The Sinonasal Outcome Test 22 score in persons without chronic rhinosinusitis.

OBJECTIVES: To determine the Sinonasal Outcome Test 22 (SNOT 22) score in persons without chronic rhinosinusitis. DESIGN AND SETTING: As part of a trans-European study selected, respondents to a survey questionnaire were invited for a clinical visit. Subjective symptoms and rhinoscopy were used for the clinical diagnosis of chronic rhinosinusitis according to EPOS. PARTICIPANTS: A total of 366 persons participated at the clinical visit and of these 268 did not have chronic rhinosinusitis. All participants completed the SNOT 22. MAIN OUTCOME MEASURES: The SNOT 22. RESULTS: The SNOT 22 score ranged from 0 to 67 with a mean score of 10.5 (CI: 9.1-11.9) and the median score was 7. Persons with allergic rhinitis and blue-collar workers had a significant higher score. CONCLUSION: The median value of 7 is taken as the normal SNOT 22 score in persons without CRS and can be used as a reference in clinical settings and research. Allergic rhinitis and occupation affect SNOT 22 in persons without CRS.

Acoustic rhinometry in persons recruited from the general population and diagnosed with chronic rhinosinusitis according to EPOS.

Chronic rhinosinusitis (CRS) is a disease related to the nose and the paranasal sinus as defined by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria. The criteria include subjective symptoms, such as nasal obstruction, and objective findings by endoscopy. Acoustic rhinometry (AR) is an objective method to determine nasal cavity geometry. The technique is based on a sound pulse reflection analysis in the nasal cavity and determines cross-sectional areas as a function of distance as well as volume. AR measurements in persons recruited from the general population, with and without CRS based on the clinical EPOS criteria, were investigated. As part of a trans-European study, 362 persons, comprising 91 persons with CRS and 271 persons without CRS, were examined by an otolaryngologist including rhinoscopy. Minimum cross-sectional area, distance to minimum cross-sectional area, and volume in the nasal cavity were measured by acoustic rhinometry and all participants underwent Peak Nasal Inspiratory Flow (PNIF) and allergy test. A difference in AR was found before and after decongestion, but no difference was seen between CRS patients and controls. Positive correlation between AR and PNIF was found and AR was capable of identifying mucosal oedema and septum deviation visualised by rhinoscopy. In conclusion, AR, as a single instrument, was not capable of discriminating persons with CRS from persons without CRS in the general population. However, AR correlates well with PNIF and was capable of identifying septum deviation and mucosal oedema.

Quality of life and associated factors in persons with chronic rhinosinusitis in the general population: a prospective questionnaire and clinical cross-sectional study.

OBJECTIVES: The European Position Paper on Rhinosinusitis and Nasal Polyps describes methods to perform population-based and clinical studies on chronic rhinosinusitis in a standardised way, and it also describes how to clinical investigate CRS. The aim of this cross-sectional study was to evaluate quality of life and objective findings in persons with chronic rhinosinusitis recruited from the general population. DESIGN: As part of a trans-European study, selected respondents to a survey questionnaire were invited for a clinical visit. Subjective symptoms and rhinoscopy were used for the clinical diagnosis of chronic rhinosinusitis, and persons with and without chronic rhinosinusitis were compared. SETTING: This research took place in the department of Otolaryngology, Odense University Hospital. PARTICIPANTS: A total of 366 persons participated at the clinical visit, and of these, 91 were diagnosed with chronic rhinosinusitis, 271 without chronic rhinosinusitis and four persons were excluded. MAIN OUTCOME MEASURES: Severity of symptoms and disease-specific quality of life were measured using the Sino-Nasal Outcome Test 22, and generic quality of life was measured using European quality of life - 5 dimensions including an index score and a visual analogue scale. RESULTS: The prevalence of chronic rhinosinusitis was 9%, and the prevalence of polyps was 4%. Persons with chronic rhinosinusitis had significantly reduced disease-specific quality of life (P = 0.00) and generic quality of life (P = 0.04 and 0.01) compared with persons without chronic rhinosinusitis. Having chronic rhinosinusitis was correlated to age, allergic rhinitis and smell. CONCLUSION: This study gives insight into health-related quality of life and objective findings in persons with chronic rhinosinusitis recruited from the general population.

