Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-02-2017 | Rhinology

Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome

Authors: Choaib Adnane, Taoufik Adouly, Amine Khallouk, Sami Rouadi, Redallah Abada, Mohamed Roubal, Mohamed Mahtar

Published in: European Archives of Oto-Rhino-Laryngology | Issue 2/2017

Abstract

The purpose of this study is to use unsupervised cluster methodology to identify phenotype and mucosal eosinophilia endotype subgroups of patients with medical refractory chronic rhinosinusitis (CRS), and evaluate the difference in quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) between these clusters for better surgical case selection. A prospective cohort study included 131 patients with medical refractory CRS who elected ESS. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate QOL before and 12 months after surgery. Unsupervised two-step clustering method was performed. One hundred and thirteen subjects were retained in this study: 46 patients with CRS without nasal polyps and 67 patients with nasal polyps. Nasal polyps, gender, mucosal eosinophilia profile, and prior sinus surgery were the most discriminating factors in the generated clusters. Three clusters were identified. A significant clinical improvement was observed in all clusters 12 months after surgery with a reduction of SNOT-22 scores. There was a significant difference in QOL outcomes between clusters; cluster 1 had the worst QOL improvement after FESS in comparison with the other clusters 2 and 3. All patients in cluster 1 presented CRSwNP with the highest mucosal eosinophilia endotype. Clustering method is able to classify CRS phenotypes and endotypes with different associated surgical outcomes.

Piccirillo JF, Merritt MG, Richards ML (2002) Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg 126:41–47CrossRefPubMed

Anand VK (2004) Epidemiology and economic impact of rhinosinusitis. Ann Oto Rhinol Laryngol Suppl 193:3–5CrossRef

Meltzer EO, Hamilos DL, Hadley JA, American Academy of Allergy, Asthma and Immunology, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology–Head and Neck Surgery, American College of Allergy, Asthma and Immunology, American Rhinologic Society et al (2004) Rhinosinusitis: establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg 131(6 Suppl):S1–S62CrossRefPubMed

Lane AP, Turner JH (2012) Etiologic factors in chronic rhinosinusitis. In: Kennedy DW, Hwang PH (eds) Rhinology: diseases of the nose, sinuses, and skull base. Thieme Medical Publishers, New York, pp 171–181

Kennedy DW, Ramakrishnan VR (2012) Functional endoscopic sinus surgery: concepts, surgical indications, and techniques. In: Kennedy DW, Hwang PH (eds) Rhinology: diseases of the nose, sinuses, and skull base. Thieme Medical Publishers, New York, pp 306–335

Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP (2009) Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 34:447–454CrossRefPubMed

Bousquet J, Anto JM, Sterk PJ et al (2011) Systems medicine and integrated care to combat chronic noncommunicable diseases. Genome Med 3:43CrossRefPubMedPubMedCentral

Agache I, Akdis C, Jutel M, Virchow JC (2012) Untangling asthma phenotypes and endotypes. Allergy 67:835–846CrossRefPubMed

Akdis CA (2012) Therapies for allergic inflammation: refining strategies to induce tolerance. Nat Med 18:736–749CrossRefPubMed

10.

Adnane C, Adouly T, Zouak A, Mahtar M (2015) Quality of life outcomes after functional endoscopic sinus surgery for nasal polyposis. Am J Otolaryngol 36(1):47–51CrossRefPubMed

11.

Fokkens WJ, Lund V, Mullol J (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23:1–298

12.

Lund V, Kennedy D (1995) Quantification for staging sinusitis. Ann Otol Rhinol Laryngol 104(Suppl 10):1–31

13.

Soler ZM, Sauer DA, Mace J, Smith TL (2009) Relationship between clinical measures and histopathologic findings in chronic rhinosinusitis. Otolaryngol Head Neck Surg 141:454–461CrossRefPubMedPubMedCentral

14.

Smith KA, Smith TL, Mace JC, Rudmik L (2014) Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitis. Int Forum Allergy Rhinol 4:823–827CrossRefPubMedPubMedCentral

15.

Soler ZM, Rudmik L, Hwang PH, Mace JC, Schlosser RJ, Smith TL (2013) Patient-centered decision making in the treatment of chronic rhinosinusitis. Laryngoscope 123(10):2341–2346PubMedPubMedCentral

16.

Dursun E, Korkmaz H, Eryilmaz A, Bayiz U, Sertkaya D, Samim E (2003) Clinical predictors of long-term success after endoscopic sinus surgery. Otolaryngol Head Neck Surg 129:526–531CrossRefPubMed

17.

Smith TL, Mendolia-Loffredo S, Loehrl TA, Sparapani R, Laud PW, Nattinger AB (2005) Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 115:2199–2205CrossRefPubMed

18.

Kennedy JL, Hubbard MA, Huyett P, Patrie JT, Borish L, Payne SC (2013) Sino-nasal outcome test (SNOT-22): a predictor of postsurgical improvement in patients with chronic sinusitis. Ann Allergy Asthma Immunol 111(4):246–251CrossRefPubMedPubMedCentral

19.

Bhattacharyya N (2007) Influence of polyps on outcomes after endoscopic sinus surgery. Laryngoscope 117(10):1834–1838CrossRefPubMed

20.

Hopkins C, Rimmer J, Lund VJ (2015) Does time to endoscopic sinus surgery impact outcomes in chronic rhinosinusitis? Prospective findings from the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis. Rhinology 53(1):10–17PubMed

21.

Soler ZM, Sauer D, Mace J, Smith TL (2010) Impact of mucosal eosinophilia and nasal polyposis on quality-of-life outcomes after sinus surgery. Otolaryngol Head Neck Surg 142:64–71CrossRefPubMed

22.

Eweiss A, Dogheim Y, Hassab M, Tayel H, Hammad Z (2009) VCAM-1 and eosinophilia in diffuse sino-nasal polyps. Eur Arch Otorhinolaryngol 266:377–383CrossRefPubMed

23.

Soler ZM, Hyer JM, Ramakrishnan V et al (2015) Identification of chronic rhinosinusitis phenotypes using cluster analysis. Int Forum Allergy Rhinol 5(5):399–407CrossRefPubMedPubMedCentral

24.

Nakayama T, Asaka D, Yoshikawa M et al (2012) Identification of chronic rhinosinusitis phenotypes using cluster analysis. Am J Rhinol Allergy 26(3):172–176CrossRefPubMed

25.

Soler ZM, Hyer JM, Rudmik L, Ramakrishnan V, Smith TL, Schlosser RJ (2016) Cluster analysis and prediction of treatment outcomes for chronic rhinosinusitis. J Allergy Clin Immunol 137(4):1054–1062CrossRefPubMed

Title: Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome
Authors: Choaib Adnane
Taoufik Adouly
Amine Khallouk
Sami Rouadi
Redallah Abada
Mohamed Roubal
Mohamed Mahtar
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 2/2017
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-016-4315-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2017

The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty

Surgical treatment of concomitant thyroid and parathyroid disorders: analysis of 4882 cases

Botulinum toxin injection in laryngeal dyspnea

A new surgical technique versus an old marker: can expansion sphincter pharyngoplasty reduce C-reactive protein levels in patients with obstructive sleep apnea?

Visualization of anatomy in normal and pathologic middle ears by cone beam CT

Surgical technique and post-tonsillectomy hemorrhage: a single institution’s retrospective study