Translation, cross-cultural adaptation, and validation of the sino-nasal outcome test (snot)-22 for Finnish patients.

PURPOSE: The Sino-Nasal Outcome Test-22 (SNOT-22) is the most commonly used disease-specific quality of life questionnaire in rhinology. The purpose of this prospective study was to translate and validate SNOT-22 into Finnish. METHODS: The validation process followed the guidelines proposed for cross-cultural adaptation of health-related measures of quality of life. The study consisted of three groups: rhinologic out-patients (N = 96), FESS patients (N = 49) and healthy controls (N = 79). Out-patient and FESS groups completed the questionnaire twice (answers A and B), out-patients after two weeks and FESS patients after 3 months. Validity, reliability and responsiveness were evaluated. RESULTS: The mean SNOT-22 sum score of the out-patient questionnaires were 35.3 points (answer A) and 32.4 points (answer B). ICC in out-patient group was 0.879. For the FESS patients, the mean pre- and postoperative (answer A and B) SNOT-22 sum scores were 46.8 and 21.9 points, respectively (p < 0.0001). The mean SNOT-22 of healthy controls was 8.9 points. The out-patients (answer A) and healthy controls had statistically significant difference in SNOT-22 scores (p < 0.0001). CONCLUSIONS: The results of our study show that the validated Finnish version of the SNOT-22 questionnaire demonstrates good validity, reliability and responsiveness.

Ethmoidal drug-eluting stent therapy is not superior to nasal corticosteroid spray in the prevention of endoscopic sinus surgery: Results from a randomised, clinical trial.

OBJECTIVES: To evaluate whether an ethmoidal drug-eluting stent (DES) (the Relieva Stratus™ MicroFlow Spacer) could better prevent endoscopic sinus surgery (ESS) than standard non-invasive therapy using corticosteroid nasal spray in patients suffering from chronic rhinosinusitis (CRS). DESIGN: Prospective, randomised clinical trial. SETTING: Tertiary referral centre. PARTICIPANTS: Sixty-three adult patients with ethmoidal involvement in cone beam computerised tomography (CBCT) whose first-line medical treatment with topical corticosteroids had failed and who were candidates for ESS were randomised either to a DES group, which received triamcinolone acetonide stents (n = 34), or to a topical intranasal corticosteroid group (n = 29) that used optimally dosed triamcinolone acetonide nasal spray. OUTCOME MEASURES: Patients were followed up prospectively for 6 months and at 36 months. Freedom from ESS was the primary endpoint. Further, we identified those factors predicting ESS. RESULTS: At 6 months, ESS could be prevented in almost half of the patients in both groups (DES 13/28, 46.4%, nasal spray 14/29, 48.3%). At 36 months, 20/28 (71.4%) patients in the DES group and 18/29 (62.1%) in the nasal spray group had been operated. The differences were not statistically significant at either timepoint. Patients who smoked (14/19, 73.7% vs 16/38, 42.1%) were more likely to be operated at 6 months. CONCLUSION: Endoscopic sinus surgery can be prevented using both therapies in the medium term in almost half of cases with neither therapy being statistically superior. This effect was somewhat diminished in the long term with a trend towards more patients being operated in the DES group. Considering the additional costs, the need for general anaesthesia and the potential side effects associated with DES, its potential clinical role appears to be limited. Smoking was significantly associated with ESS.

Treatment of rhinosinusitis and histopathology of nasal mucosa: A controlled, randomized, clinical study.

OBJECTIVES/HYPOTHESIS: To study the pathology of upper airway mucosa, as well as valuate and compare changes in pathology after the treatment of chronic rhinosinusitis (CRS) patients with balloon sinuplasty versus uncinectomy. METHODS: A prospective randomized controlled trial in patients with CRS of the maxillary sinuses without severe pathology of other sinuses. Patients were randomized into two groups: uncinectomy and balloon sinuplasty. The main variables in our study are histopathology of nasal mucosa and expression of metalloproteinase-9 protein. These parameters were analyzed preoperatively and at 3 months, 6 months, and 12 months postoperatively. RESULTS: Thickened epithelium, absence of cilia, metaplasia of epithelium, hyperplasia of mucosal glands, angiogenesis, and increased inflammatory cells were observed in the majority of preoperative samples. History of allergy was associated with a higher number of goblet cells, and shedding of epithelium was associated with worse quality of life. A higher number of inflammatory cells were associated with an increased number of goblet cells preoperatively, as well as after treatment. Both treatments resulted in a decrease of inflammation in the mucosa and epithelium. Hypertrophy of the mucosal glands, hyperplasia of blood vessels, and mucosal edema decreased after treatment. These changes were more noticeable in uncinectomy group. Balloon sinuplasty was associated with a higher number of inflammatory cells at 6 months after treatment (P = 0.05). LEVEL OF EVIDENCE: 1b. Laryngoscope, 126:2652-2658, 2016.

