On Health-Related Quality of Life and Diagnostic Improvements in Rhinosinusitis

Abstract: Rhinosinusitis is defined as an inflammatory process involving the mucosa of the nose and one or more of the paranasal sinuses. The aims of the work presented in this thesis were to investigate the degree to which rhinosinusitis affects the health-related quality of life (HRQOL), and to determine whether the diagnosis of this condition can be improved using Doppler ultrasound. The HRQOL of 207 patients divided into three subgroups, one with recurrent acute rhinosinusitis, and two with chronic rhinosinusitis, with or without nasal polyps, was evaluated with the 22 Sinonasal Outcome Test (SNOT-22), the 36-item short-form questionnaire (SF-36), the Hospital Anxiety and Depression (HAD) scale and a total visual analogue scale (VAS). These patients’ HRQOL was significantly decreased compared to normative values. Some significant differences in HRQOL scoring were found between the three subgroups. The study cohort reported 8-14 days of absenteeism per year due to their sinus problems. SNOT-22 and the total VAS appeared to be appropriate outcome measures in cases of rhinosinusitis in the Swedish population. It is not possible to differentiate serous sinus fluid (with a low viscosity) from mucopurulent sinus secretions (with high viscosity) with computed tomography (CT) or ultrasound. A means of determining the properties of sinus secretions non-invasively would, however, be of value, as bacteria are often found in mucopurulent secretions in rhinosinusitis. In order to improve the diagnosis of these patients, the ultrasound technique was further developed. In this thesis, it was demonstrated that it is possible to induce acoustic streaming in a sinus model, and that the acoustic properties of a fluid can be determined with Doppler ultrasound. The appropriate frequency of the ultrasound was found to be ~5 MHz. The anatomical dimensions of the maxillary and frontal sinuses were studied on computed tomography images in order to be able to develop a clinically useful Doppler instrument. It was shown how serous sinus fluid can be distinguished from mucopurulent sinus secretion with Doppler ultrasound, without exposing the patient to a harmful increase in temperature.