Staphylococcus aureus enterotoxin-specific IgE is associated with asthma in the general population: a GA(2)LEN study.

BACKGROUND: Specific IgE to Staphylococcus aureus enterotoxins (SE-IgE) has been associated with asthma. In the general population, we aimed to determine the prevalence of and risk factors for serum SE-IgE and to examine the association with asthma. METHODS: A postal questionnaire was sent to a random sample of adults in 19 centers across Europe. A random sample of respondents was invited for clinical examination upon which they answered a questionnaire, underwent skin prick tests (SPTs) for common aeroallergens, and provided blood for measurement of total IgE and SE-IgE. Risks were analyzed within centers using weighted logistic regression, and overall estimates calculated using fixed-effects meta-analysis. RESULTS: 2908 subjects were included in this analysis. Prevalence of positive SE-IgE was 29.3%; no significant geographic variation was observed. In contrast to positive skin prick tests, SE-IgE was more common in smokers (<15 pack-year: OR 1.11, P = 0.079, ≥15 pack-year: OR 1.70, P < 0.001), and prevalence did not decrease in older age-groups or in those with many siblings. Total IgE concentrations were higher in those with positive SE-IgE than in those with positive SPT. SE-IgE was associated with asthma (OR 2.10, 95% confidence interval [1.60-2.76], P = 0.001) in a concentration-dependent manner. This effect was independent of SPT result and homogeneous across all centers. CONCLUSIONS: We report for the first time that SE-IgE is common in the general population throughout Europe and that its risk factors differ from those of IgE against aeroallergens. This is the first study to show that SE-IgE is significantly and independently associated with asthma in the general population.

Diagnosing chronic rhinosinusitis: comparing questionnaire-based and clinical-based diagnosis.

BACKGROUND: The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic and endo- scopic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies the definition is based on symptoms only. The aim of this study was to evaluate the correlation between questionnaire-based and clinical-based CRS. METHODS: Based on the GA2LEN postal survey data a total of 366 persons participated at the follow-up at the Danish centre and provided information on questionnaire-based CRS. At the same occasion the 366 participants underwent clinical inter- view and examination by an otorhinolaryngologist to provide information for a clinical-based CRS diagnosis. The association between questionnaire-based and clinical-based CRS diagnosis was determined using logistic regression models and kappa statistics. RESULTS: Mean age of respondents to the postal questionnaire was 45.3 years and 52.9% were female. Persons with asthma were 8.4 % and 26.2 % were actual smokers. There was moderate agreement between questionnaire-based and clinical-based CRS. Sensitivity was [corrected] low comparing questionnaire-based CRS with clinical-based CRS. Incorporation of self reported CRS and medical history in diagnosing CRS by questionnaire increased increased [corrected] the agreement and sensitivity while specificity stayed at a high level. [corrected] CONCLUSION: Evaluating the correlation between questionnaire-based and clinical-based CRS showed only moderate agree- ment and questions whether they evaluate the same disease. It brings into consideration that adjustments are needed to justify correlation between questionnaire-based and clinical-based diagnosis of CRS.

Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis--a GA² LEN study.

BACKGROUND: The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic, endoscopic, and radiologic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies, the definition is based on symptoms only. We aimed to assess the reliability and validity of a symptom-based definition of CRS using data from the GA(2) LEN European survey. METHODS: On two separate occasions, 1700 subjects from 11 centers provided information on symptoms of CRS, allergic rhinitis, and asthma. CRS was defined by the epidemiological EP3OS symptom criteria. The difference in prevalence of CRS between two study points, the standardized absolute repeatability, and the chance-corrected repeatability (kappa) were determined. In two centers, 342 participants underwent nasal endoscopy. The association of symptom-based CRS with endoscopy and self-reported doctor-diagnosed CRS was assessed. RESULTS: There was a decrease in prevalence of CRS between the two study phases, and this was consistent across all centers (-3.0%, 95% CI: -5.0 to -1.0%, I(2) = 0). There was fair to moderate agreement between the two occasions (kappa = 39.6). Symptom-based CRS was significantly associated with positive endoscopy in nonallergic subjects, and with self-reported doctor-diagnosed CRS in all subjects, irrespective of the presence of allergic rhinitis. CONCLUSION: Our findings suggest that a symptom-based definition of CRS, according to the epidemiological part of the EP3OS criteria, has a moderate reliability over time, is stable between study centers, is not influenced by the presence of allergic rhinitis, and is suitable for the assessment of geographic variation in prevalence of CRS.

