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      Assessment of quality of life after endoscopic sinus surgery for chronic rhinosinusitis

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          Abstract

          Chronic rhinosinusitis is a disease of undefined etiology that significantly impacts the quality of life of its patients. Various studies carried out in countries other than Brazil have shown endoscopic sinus surgery as an effective means of treating this condition.

          Objective

          This study aims to analyze, with the aid of SNOT-20, the association between endoscopic sinus surgery and disease-specific quality of life of Brazilian patients treated for chronic rhinosinusitis accompanied or not by nasal polyps.

          Materials and Methods

          This prospective study enrolled patients submitted to endoscopic sinus surgery after drug therapy failed to improve their symptoms. They were assessed based on questionnaire SNOT-20p before and 12 months after surgery. Improvement on total scores and on the five items deemed more important by each patient were assessed. The study also looked into the correlation between preoperative scores and postoperative improvement and if there were any gender-related improvement differences.

          Results

          Forty-three patients aged 44 (19), md (IQR), 65% of whom (26/43) were males. Statistically significant improvement was seen on SNOT-20 and SNOT-20(5+) and a correlation was established between preoperative scores and postoperative improved scores ( p<0.001). No gender-related differences were observed in quality of life.

          Conclusion

          Endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with statistically significant improvements in disease-specific quality of life.

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          Most cited references61

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          Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures

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            Psychometric validity of the 22-item Sinonasal Outcome Test.

            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 was a prospective cohort study collecting data on 3128 adult patients undergoing sinonasal surgery in 87 NHS hospitals in England and Wales. Data were collected preoperatively and at 3 months after surgery, and analysed to determine validity of the SNOT-22. Test-retest reliability was assessed in a separate cohort of patients in a single centre. The SNOT-22, a derivative of the SNOT-20 was the main outcome measure. Patients were also asked to report whether they felt better, the same or worse following surgery. To evaluate the SNOT-22, the internal consistency, responsiveness, known group differences and validity were analysed. Preoperative SNOT-22 scores were completed by 2803 patients. 3-month postoperative SNOT-22 scores were available for 2284 patients of all patients who completed a preoperative form (81.5% response rate). The Cronbach's alpha scores for the SNOT-22 were 0.91 indicating high internal consistency. The test-retest reliability coefficient was 0.93, indicating high reliability of repeated measures. The SNOT-22 was able to discriminate between patients known to suffer with chronic rhinosinusitis and a group of healthy controls (P < 0.0001, t = 85.3). It was also able to identify statistically significant differences in sub-groups of patients with chronic rhinosinusitis. There was a statistically significant (P < 0.0001, t = 39.94) decrease in patient reported SNOT-22 scores at 3 months. At 3 months the overall effect size in all patients was 0.81, which is considered large. We found the minimally important difference that is the smallest change in SNOT-22 score that can be detected by a patient, to be 8.9 points. We have found the SNOT-22 to be valid and easy to use. It can be used to facilitate routine clinical practice to highlight the impact of chronic rhinosinusitis on the patient's quality of life, and may also be used to measure the outcome of surgical intervention. The minimally important difference allows us to interpret scores in a clinical context, and may help to improve patient selection for surgery.
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              Guidelines for the process of cross-cultural adaptation of self-report measures

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                Author and article information

                Journal
                Braz J Otorhinolaryngol
                Braz J Otorhinolaryngol
                Brazilian Journal of Otorhinolaryngology
                Elsevier
                1808-8694
                1808-8686
                20 October 2015
                Mar-Apr 2012
                20 October 2015
                : 78
                : 2
                : 96-102
                Affiliations
                [a ]MD, ENT, PhD student at Faculdade de Medicina da USP
                [b ]MD, FACS (Professor of the Department of Otolaryngology-Head and Neck Surgery, Division of Clinical Outcomes Research, Washington University School of Medicine, St. Louis, MO 63110, USA)
                [c ]MD, ENT (Fellow in Rhinology at HCFMUSP)
                [d ]MD, ENT, PhD student at Faculdade de Medicina da USP
                [e ]PhD (Assistant Physician at HCFMUSP)
                [f ]PhD, MD, ENT Faculdade de Medicina da Universidade de São Paulo
                [g ]Professor (Director of Rhinology at HCFMUSP Associate Professor at FMUSP). Faculdade de Medicina da Universidade de São Paulo
                Author notes
                [* ]Send correspondence to: Rua Dr. Eneas de Carvalho Aguiar, 255/6° andar – 6167 – Cerqueira Cesar – São Paulo – S P. CEP: 05403-000. Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial
                Article
                S1808-8694(15)30015-X
                10.1590/S1808-86942012000200015
                9443913
                22499376
                99d3f857-a085-4d64-9a00-07c0d4447a3e
                .

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 13 December 2011
                Categories
                Original Article

                chronic disease,indicators of quality of life,quality of life,sinusitis

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