Margalith van Huiden
Department of Otorhinolaryngology
Room: D2-312
Meibergdreef 9
1105AZ Amsterdam
The Netherlands
m.b.vanhuiden@amc.uva.nl
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INTRODUCTION: The Lund-MacKay score (LMS) correlates poorly with chronic rhinosinusitis (CRS) symptom severity. Patients with CRS also tend to report relatively lower levels of mental wellbeing. Our purpose was to determine if there is a correlation between socio-economic status (SES) and CRS severity as measured by the LMS, and if there is an association between depression symptoms and the severity of CRS using the LMS.
METHODS: A total of 127 patients diagnosed with CRS were prospectively recruited and assessed with a sinonasal assessment questionnaire (SNAQ-11), and the Patient Health Questionnaire (PHQ-9) for depression. Each patient’s education level, family income, and smoking behavior were determined. The sinus CT scan was scored using the LMS. The data were analyzed using ordinary least squares (OLS) regression techniques.
RESULTS: Having a highschool education or less was associated with higher SNAQ-11 scores while being a daily smoker was associated with higher SNAQ-11 scores. There was no significant relationship between educational attainment, financial income or daily smoking and sinus CT score. Including depression scores in the SNAQ-11, regression equations indicated a significant and positive relationship between depression severity and SNAQ-11 score. CRS with polyps was negatively associated with SNAQ-11 scores but, as expected, it was positively associated with a higher LMS.
CONCLUSIONS: Lower SES status is a negative modifying factor of subjective CRS severity but it has no impact on the LMS. Depression symptoms are associated with increased subjective CRS severity but they have no effect on the LMS. How SES and depression impact on a patient’s self-reported disease severity requires further study.
The differences in the shape and size of the nose have been proposed to be an adaptation to climate with broad noses (platyrrhine) evolving in a warm humid environment where there was little need for air conditioning and narrow noses (leptorrhine) evolving in colder climates where the air needed more warming. The main aim of this research was to determine if there was any relationship between the shape of the nose as expressed in terms of nasal height and width (nasal index) and total nasal airway resistance (NAR), as one would predict that the narrower leptorrhine noses would have a greater resistance to air flow than the broader platyrrhine noses. It was also proposed that the narrow leptorrhine nose would have better developed vascular tissue than the broad platyrrhine nose in order to condition cold air, and would exhibit a greater response to nasal decongestion. No correlation was found between nasal index and NAR (r = -0.09) and similarly no correlation was found between nasal index and response to a topical nasal decongestant (r = 0.02). The absence of any physiological differences between the different nose types may be due to acclimatisation of participants to the area of recruitment.
BACKGROUND: Although oral steroids are widely used for the treatment of nasal polyposis, a subset of patients shows an unfavorable therapeutic outcome. The aim of this study was to evaluate the efficacy of a short course of oral prednisolone in nasal polyposis and to evaluate which, if any, clinical variables can predict treatment outcome in these patients.
METHODOLOGY/PRINCIPAL: Using a 3:2 randomization ratio, 63 patients with nasal polyposis received 50 mg of prednisolone and 46 patients received placebo daily for 14 days. Clinical response was evaluated by total nasal symptoms score (TNSS), peak expiratory flow index (PEFI) and total nasal polyps score (TNPS). Potential predictor variables were assessed by clinical history, nasal endoscopy, allergy skin test and sinus radiography.
RESULTS: The prednisolone-treated group showed significantly greater improvements in all nasal symptoms, nasal flow and polyp size than the placebo-treated group (p < 0.001, all). In the prednisolone-treated group, patients with grade 3 polyps and positive nasal endoscopy showed significantly less improvement in TNSS, PEFI and TNPS than patients with grades 1-2 size and with negative nasal endoscopy.
CONCLUSIONS: A short course of oral steroids showed good clinical efficacy in the treatment of nasal polyposis, however, polyps size grade 3 and/or positive nasal endoscopy predispose to a poorer treatment outcome.
OBJECTIVE: The purpose of this study was to explore the influence of smoking on long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis.
METHODS: The study prospectively enrolled 274 patients at the Department of Otolaryngology of the Warsaw Medical University from 1993 to 2000. All patients were diagnosed with chronic rhinosinusitis and scheduled for the endoscopic sinus surgery. We evaluated subgroups of patients with respect to bronchial asthma, allergy, aspirin triad, gastro-esophageal reflux disease and nasal septal deviation. Patients were divided into smokers and non-smokers. Patient CT scan results were recorded according to the four-grade classification system by Kennedy. Patients were observed over a period between 2 to 9 years following the surgical intervention and had their surgery revised if the severity of symptoms were at the same level or worsened.
RESULTS: Prior to endoscopic sinus surgery, 23% of smokers and 20% of non-smokers scored III or IV on the Kennedy Scale. The revision ESS was carried out in 27 patients. In this group there were 20% smokers and 7% non-smokers, with the difference being significant. There was no significant difference in the postoperative quality of life scale scores.
CONCLUSIONS: The study shows that while smoking did not influence preoperative symptoms, smokers had worse postoperative outcomes.
In the United Kingdom this time of year is traditionally the occasion for a very particular entertainment, the Christmas pantomime. One of the most popular subjects for this comedy pastiche of fairy tale and morality play is the story of Cinderella, that archetypal tale of ‘rags to riches’. Whilst the analogy may seem a little far-fetched, olfaction is not infrequently referred to as the ‘Cinderella of the senses’ presumably as it is perceived as receiving less attention than the other senses so it is perhaps appropriate that this December issue should contain a number of publications on this topic.
Smell influences our lives from conception to death, our very survival may depend on it and yet it is interesting to reflect that whilst Nobel prizes were given in the early 1960’s for the discovery of the rod and cone mechanism in the eye and to von Bekesy for his work on hearing, it was not until 2004 that Richard Axel and Linda Buck received the Nobel Prize in
Physiology or Medicine for discovering olfactory receptor proteins which make up the largest gene family thus discovered.