Rhinosinusitis

Rhinosinusitis is an inflammatory process involving one or more of the paranasal sinuses that typically follows a viral upper respiratory infection or allergic reaction. Drainage from the sinus outflow tracks can be obstructed by swelling of the nasal mucous membranes, leading to pooling of mucus in the paransal sinuses. The primary symptoms of chronic rhinosinusitis are nasal obstruction, nasal congestion (frequently with a more severe nocturnal component), purulent rhinorrhea, postnasal drip, facial or dental pain, headache, hyposmia, and cough. Patients may also experience tenderness over the sinus cavities, periorbital edema, mucosal edema, increased posterior pharyngeal secretions, halitosis, ear pain/pressure/fullness, mailaise, fatigue, and/or sore throat.

Clinical studies of RS have traditionally assessed outcomes in terms of physiologic measurements, including rhinometry, CT scans, IgE levels, and complication rates. However, these outcomes do not capture the primary reason patients seek out and evaluate their care - to feel better in terms of their physical, social and work activity, interpersonal relationships, and general psychological well-being (HRQL). Both generic and respiratory condition-specific instruments have been used to measure HRQL in this population, although some have focused on different components of the condition (sinusitis, rhinoconjunctivitis, rhinitis alone, or rhinosinusitis). As the constellation of conditions are increasingly recognized as a single entity with various manifestations, this section summarizes all related instruments.

Generic Health-Related Quality of Life Instruments Used in Rhinosinusitis

Medical Outcomes Study SF-36

• Bagenstose SE, Bernstein JA . Treatment of chronic rhinitis by an allergy specialist improves quality of life outcomes. Ann Allergy Asthma Immunol. 1999 Dec;83(6 Pt 1):524-8.
• Baiardini I, Pasquali M, Giardini A, et al. Rhinasthma: a new specific QoL questionnaire for patients with rhinitis and asthma. Allergy. 2003;58(4):289-94.
• Bousquet J, Bullinger M, Fayol C, Marquis P, Valentin B, Burtin B. Assessment of quality of life in patients with perennial allergic rhinitis with the French version of the SF-36 health status questionnaire. J Allergy Clin Immunol. 1994;94:182-8.
• Bousquet J, Duchateau J, Pignat JC, Fayoll C, Marquis P, Mariz S, Ware JE, Valentin B, Burtin B. Improvement of quality of life by treatment with cetirizine in patients with perennial allergic rhinitis as determined by a French version of the SF-36 questionnaire. J Allergy Clin Immunol. 1996;98(2):309-16.
• Ciprandi G, Canonica WG, Grosclaude M, Ostinelli J, Brazzola GG, Bousquet J. Effects of budesonide and fluticasone propionate in a placebo- controlled study on symptoms and quality of life in seasonal allergic rhinitis. Allergy. 2002 Jul;57(7):586-591.
• Corren J, Harris AG, Aaronson D, Beaucher W, Berkowitz R, Bronsky E, Chen R, Chervinsky P, Cohen R, Fourre J, Grossman J, Meltzer I, Pedinoff A, Stricker W, Wanderer A. Efficacy and safety of loratadine plus pseudoephedrine in patients with seasonal allergic rhinitis and mild asthma. J Allergy Clin Immunol. 1997;100:781-8.
• Gliklich RE, Hilinski JM. Longitudinal sensitivity of generic and specific health measures in chronic sinusitis. Qual Life Res. 1995;4:27-32.
• Gliklich RE, Metson R. Economic implications of chronic sinusitis. Otolaryngol Head Neck Surg. 1998;118:344-9.
• Gliklich RE, Metson R. Effect of sinus surgery on quality of life. Otolaryngol Head Neck Surg. 1997;117:12-17.
• Gliklich RE, Metson R. Techniques for outcomes research in chronic sinusitis. Laryngoscope. 1995;105:387-90.
• Juniper EF, Thompson AK, Roberts JN. Can the standard gamble and rating scale be used to measure quality of life in rhinoconjunctivitis? Comparison with the RQLQ and SF-36. Allergy. 2002 Mar;57(3):201-206.
• Metson R, Gliklich RE. Clinical outcome of endoscopic surgery for frontal sinusitis. Arch Otolaryngol Head Neck Surg. 1998;124:1090-6.
• Scheuller MC, Murr AH, Goldberg AN, Mhatre AN, Lalwani AK. Quantitative analysis of fungal DNA in chronic rhinosinusitis. Laryngoscope. 2004;114(3):467-71.
• Stuck BA, Czajkowski J, Hagner AE, Klimek L, Verse T, Hormann K, Maurer JT. Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial. J Allergy Clin Immunol. 2004; 113(4):663-8.
• Terreehorst I, Duivenvoorden H et al. The unfavorable effects of concomitant asthma and sleeplessness due to the atopic eczema/dermatitis syndrome on quality of life in subjects allergic to house-dust mites. Allergy. 2002 ; 57:919-925.
• van Agthoven M, Fokkens WJ, et al. Quality of life of patients with refractory chronic rhinosinusitis: effects of filgrastim treatment. Am J Rhinol. 2001;15(4): 231-7.
• Wang PC, Tai CJ, Lin MS, Chu CC, Liang SC. Quality of life in Taiwanese adults with chronic rhino-sinusitis. Qual Life Res. 2003;12(4):443-8.
• Winstead W, Barnett SN. Impact of endoscopic sinus surgery on global heatlh perception. Otolaryngol Head Neck Surg. 1998;119:486-91.

Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ)

• Juniper EF, Rohrbaugh T, Meltzer EO. A questionnaire to measure health-related quality of life in adults with nocturnal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2003; 111: 484-90.

Condition-Specific Health-Related Quality of Life Instruments Used in Rhinosinusitis (Adults)

Asthma Quality of Life Questionnaire [Marks']

• Scheuller MC, Murr AH, Goldberg AN, Mhatre AN, Lalwani AK . Quantitative analysis of fungal DNA in chronic rhinosinusitis. Laryngoscope. 2004; 114(3):467-71.

Rhinoconjunctivitis Quality of Life Questionnaire

• Alexander M, Patel P, Allegro S, Hicks A. Supplementation of fexofenadine therapy with nedocromil sodium 2% ophthalmic solution to treat ocular symptoms of seasonal allergic conjunctivitis. Clin Experiment Ophthalmol. 2003;31(3):206-12.
• Bagenstose SE, Bernstein JA . Treatment of chronic rhinitis by an allergy specialist improves quality of life outcomes. Ann Allergy Asthma Immunol. 1999 Dec;83(6 Pt 1):524-8.
• Berger WE, Kaiser H, Gawchik SM, et al. Triamcinolone acetonide aqueous nasal spray and fluticasone propionate are equally effective for relief of nasal symptoms in patients with seasonal allergic rhinitis. Otolaryngol Head Neck Surg. 2003;129(1):16-23.
• Bousquet J, Lund VJ, van Cauwenberge P, et al. Implementation of guidelines for seasonal allergic rhinitis: a randomized controlled trial. Allergy. 2003;58(8):733-41.
• Chervinsky P, Casale T, Townley R, et al. Omalizumab, an anti-IgE antibody, in the treatment of adults and adolescents with perennial allergic rhinitis. Ann Allergy Asthma Immunol. 2003;91(2):160-7.
• Ciprandi G, Canonica WG, Grosclaude M, Ostinelli J, Brazzola GG, Bousquet J. Effects of budesonide and fluticasone propionate in a placebo- controlled study on symptoms and quality of life in seasonal allergic rhinitis. Allergy. 2002 Jul;57(7):586-591.
• Corren J, Harris AG, Aaronson D, Beaucher W, Berkowitz R, Bronsky E, Chen R, Chervinsky P, Cohen R, Fourre J, Grossman J, Meltzer E, Pedinoff A, Stricker W, Wanderer A. Efficacy and safety of loratadine plus pseudoephedrine in patients with seasonal allergic rhinitis and mild asthma. J Allergy Clin Immunol. 1997 Dec;100(6 Pt 1):781-8.
• Craig TJ, Mende C, Hughes K, Kakumanu S, Lehman EB, Chinchilli V. The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. Allergy Asthma Proc. 2003;24(1):53-8.
• de Graaf-in 't Veld T, Koenders S, Garrelds IM, Gerth van Wijk R. The relationships between nasal hyperreactivity, quality of life, and nasal symptoms in patients with perennial allergic rhinitis. J Allergy Clin Immunol. 1996;98:508-13.
• Gross G, Jacobs RL, Woodworth TH, Georges GC, Lim JC. Comparative efficacy, safety, and effect on quality of life of triamcinolone acetonide and fluticasone propionate aqueous nasal sprays in patients with fall seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2002 Jul;89(1):56-62.
• Guyatt G, Norman, G et al. A critical look at transition ratings. J Clin Epid. 2002; 55:900-908.
• Hu G, Walls RS, Bass D, et al. The Chinese herbal formulation biminne in management of perennial allergic rhinitis: a randomized, double-blind, placebo-controlled, 12- week clinical trial. Ann Allergy Asthma Immunol. 2002 May;88(5):478-487.
• Juniper EF, Guyatt GH. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy. 1991;21:77-83.
• Juniper EF, Guyatt GH, Andersson B, Ferrie PJ. Comparison of powder and aerosolized budesonide in perennial rhinitis: validation of rhinitis quality of life questionnaire. Annals Allergy. 1993; 70: 225-230.
• Juniper EF, Guyatt GH, Archer B, Ferrie PJ. Aqueous beclomethasone dipropionate in the treatment of ragweed pollen-induced rhinitis: further exploration of "as needed" use. J Allergy Clin Immunol. 1993;92(1 pt 1):66-72.
• Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. First-line treatment of seasonal (ragweed) rhinoconjunctivitis: a randomized management trial comparing a nasal steroid spray and a nonsedating antihistamine. Can Med Assoc J. 1997:156:1123-31.
• Juniper EF, Guyatt GH, Griffith LF, Ferrie PJ. Interpretation of rhinoconjunctivitis quality of life questionnaire data. J Allergy Clin Immunol. 1996;98(4):843-845.
