliability), internal consistency, known group differences, responsiveness to treatment, validity and correlation to other clinical instruments (visual analogue scale, Nasal Obstruction Symptoms Evaluation score and Lund-Mackay score).ResultsThe test–retest reliability coefficient was 0.78, indicating a good reliability when administering the instrument on two different occasions. The internal consistency was high with a Cronbach's alpha value of 0.93. Our questionnaire was able to detect differences between rhinological patients and control subjects (p<0.0001) and improved significantly after nose and sinus surgery (p<0.0001), indicating a good responsiveness. There was a relative correlation with visual analogue scale and NOSE score, but no correlation with Lund-Mackay score.Conclusion The SNOT-22 is a reliable and valid tool to assess quality of life in French-speaking patients and correlates well with known indices of disease severity.This article is protected by copyright. All rights reserved.Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 10/2014; 40(1). DOI:10.1111/coa.12315 · 2.27 Impact Factor