Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome.

The purpose of this study is to use unsupervised cluster methodology to identify phenotype and mucosal eosinophilia endotype subgroups of patients with medical refractory chronic rhinosinusitis (CRS), and evaluate the difference in quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) between these clusters for better surgical case selection. A prospective cohort study included 131 patients with medical refractory CRS who elected ESS. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate QOL before and 12 months after surgery. Unsupervised two-step clustering method was performed. One hundred and thirteen subjects were retained in this study: 46 patients with CRS without nasal polyps and 67 patients with nasal polyps. Nasal polyps, gender, mucosal eosinophilia profile, and prior sinus surgery were the most discriminating factors in the generated clusters. Three clusters were identified. A significant clinical improvement was observed in all clusters 12 months after surgery with a reduction of SNOT-22 scores. There was a significant difference in QOL outcomes between clusters; cluster 1 had the worst QOL improvement after FESS in comparison with the other clusters 2 and 3. All patients in cluster 1 presented CRSwNP with the highest mucosal eosinophilia endotype. Clustering method is able to classify CRS phenotypes and endotypes with different associated surgical outcomes.

Moroccan adaptation and validation of the rhinosinusitis quality-of-life survey.

The aim of this study was to validate the Moroccan translation and sociocultural adaptation of the RhinoQOL questionnaire. The questionnaires were translated into Moroccan and then translated back into English. The final version was administered twice to an asymptomatic control population (n = 50) and once to a patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS) (n = 99). Both of the groups answered the questionnaire before and one year after surgery. The psychometric properties, reliability, validity with correlation to other clinical instruments and responsiveness to treatment, were analyzed. Univariate and multivariate analyses were performed. The test-retest reliability was excellent [intraclass correlation coefficient (ICC) >0.9], indicating a good reliability when administering the instrument on repeated occasions. The internal consistency was 0.80, 0.75 and 0.94 for the scores of the RhinoQOL sub-scales (frequency, bothersomeness, and impact, respectively). Firstly, our questionnaire was able to detect differences between patients with CRS and group of healthy volunteers (p < 0.0001) and secondly, it improved significantly after surgery (p < 0.0001), indicating a good responsiveness. A good correlation was found between the Moroccan version, the preoperative objective scores, and SNOT-22 and RSDI scores. The Moroccan RhinoQOL questionnaire appears to be culturally appropriate and psychometrically valid.

Psychometric Validation of a Moroccan Version of the 22-Item Sino-Nasal Outcome Test.

OBJECTIVE: The objective of this study paper was to culturally adapt and validate the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire for Moroccan Arabic speaking patients. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral center; Ibn Rochd University Hospital, Casablanca, Morocco. SUBJECTS AND METHODS: The SNOT-22 was conducted in patients with chronic rhinosinusitis (CRS) undergoing sinonasal surgery and in healthy volunteers, from January 2012 to December 2013. It was translated into Moroccan Arabic language. To evaluate this questionnaire, internal consistency, test-retest reliability, responsiveness to treatment, and validity were analyzed. RESULTS: Preoperative SNOT-22 scores were completed by 88 patients. Six-month postoperative SNOT-22 scores were available for 74 patients. The Cronbach's alpha coefficient for the SNOT-22 was 0.968, indicating high internal consistency. The test-retest reliability coefficient was 0.993, indicating high reliability when administering the instrument on repeated occasions. The Moroccan version of the SNOT-22 was able to highly discriminate between patients with CRS and group of healthy volunteers (P < .0001). There was a statistically significant reduction in patient reported SNOT-22 scores at 6 months after surgery (P < .0001). CONCLUSION: The present study has found the Moroccan version of SNOT-22 to be valid and easy to use with good reliability, validity, and responsiveness. It can be used to measure the impact of CRS on the patient's quality of life and may also be used to evaluate CRS treatment.

An unusual giant schwannoma of cervical sympathetic chain: a case report.

BACKGROUND: Schwannomas are benign, well-differentiated tumors that originate from Schwann cells. Involvement of the cervical sympathetic nerve is relatively rare. Computed tomography is indispensable for the diagnosis. The treatment is surgical. Histological examination confirms the diagnosis. Horner's syndrome postoperatively is supportive of the diagnosis. The rarity of giant cervical sympathetic chain schwannoma made the case of our patient interesting to report. Furthermore, our patient's immense tumor size is very rare, and we could not find any similar report in the literature. Cervical sympathetic chain schwannoma is frequently confused with schwannoma of the vagus nerve on clinical and radiological examination, and its diagnosis can therefore be challenging for clinicians, radiologists, and pathologists. CASE PRESENTATION: We report a rare case of cervical schwannoma in a 40-year-old Moroccan woman who presented with a large parapharyngeal mass. Computed tomography revealed a giant, heterogeneous, well-defined mass measuring 110 × 100 × 147 mm, occupying the right carotid triangle, and descending to the superior mediastinum. Surgical excision with a transcervical approach was done. Histological examination confirmed the diagnosis. The patient's postoperative course was marked by Horner's syndrome. CONCLUSIONS: Cervical sympathetic chain schwannoma is a rare, benign tumor. It should be considered in the differential diagnosis in patients presenting with a lateral neck mass. Surgical exploration must be discussed for a tumor with a large volume.

Cross-cultural and Moroccan Validation of the University of Washington Quality of Life Questionnaire for Patients With Head and Neck Cancer.

OBJECTIVES: To translate the original English version of the University of Washington Quality of Life (UW-QOL) questionnaire into Moroccan Arabic version and investigate its psychometric validity and reliability for Moroccan-speaking patients with head and neck cancer. METHODS: The UW-QOL was conducted in 104 patients treated for head and neck cancer in the department of head and neck surgery, Ibn Rochd university hospital, Casablanca. A control group of 57 healthy volunteers was also evaluated. The questionnaire was translated into Moroccan language. RESULTS: Cronbach's alpha coefficient was 0.829, suggesting good internal consistency, and test-retest reliability was excellent (intraclass correlation coefficient [ICC] = 0.987). A good correlation was observed between UW-QOL composite scores and European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) global health status/QOL scores (P < .001). There was also low concordance between the UW-QOL scores and the Physical Component Summary and Mental Component Summary scores of the 36-Item Short-Form questionnaire (SF-36) (P = .017 and P = .014, respectively). CONCLUSIONS: The Moroccan UW-QOL questionnaire appears to be culturally appropriate and psychometrically valid.