The effect of dietary calcium and phosphorus supplementation in zeolite a treated dry cows on periparturient calcium and phosphorus homeostasis.

Previous studies have proved the possibility of preventing parturient hypocalcaemia by zeolite A supplementation during the dry period, and a recent in vitro study has indicated a marked calcium (Ca) as well as phosphorus (P) binding effect of zeolite A in rumen fluid solutions. Because of the connection between the Ca and P homeostatic systems, the preventive effect against parturient hypocalcaemia may arise from zeolite induced decreased availability of dietary Ca as well as P. In the present study, the expected Ca and P binding capacity was challenged by feeding high and low levels of dietary Ca and/or P to zeolite A treated dry cows. Twenty-one pregnant dry cows were assigned to four experimental groups receiving a dry cow ration unsupplemented or supplemented with extra Ca and/or P. During the last 2 weeks of the dry period all cows additionally received 600 g of zeolite A per day. A high level of dietary P prepartum significantly decreased the plasma Ca concentration before as well as immediately after calving (day 0-3). Conversely, the plasma inorganic phosphate concentration was higher among these cows than among cows receiving no supplemental P. The prepartum dietary Ca level significantly affected the serum 1,25-dihydroxyvitamin D concentration during zeolite supplementation, whereas the periparturient plasma Ca concentration was apparently not affected by the dietary Ca level. During zeolite A supplementation plasma parathyroid hormone was significantly higher among cows receiving additional P. The urinary deoxypyridinoline/creatinine ratio was not affected by the prepartal dietary Ca or P level. Serum aluminium (Al) was significantly higher during zeolite A supplementation than during the preceding period, indicating partial destruction of the zeolite in the intestinal tract with subsequent release and absorption of Al. It is suggested that the effect of prepartum zeolite supplementation on the periparturient Ca homeostasis depends on the level of Ca as well as P in the dry cow ration.

In vitro binding capacity of zeolite A to calcium, phosphorus and magnesium in rumen fluid as influenced by changes in pH.

An in vitro experiment was designed to mimic the transport of ingested zeolite A in the forestomachs and proximal part of the small intestine so as to evaluate the binding capacity of zeolite A to Ca, P and Mg as influenced by changes in pH. This was done by incubation of rumen fluid solutions with and without zeolite, as well as varying the content of Ca and/or P. The pH was lowered by addition of HCl so as to mimic abomasal conditions, followed by subsequent HCO3- addition to mimic small intestinal pH. Rumen fluid samples were taken at strategic time points in the experiment. All samples were centrifuged and the supernatant analysed for Ca, P and Mg as indicators of the amount of unbound mineral. The addition of zeolite to rumen fluid solutions reduced the amount of supernatant Ca and Mg at rumen pH, whereas the level of P was not reduced. After adding HCl, a large proportion of the zeolite-bound Ca and Mg was released, increasing supernatant Ca and Mg levels; whereas, HCl addition led to a profound drop in supernatant P in zeolite samples, indicating binding of P. A low level of supernatant P was maintained after HCO3- addition. Neutralization by HCO3- led to a zeolite-induced drop in supernatant Ca and Mg. The reduction in supernatant Ca observed in the present study concurs well with the theoretical rationale of prepartum zeolite supplementation in milk fever prevention. Furthermore, the apparent binding of P by the zeolite may also contribute because of the connection between the calcium and phosphorus homeostasis. The zeolite-induced reduction in supernatant Mg indicates that zeolite supplementation should probably be avoided in Mg-deficient herds unless Mg supplementation is initiated.