Patlada Kowatanamongkon

Objectives: The Chronic Rhinosinusitis Patient‐Reported Outcome (CRS‐PRO) questionnaire was recently developed for use in chronic rhinosinusitis (CRS) patients. This instrument was developed using current diagnostic criteria. This study aimed to translate and validate CRS‐PRO for Thai CRS patients. Methods: The three‐phase translation process and validation were conducted at Rajavithi Hospital, a tertiary hospital in Bangkok, Thailand. Adults (> 18 years) with primary CRS, diagnosed using EPOS2020 criteria, were recruited alongside non‐CRS controls. Discriminant validity was assessed by comparing scores between CRS patients and non‐CRS controls. Concurrent validity was evaluated by correlating CRS‐PRO with the Thai version of the Sinonasal Outcome Test‐22 (SNOT‐22). Reliability was assessed using internal consistency (Cronbach's alpha) and test–retest reliability using intraclass correlation coefficient (ICC). Results: A total of 85 CRS patients and 40 non‐CRS controls were enrolled. The Thai CRS‐PRO was completed in (101.80 ± 26.36) seconds. CRS patients had significantly higher scores than controls (16 [10–24] vs. 2 [0–5], p < 0.001) (median [IQR]). CRS‐PRO demonstrated strong concurrent validity with SNOT‐22 ( ρ = 0.82, p < 0.001), high internal consistency (Cronbach's alpha = 0.89), and high test–retest reliability (ICC = 0.81, 95% confidence interval 0.72–0.88). Conclusions: The Thai‐translated CRS‐PRO has been developed and validated. It demonstrated significant discriminant validity between patients and non‐patients, a very strong correlation with the Thai version of SNOT‐22, and good reliability. Its brevity and time efficiency support its applicability in both clinical practice and research, enhancing its potential for widespread adoption.

Introduction: Tissue eosinophil counts (TEC) might serve as a biomarker linking chronic rhinosinusitis (CRS) and the presence of adult‐onset asthma. This study aimed to determine if TEC in sinus mucosa/polyps in CRS patients is an independent indicator of asthma and to identify its optimal cut‐off point.Methods: This cross‐sectional study was conducted on primary CRS patients scheduled for surgery. All patients were assessed by a pulmonologist for asthma diagnosis. Tissues were collected during surgery and evaluated for TEC. Logistic regression and receiver operating characteristic analysis were used to determine significant factors and the optimal cut‐off points of TEC associated with asthma.Results: A total of 103 CRS patients were included. Ten patients (9.7%) had underlying asthma, while 13 (12.6%) were first diagnosed by the pulmonologist. TEC ≥40 cells per high‐powered field (HPF) exhibited a significant correlation with asthma (area under the curve = 0.71, p < 0.001). The sensitivity of this cut‐off point was 0.70 (95% confidence interval [CI] = 0.47–0.87), and specificity was 0.66 (95% CI = 0.55–0.76). Positive predictive value and negative predictive value were 0.37 and 0.88, respectively. The cut‐off point significantly associated with the presence of asthma, with an adjusted odds ratio of 3.13 (95% CI = 1.05–9.35, p = 0.04), controlling for polyps, allergic rhinitis, and computerized tomography (CT) score.Conclusion: TEC in CRS patients can help determine the presence of adult‐onset asthma, with an optimal threshold of ≥40 cells/HPF. This threshold is significantly associated with asthma independent of polyps, allergy, and CT score.

Introduction: EuroQol‐5‐dimensions‐5‐levels (EQ‐5D‐5L), visual analog scale (VAS), time trade‐off (TTO), and standard gamble (SG) are used for the assessment of Health Utility Scores (HUS) of chronic rhinosinusitis (CRS). This study aimed to determine the overall HUS of CRS, the factors which influence the HUS, and the preferable method.Methods: A cross‐sectional study was conducted. Patients with primary CRS were recruited. Clinical and socioeconomic data together with HUS were assessed. Four HUS scores determined from the four different methods were compared.Results: A total of 335 patients were enrolled. The overall HUS, as measured by EQ‐5D‐5L, VAS, TTO, and SG, was 0.88 ± 0.14, 0.79 ± 0.17, 0.89 ± 0.15, and 0.86 ± 0.16, respectively. The multivariable linear regression revealed that each increasing 22‐item sinonasal outcome test (SNOT‐22) score predicted a reduction of 0.002 to 0.003 in HUS (all methods, p < 0.01). Patients who scheduled for endoscopic sinus surgery had 0.06 to 0.11 HUS lower than other groups in EQ‐5D‐5L and VAS (all p < 0.05). Higher endoscopy score, age, presence of comorbid airway diseases, and lower education correlated with lower HUS (p < 0.05). Given the HUS results and regression models, the EQ‐5D‐5L is likely the preferable choice.Conclusion: The overall HUS of CRS was approximately 0.79–0.89. High SNOT‐22 score and those who failed medications, presence of comorbid AR/asthma, increased age, high endoscopy score, and low education negatively impacted HUS. Our data suggest that EQ‐5D‐5L is a preferable method for measuring HUS in patients with CRS.

Background: Endoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients with chronic rhinosinusitis (CRS) who require the surgery. HUS varies depending on the geographical or living environment. HUS in CRS has never been evaluated in Thailand. The objective of this study was to evaluate the HUS of Thai patients with CRS before and after ESS through multiple approaches.Methods: Thai patients (age ≥ 18) with CRS scheduled for ESS were enrolled in this prospective study. The preoperative (baseline) demographics, 22‐items sinonasal outcome test, endoscopic score, and CT score were recorded. The HUS was evaluated using four methods: the EuroQoL‐5 Dimension‐5 level (EQ‐5D‐5L), Visual Analog Scale (VAS), Standard gamble (SG), and Time trade‐off (TTO); at baseline, three months and six months post‐operation.Results: Data from 60 patients were analyzed. The mean baseline HUS scores by EQ‐5D‐5L, VAS, SG, and TTO were 0.75, 0.65, 0.79, and 0.85, respectively. The postoperative HUS significantly improved to 0.96, 0.91, 0.96, 0.97 at three months, and 0.97, 0.92, 0.97, and 0.98 at six months, respectively. ESS raised the HUS by 0.12–0.27 points. Among the four methods, VAS showed the lowest HUS at all time points.Conclusion: The preoperative HUS in Thai patients with CRS generally increased to near‐perfect values after the ESS. The increase in HUS reflecting the improved general quality of life, was demonstrated at three and up to six months after ESS.Level of Evidence: 4 Laryngoscope, 134:2070–2076, 2024