• Juniper EF, Guyatt GH, Ferrie PJ, King DR. Sodium cromoglycate eye drops: Regular versus "as needed" use in the treatment of seasonal allergic conjunctivitis. J Allergy Clin Immunol. 1994;94:36-43.
• Juniper EF, Guyatt GH, O'Byrne PM, Viveiros M. Aqueous beclomethasone dipropionate nasal spray: Regular versus "as required" use in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol. 1990;86:380-6.
• Juniper EF, Howland WC, Roberts NB, Thompson AK, King DR. Measuring quality of life in children with rhinoconjunctivitis. J Allergy Clin Immunol. 1998;101:163-70.
• Juniper EF, Thompson AK, Roberts JN. Can the standard gamble and rating scale be used to measure quality of life in rhinoconjunctivitis? Comparison with the RQLQ and SF-36. Allergy. 2002 Mar;57(3):201-206.
• Juniper EF, Willms DG, Guyatt GH, Ferrie PJ. Aqueous beclomethasone dipropionate nasal spray in the treatment of seasonal (ragweed) rhinitis. Can Med Assoc J. 1992;147(6):887-892.
• Kaszuba SM, Baroody FM, et al. Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis. Arch Intern Med. 2001;161(21): 2581-7.
• Katelaris C, Carrozzi et al Effects of intranasal budesonide on symptoms, quality of life, and performance in elite athletes with allergic rhino conjunctivitis. Clin J Sport Med. 2002; 12:296-300.
• Kirchhoff CH, Kremer B, Haaf-von Below S, Kyrein HJ, Mosges R. Effects of dimethindene maleate nasal spray on the quality of life in seasonal allergic rhinitis. Rhinology. 2003;41(3):159-66.
• Litaker D. New technology in quality of life research: are all computer-assisted approaches created equal? Qual Life Res. 2003;12(4):387-93.
• Mansfield LE, Diaz G, Posey CR, Flores-Neder J. Sleep disordered breathing and daytime quality of life in children with allergic rhinitis during treatment with intranasal budesonide. Ann Allergy Asthma Immunol. 2004; 92(2):240-4.
• Murray J, Nathan R et al Comprehensive evaluation of cetirizine in the management of seasonal allergic rhinitis: impact on symptoms, quality of life and activity impairment. Allergy Asthma Proc. 2002; 23:391-398.
• Naclerio RM, Baroody FM, Bidani N, De Tineo M, Penney BC. A comparison of nasal clearance after treatment of perennial allergic rhinitis with budesonide and mometasone. Otolaryngol Head Neck Surg. 2003;128(2):220-7.
• Naclerio RM, deTineo ML, Baroody FM. Ragweed allergic rhinitis and the paranasal sinuses. Arch Otolaryngol Head Neck Surg. 1997;123:193-6.
• Nascimento Silva M, Naspitz C, et al. Evaluation of quality of life in children and teenagers with allergic rhinitis: adaptation and validation of the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Allergol Immunopathol (Madr). 2001;29(4): 111-8.
• Nayak AS, Philip G, Lu S, Malice MP, Reiss TF. Efficacy and tolerability of montelukast alone or in combination with loratadine in seasonal allergic rhinitis: a multicenter, randomized, double-blind, placebo-controlled trial performed in the fall. Ann Allergy Asthma Immunol. 2002 Jun;88(6):592-600.
• Noonan MJ, Raphael GD, Nayak A, et al. The health-related quality of life effects of once-daily cetirizine HCl in patients with seasonal allergic rhinitis: a randomized double-blind, placebo-controlled trial. Clin Exp Allergy. 2003;33(3):351-8.
• Potter PC, Van Niekerk CH, Schoeman HS. Effects of triamcinolone on quality of life in patients with persistent allergic rhinitis. Ann Allergy Asthma Immunol. 2003;91(4):368-74.
• Radcliffe MJ, Lewith GT, Turner RG, Prescott P, Church MK, Holgate ST. Enzyme potentiated desensitisation in treatment of seasonal allergic rhinitis: double blind randomised controlled study. BMJ. 2003;327(7409):251-4.
• Rechtweg JS, Moinuddin R, Houser SM, Mamikoglu B, Corey JP. Quality of life in treatment of acute rhinosinusitis with clarithromycin and amoxicillin/clavulanate. Laryngoscope. 2004; 114(5):806-10.
• Rhee JS, Book DT, Burzynski M, Smith TL. Quality of life assessment in nasal airway obstruction. Laryngoscope. 2003;113(7):1118-22.
• Walker SM, Pajno GB, Lima MT, Wilson DR, Durham SR. Grass pollen immunotherapy for seasonal rhinitis and asthma: a randomized, controlled trial. J Allergy Clin Immunol. 2001;107:87-93.
• Xue CC, Thien FC, Zhang JJ, Da Costa C, Li CG. Treatment for seasonal allergic rhinitis by Chinese herbal medicine: a randomized placebo controlled trial. Altern Ther Health Med. 2003;9(5):80-7.

