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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 25
| Issue : 1 | Page : 18-23 |
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Impact of chronic rhinosinusitis on patients' quality of life in the western region, Saudi Arabia 2022
Nisreen Ghazi Albouq1, Majid A Albeladi1, Layal Bakor Alyahyawi2, Raghad Meteb Albalawi2, Hajer Awadah Almutairi2, Ma'ad Mohammed Aljohani1
1 Department of Otorhinolaryngology, Head and Neck Surgery, Ohud Hospital, Medina, Kingdom of Saudi Arabia
2 College of Medicine, Al-Rayan College, Medina, Kingdom of Saudi Arabia
| Date of Submission | 10-Jan-2023 |
| Date of Decision | 24-Feb-2023 |
| Date of Acceptance | 25-Feb-2023 |
| Date of Web Publication | 29-Mar-2023 |
Correspondence Address:
Dr. Nisreen Ghazi Albouq
Department of Otorhinolaryngology, Head and Neck Surgery, Ohud Hospital, Medina
Kingdom of Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/sjoh.sjoh_3_23
Background: Rhinosinusitis is distinguished by the simultaneous inflammation of the sinonasal mucosa. Chronic rhinosinusitis (CRS) has been demonstrated to have a negative influence on people's quality of life (QoL), as measured by a variety of standardized outcome instruments. We conducted this study to explore the impact of CRS on patients' QoL in the Western Region, Saudi Arabia. Subjects and Methods: This was an observational cross-sectional study carried out among population of the Western Region in Saudi Arabia in 2022. All males and females above the age of 18 years old were invited for participation. The data were collected by using a self-administered semi-structured questionnaire which was distributed via social media. SPSS version 23.0 was used for data analysis. Results: A total number of participants were 468. Most of them were females (76.9%), with males representing 23.1%. More than half of the respondents were from age between 18 and 28 years. In addition, our results revealed that during the past 8 weeks, a 1–2 week period was the most commonly reported duration of symptoms. Furthermore, the most commonly affected domain of rhinosinusitis disability index was the physical domain, followed by the emotional domain and functional domain. Conclusion: Our results suggested that CRS reduced QoL among people from the Western Region, Saudi Arabia. Further evaluation and research are needed to minimize the disability caused by CRS.
Keywords: Chronic rhinosinusitis, chronic sinusitis survey, quality of life, rhinosinusitis disability index
How to cite this article:
Albouq NG, Albeladi MA, Alyahyawi LB, Albalawi RM, Almutairi HA, Aljohani MM. Impact of chronic rhinosinusitis on patients' quality of life in the western region, Saudi Arabia 2022. Saudi J Otorhinolaryngol Head Neck Surg 2023;25:18-23 |
How to cite this URL:
Albouq NG, Albeladi MA, Alyahyawi LB, Albalawi RM, Almutairi HA, Aljohani MM. Impact of chronic rhinosinusitis on patients' quality of life in the western region, Saudi Arabia 2022. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2023 [cited 2023 Jun 4];25:18-23. Available from: https://www.sjohns.org/text.asp?2023/25/1/18/372816 |
| Introduction | |  |
Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses involving the maxillary, frontal, sphenoidal, ethmoidal, and nasal passage linings. It usually lasts for at least 12 weeks. The presence of objective evidence of mucosal inflammation is required for the diagnosis of CRS.[1] CRS might present as a nonspecific upper respiratory infection or acute sinusitis that fails to recover, or it can develop gradually and insidiously over months or years. A relatively acute presentation of CRS with severe headaches, face pain, or visual changes may be the first symptom.[1] CRS is diagnosed by the presence of at least two symptoms that persist for 12 weeks, such as facial pressure, fullness, or pain, nasal blockage, clear or mucopurulent nasal discharge, and hyposmia or anosmia. As the prior symptoms are not specific, a physical examination is required and a radiological examination is fundamental in the diagnostic workup of CRS. Nasal endoscopy is usually recommended before obtaining imaging because it enables the mucosa lining and purulent discharge to be visualized.[2],[3]
The management of CRS may include medical and/or surgical treatment.[3] CRS adversely affects the quality of life (QoL) of patients. A previous study reported that patients express a reduction in QoL in both physical and mental aspects.[2],[3],[4] This detrimental effect is especially prominent in emotional function, general health, and physical function. It is also prominent among females, the elderly and people with a high degree of education.[5] Other studies support sleep disturbances that are significantly more common in CRS patients. This is connected to a lower QoL, poorer cognitive performance, and low mood.[6],[7],[8]
However, QoL assessment assists physicians when evaluating the level of symptom control, treatment plan, and how the disease affects the general QoL.[9] The aim of this study was to determine the impact of CRS on patients' QoL in different aspects in the Western Region of Saudi Arabia.
Previous studies have investigated the effects of chronic sinusitis on patients' QoL in different countries, but there is no current study in the Western Region of Saudi Arabia. This study will therefore investigate the effect of chronic sinusitis on patient QoL in different aspects in the Western Region of Saudi Arabia.
| Objectives | | |
General
To explore the impact of CRS on patients' QoL in the Western Region, Saudi Arabia.
