Utjecaj nosne polipoze na kvalitetu života u bolesnika s kroničnim rinosinuitisom

master's thesis

• Title (english): The impact of nasal polyposis on quality of life in patients with chronic rhinosinuitis
• Author: Lana Jurlin
• Mentor: Livije Kalogjera (mentor)
• Committee member: Tomislav Baudoin (predsjednik povjerenstva)
• Committee member: Mirko Ivkić (član povjerenstva)
• Committee member: Livije Kalogjera (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2015-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Kronični rinosinuitis (KRS) je kronični upalni sindrom koji se dijagnosticira na temelju prisutnosti definirane kombinacije simptoma: nosne opstrukcije, nosne sekrecije, postnazalnog slijeva, boli/pritiska u licu te smetnji njuha. Kronični rinosinusitis bitan je zdravstveni problem jer značajno umanjuje kvalitetu života. Dva su glavna fenotipa KRS-a, sa i bez nosnih polipa, koji se diferenciraju endoskopski. -----
Cilj istraživanja bio je usporediti razlike između dva fenotipa KRS-a u intenzitetu simptoma i učinku na kvalitetu života prema subjektivnoj ocjeni težine bolesti dobivenoj specifičnim upitnikom. Također, usporediti subjektivne s objektivnim nalazima; opsežnosti sluzničkih promjena na CT snimkama i upalnom infitracijom sinusne sluznice na histološkim preparatima. -----
U istraživanje smo uključili 126 bolesnika, koji su prema EPOS smjernicama udovoljili kriterijima za dijagnozu KRS-a. Dob bolesnika je bila od 19 do 78 godina, a među uključenima je bilo 65 žena i 61 muškarac. Udio bolesnika s nosnim polipima bio je 43%. Težina simptoma i promjene kvalitete života ocjenjivani su SNOT-22 upitnikom. CT ocjena sluzničnih promjena analizirana je Lund-Mackay-ovim sustavom bodovanja. Kod 65 bolesnika, čiji su postoperativni uzorci sluznice bili dostupni za patohistološku analizu, učinjena je semikvantitativna analiza stanične upalne infiltracije. Uspoređena je gustoća upale te dominacija upalnih stanica, ovisno o fenotipu. -----
Statistički značajna razlika (p<0,05) dokazana je kod simptoma nosne opstrukcije, nosne sekrecije, ispuhivanja te smetnji njuha u fenotipu s nosnim polipima. U fenotipu bez polipa izražena je vrtoglavica, bol u uhu, pritisak u licu, jutarnji umor, kao i smetnje koncentracije. Značajno je viša eozinofilna infiltracija i Lund-Mackay-ov zbroj u skupini s polipima. Nema razlike u ukupnom zbroju SNOT-22 upitnika između fenotipa. -----
Značajne razlike u intenzitetu nosnih simptoma, intenzitetu upale te stupnju bolesti na CT snimkama govore o većoj težini bolesti kod KRS-a s nosnim polipima. Bez obzira na to, bolesnici s KRS-om bez nosnih polipa znatno lošije ocjenjuju stavke SNOT-22 upitnika o kvaliteti života. Stoga, ukupna težina bolesti ocijenjena kombinacijom nosnih simptoma i kvalitete života, pokazuje da nema razlike u težini bolesti između fenotipa KRS sa i bez nosnih polipa.

Abstract (english)

Chronic rhinosinusitis (CRS) is a chronic inflammatory syndrome which is diagnosed by characteristic symptoms: nasal obstruction, nasal secretion, postnasal drip, facial pain and hyposmia. Fatigue, problems with sleep and pain syndrome are common and have a significant impact on related quality of life (QOL). There are two major phenotypes: CRS with and without nasal polyps. -----
The aim of the study was to compare the severity of symptoms, HRQL impairment and the objective severity of CRS using CT scores and inflammatory cells infiltration between both phenotypes of CRS. -----
The study included 126 CRS patients, of both phenotypes, 61 male and 65 female, their age ranging from 19-78. After the informed consent, the patients filled in a validated Sinonasal Outcome test 22 (SNOT-22) questionnaire and underwent sinus CT scan. SinusCT scans were scored using Lund Mackay staging system. In 64 patients with surgical samples available, semiquantitative scoring (0-4) of eosinophils and mononuclear cells in sinus mucosa was done. Gender related differences from SNOT-22 were calculated Scores were correlated with CT and histopathology scores. -----
The significant difference between two phenotypes (p<0,05) was shown in several symptoms. Nasal obstruction, nasal secretion and hyposmia were higher in the phenotype with nasal polyps. Patients with CRS without nasal polyps had significant problem with vertigo, ear pain, fatigue and concentration. There was a significant higher eosinophilic infiltration and Lund Mackay score in patients with CRS with nasal polyps. There was no difference between the total SNOT-22 score between two phenotypes. -----
The higher intensity of nasal symptoms, higher CT score and higher inflammation intensity show the severity of CRS with nasal polyps. However, the impact of chronic rhinosinusitis on the quality of life is worse in patients with CRS without nasal polyps. The overall severity of life adding nasal symptoms and the quality of life shows us that there is no difference in severity between two phenotypes of CRS.

• Keywords: kronični rinosinusitis (KRS); kvaliteta života; upitnik Sino-Nasal Outcome Test-22 (SNOT-22)
• Keywords (english): chronic rhinosinusitis (CRS); health-related quality of life (HRQL); Sino-Nasal Outcome Test Questionnaire (SNOT 22)
• Language: croatian
• URN:NBN: urn:nbn:hr:105:991232
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-08-08 11:35:02