Sino-Nasal Outcomes Test

• Anderson ER, Murphy MP, Weymuller EA, Jr. Clinimetric evaluation of the Sinonasal Outcome Test-16. Otolaryngol Head Neck Surg. 1999;121:702-7.
• Jones ML, Piccirillo, JF, Haiduk A, Thawley SE. Functional encoscopid sinus surgery: do ratings of appropriateness predict patient outcomes. Am J Rhinol. 1998;12:249-55.
• Piccirillo JF, Edwards D, Haiduk A, Yonan C, Thawley S. Psychometric and clinimetric validity of the 31-item rhinosinusitis outcome measure (RSOM-31). Am J Rhinol. 1995;9:297-306.

Rhinosinusitis Disability Index

• Benninger MS and Senior BA. The development of the Rhinosinusitis Disability Index. Arch Otolaryngol Head Neck Surg. 1997;123:1175-9.
• Senior BA, Glaze C, Benninger MS. Use of the Rhinosinusitis Disability Index (RSDI) in rhinologic disease. American Journal of Rhinology. 2001;15(1):15-20.

Condition-Specific Health-Related Quality of Life Instruments Used in Rhinosinusitis (Children)

• Fokkens W, Cserhati E, et al Budesonide aqueous nasal spray is an effectual treatment in children with perennial allergic rhinitis, with an onset of action within 12 hours. Ann Allergy Asthma Immunol. 2002; 89:279-284.
• Juniper EF, Guyatt GH, Dolovich J. Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol. 1994; 93: 413-423.
• Meltzer EO, Orgel HA, Biondi R, Georgitis J, Milgrom H, Munk Z, van Bavel J, Wood CC, Drda K. Ipratropium nasal spray in children with perennial rhinitis. Ann Allergy Asthma Immunol. 1997;78:485-91.

Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ)

• Roberts G, Hurley C, Lack G. Development of a quality-of-life assessment for the allergic child or teenager with multisystem allergic disease. J Allergy Clin Immunol. 2003;111(3):491-7.

Pediatric Rhinoconjunctivitis Quality of Life Questionnaire

• Fokkens W, Cserhati E, et al Budesonide aqueous nasal spray is an effectual treatment in children with perennial allergic rhinitis, with an onset of action within 12 hours. Ann Allergy Asthma Immunol. 2002; 89:279-284.
• Juniper EF, Howland WC, Roberts NB, Thompson AK, King DR. Measuring quality of life in children with rhinoconjunctivitis. J Allergy Clin Immunol. 1998 Feb;101(2):163-170.
• Wang MF, Lin HC, Wang YY , Hsu CH. Treatment of perennial allergic rhinitis with lactic acid bacteria. Pediatr Allergy Immunol. 2004; 15(2):152-8.

Sino-Nasal Outcomes Test

• Perry BF, Login IS, Kountakis SE. Nonrhinologic headache in a tertiary rhinology practice. Otolaryngol Head Neck Surg. 2004; 130(4):449-52.
• Scheuller MC, Murr AH, Goldberg AN, Mhatre AN, Lalwani AK . Quantitative analysis of fungal DNA in chronic rhinosinusitis. Laryngoscope. 2004; 114(3):467-71.