A comparative study of two grading systems for epistaxis in hereditary haemorrhagic telangiectasia.

BACKGROUND: Different institutions use different grading systems for hereditary haemorrhagic telangiectasia (HHT)-associated epistaxis. It is important to have a universal, standardized grading system to compare and evaluate the effectiveness of different treatment options. We introduced the "Intensity, Frequency and need for Blood Transfusion" (IFT) grading system for HHT-associated epistaxis in 2008. Hoag et al. proposed the "Epistaxis Severity Score" (ESS) for the International HHT foundation in 2010. This study aimed to evaluate the potential correlation between the ESS and IFT grading systems. METHODS: The study included 354 simultaneous reports using the IFT and ESS from 106 patients. The correlation between the ESS, IFT and haemoglobin levels was measured using Pearson's correlation coefficient. The ESS and IFT were scored simultaneously by the patient and doctor in 48 cases to evaluate if there was a discrepancy in the scoring applied by either set of responders. RESULTS: The measured correlation between the two grading systems was good (0.75). The grade of epistaxis reported by patients and doctors respectively showed no significant difference. Both the IFT and ESS grading systems correlate significantly to the haemoglobin level. CONCLUSIONS: Both the IFT and ESS scores correlate to each other, and their results are comparable. Whether the IFT or ESS scoring was performed by the patient or doctor had no significant impact.

Minimal unilateral peak nasal inspiratory flow correlates with patient reported nasal obstruction.

BACKGROUND: Nasal septoplasty is a common surgical procedure, but a significant number of patients report equal, or some even worsened, symptom load postoperatively. Rhinologists struggle to find objective tests that adequately reflects disease burden. This study aimed to evaluate the correlation between the PNIF measurement of the most obstructed side with patient reported outcomes. METHODS: Bilateral and unilateral PNIF measurements were performed before and after topical decongestion in 528 patients scheduled for surgery due to nasal obstruction. Subjective outcomes were measured using Nasal Obstruction VAS and SNOT-22 with subdomains. Correlations between subjective and objective measurements were calculated and further explored using multivariate regression analyses. RESULTS: Significant negative correlations between PNIF and patient reported outcomes were found. Both bilateral and minimal unilateral PNIF correlations with NO-VAS were equal and stronger than correlations with SNOT-22 including subdomains concerning problems with nasal obstruction. Minimal unilateral PNIF did not show statistically significant gender difference. Topical decongestion decreased statistical correlations. CONCLUSIONS: The minimal unilateral PNIF shows a statistically significant but weak negative correlation with preoperative patient reported nasal obstruction, and values do not differ between genders. Clinical evaluation of patients presenting complaints of nasal obstruction could be supported by minimal unilateral PNIF.

The new agreement of the international RIGA consensus conference on nasal airway function tests.

The report reflects an agreement based on the consensus conference of the International Standardization Committee on the Objective Assessment of the Nasal Airway in Riga, 2nd Nov. 2016. The aim of the conference was to address the existing nasal airway function tests and to take into account physical, mathematical and technical correctness as a base of international standardization as well as the requirements of the Council Directive 93/42/EEC of 14 June 1993 concerning medical devices. Rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow, Odiosoft-Rhino, optical rhinometry, 24-h measurements, computational fluid dynamics, nasometry and the mirrow test were evaluated for important diagnostic criteria, which are the precision of the equipment including calibration and the software applied; validity with sensitivity, specificity, positive and negative predictive values, reliability with intra-individual and inter-individual reproducibility and responsiveness in clinical studies. For rhinomanometry, the logarithmic effective resistance was set as the parameter of high diagnostic relevance. In acoustic rhinometry, the area of interest for the minimal cross-sectional area will need further standardization. Peak nasal inspiratory flow is a reproducible and fast test, which showed a high range of mean values in different studies. The state of the art with computational fluid dynamics for the simulation of the airway still depends on high performance computing hardware and will, after standardization of the software and both the software and hardware for imaging protocols, certainly deliver a better understanding of the nasal airway flux.

Bacterial biofilms in patients with chronic rhinosinusitis: a confocal scanning laser microscopy study.

BACKGROUND: Recent research into the pathophysiology of chronic rhinosinusitis suggests an important role for biofilms. They can be detected in both healthy and diseased nasal mucosa. Several different methods of detecting biofilms have been described. This study investigates the presence of biofilm in a larger group of patients with chronic rhinosinusitis undergoing primary functional endoscopic surgery. METHODS: Sixty-one patients with chronic rhinosinusitis and 25 controls, with septal deviation, were included from 2010 to 2012. Endonasal biopsies were harvested during surgery, snap frozen in isopentane, cooled on dry ice and stored at -80oC. The samples were prepared with Invitrogens' BacLight LiveDead kit, and investigated with confocal scanning laser microscopy for the presence of biofilm. RESULTS: In the chronic rhinosinusitis group 55/61 were biofilm positive as opposed to 14/25 in the control group. The difference was highly significant. The odds ratio was 7.2. CONCLUSION: Patients with chronic rhinosinusitis have a highly significant increased point prevalence of biofilms compared to controls.

A grading scale for epistaxis in hereditary haemorrhagic teleangectasia.

BACKGROUND: Epistaxis is the most common symptom in patients with Hereditary Haemorrhagic Telangiectasia (HHT). Different institutions are using different treatment modalities and different grading systems. The treatment options depend on the grade of epistaxis. It is important to have a common grading system to compare and evaluate the effectiveness of different treatment options. Furthermore, it is important to correlate quality of life with an epistaxis grading system. The aim of this work was to propose a new grading system for epistaxis in HHT. METHODS: A medical literature search was performed for grading systems of epistaxis in HHT. A questionnaire on five criteria's for a new grading system was sent to 22 internationally renowned medical experts, who have published results on epistaxis in HHT. RESULTS: Four different grading systems are currently in use for the grading of epistaxis in HHT. The response rate of the questionnaire was 43%. All the experts who answered the questionnaire agreed that the aimed grading system should be easy to understand for the patients. 90% of them wanted the system to focus on a definite time period. 70% answered that blood transfusion should be included in the grading system as an important factor. There was no clear consensus on whether the system should be a single multi-item scale or a composite scale consisting of more than one single scales, and similarly there was no clear consensus on whether is should be an absolute or a relative scale. CONCLUSION: The proposed system should be easy to understand for the patients, focus on a definite time period of observation, and include blood transfusion as one of its parameters. For statistical reasons, an epistaxis grading scale with at least one absolute end point would be preferable.