A Controlled, Randomized Clinical Study on the Impact of Treatment on Antral Mucociliary Clearance: Uncinectomy Versus Balloon Sinuplasty.

OBJECTIVES: To find out the effect of minimal invasive sinus surgery and balloon sinuplasty on mucociliary clearance and compare different methods of measuring mucociliary clearance. METHODS: Twenty-nine patients with chronic rhinosinusitis were randomized in 2 operative groups (uncinectomy or balloon sinuplasty). Before and 6 months after the treatment, patients filled out a quality of life questionnaire (Sino Nasal Outcome Test-22 [SNOT-22]), and mucociliary clearance was measured with endoscope and gamma camera after 0.03 ml of saccharine, methylene-blue dye, and human albumin labeled with Tc99m was introduced to the bottom of maxillary sinuses. RESULTS: In uncinectomy group, SNOT-22 score decreased, but treatment had no effect on mucociliary clearance. Based on saccharine test, smoking was associated with worse mucociliary clearance (r = 0.618, P < .05). Methylene blue test results associated with saccharine test (r = 0.434, P < .05) and Tc99m-labeled tracer technique (r = 0.261, P = .039) separately. CONCLUSION: Treatment positively affects patients' quality of life; however, it has no effect on mucociliary clearance. There was a statistically significant correlation between the Tc99m-labeled tracer technique and the methylene blue technique. The saccharine technique was even less accurate, but it can be useful in clinical practice because it is a quick, easy, and safe technique.

Image-guided, navigation-assisted Relieva Stratus MicroFlow Spacer insertion into the ethmoid sinus.

Anatomical complexity presents the main challenge in the administration of topical corticosteroid therapy to the paranasal sinus mucosa. This often leads to suboptimal drug delivery due to low concentrations of the therapeutic agent to the intended target area. The Relieva Stratus™ MicroFlow Spacer (Relieva Stratus) is a drug-eluting stent that is temporarily implanted into the ethmoid sinus. The reservoir of the stent is filled with triamcinolone acetonide, which is then slowly released from the device into the ethmoid sinus mucosa. The Relieva Stratus provides local and targeted delivery of the anti-inflammatory agent to the diseased mucosa. This minimally invasive implant is an option when treating ethmoid sinusitis. From January 2011 to November 2013, a total of 52 Relieva Stratus implantations into the ethmoidal cells were performed at the Department of Ear and Oral Diseases at Tampere University Hospital, Finland. C-arm fluoroscopy guidance was employed for 26 sinuses (13 patients) and optical image-guided surgery (IGS)-assisted insertions were performed on another 26 sinuses (13 patients). The accuracy of fluoroscopic insertion is not optimal, but this method is accurate enough to prevent the violation of the skull base and lamina papyracea. IGS enables the precise treatment of the diseased cells. From a technical perspective, IGS-guided insertion is a faster, safer and more exact procedure that guarantees the optimal positioning and efficacy of the implant. Moreover, IGS guidance does not entail the use of ionizing radiation.

[Osler's disease or hereditary hemorrhagic telangiectasia]. / Oslerin tauti eli hereditaarinen hemorraginen telangiektasia.

According to current knowledge, Osler's disease may be caused by gene defects of several distinct genes, causing vascular fragility and lack of contractility. The most typical symptoms are recurrent spontaneous nose bleedings. Other target organs of the disease include skin, lungs, intestinal tract, brain and liver, but symptoms in these organs are less common. The diagnosis is based on clinical findings, family history and can, if necessary, be confirmed by a gene test. Osler's disease is treated symptomatically. There is no curative treatment.