Specific
- To assess the relationship between CRS symptoms and the presence of anxiety and depression
- To investigate the degree of symptoms severity such as nasal discharge, smell loss, facial pressure, and sleep disturbance
- To investigate the effect of CRS on a patient's attention, communication with others, and feelings around them
- To assess the chronic use of intranasal sprays and antibiotics per week
- To assess the impact of CRS symptoms on patient's occupation, daily life activities, and leisure life.
| Subjects and Methods | | |
Study design and setting
A cross-sectional study was conducted in 2022 among the population of Western Region, Saudi Arabia.
Study population
Inclusion criteria
Western region population males and females above the age of 18 years old who are mentally well and willing to participate in the study.
Exclusion criteria
Population outside the Western region, below the age of 18 years old, or mentally unwell were excluded.
Sampling technique and size
All Western region males and females above the age of 18 years old were invited to participate in the study. The sample size was calculated to be 385 based on an estimated proportion of 50% among the population with a 5% margin of error at a 95% confidence level.
Data collection tools and procedures
The data were collected by using a self-administered semi-structured questionnaire developed by the researchers after extensive review of the literature and similar studies. This was distributed to the participants via social media through an assigned data collector. The questionnaire consists of three parts:
First part
questions on sociodemographic information of the participants such as age, gender, nationality (Saudi, non-Saudi), residency (Medina, Makkah, Jeddah, Taif, and others), marital status, educational level, and occupation.
Second and third parts include: Rhinosinusitis disability index and chronic sinusitis survey, which developed by other researchers
Second part
Rhinosinusitis disability index (RSDI). This is a questionnaire developed for use in sino-nasal disease to measure disease-specific health-related quality of life (HRQoL) in rhinitis. It was developed and validated by Benninger and Senior in 1997.[10] The RSDI has three subscale domains: 11 physical items, 9 functional items, and 10 emotional items. Each item is rated on a 5-point Likert scale ranging from “never” (scored as 0) to “always” (scored as 4). The overall score calculated by summing the individual items ranges from 0 to 120, with higher scores indicating worse HRQL.[11]
Third part
The chronic sinusitis survey (CSS) is a 6-item questionnaire that measures sinusitis-specific symptoms and medication use over the preceding 8 weeks.[11] Standardized total scores range between 0 and 100. In the case of CSS, lower total and subscale scores signify a greater impact of disease on the patient's.[12],[13]
Arabic versions of two instruments – the RSDI and the CSS were validated by Aldrees et al., which can be used for both clinical and research purposes.[13]
Data management and statistical analysis
Data were coded, entered, and analyzed using the Statistical Package for the Social Science (SPSS) version 23.0 (SPSS, Chicago, IL, USA). Quantitative data were represented as the mean and standard deviation (SD) and qualitative data were represented as frequencies and percentages. Spearman's correlation coefficients (rS) were calculated to assess the relationship between RSDI and CSS (they were not normally distributed). With regard to clinical significance, comparisons with r ≤0.3 were weakly or not correlated; r = 0.4–0.6 were moderately correlated, while r ≥0.7 were highly correlated. The level of significance P value was set at < 0.05.
Ethical approval
Official permissions were obtained from the Research Ethics Committee at Al-Madinah Cluster IRB log No: 022-68. Informed consent was obtained from all the participants after describing the aim of the study. Privacy and confidentiality were assured.
| Results | | |
Characteristics of the study respondents
This study involved a total of 468 participants. Females represented the majority (76.9%), with only 23.1% being male. More than half of the respondents were aged between 18 and 28 years, while only 10.7% belonged to the >50 years age group. Our findings revealed that the vast majority were Saudi Arabian, and most of them were from Jeddah (35.9%). When we assessed the level of education of our respondents, we found that the highest proportion achieved a bachelor's degree (69.2%) level of education. Almost half of the respondents were students and 27.1% of them were employed [Table 1].
Chronic sinusitis survey
Our results showed that a 1–2 week period was the most commonly reported duration of symptoms in the past 8 weeks by the participants. The highest percentage of participants suffered from headache, face aches, or pressure in the sinuses for 1–2 weeks during the past 8 weeks (42.5%). When we evaluated symptoms of runny nose or mucous behind the nose, we found that 38.7% of respondents experienced these symptoms for 1–2 weeks. Also, 32.7% of them showed a week duration. Moreover, we found that 42.1% of respondents had nasal congestion and difficulty breathing via the nose for 1–2 weeks and about one-third of them reported a week duration for these symptoms [Table 2]. | Table 2: Sinus symptom duration and chronic use of intranasal sprays and antibiotics per week
Click here to view |
In addition, our results clarified that a week duration was the most frequently reported duration for the chronic use of intranasal sprays and antibiotics during the past 8 weeks. Antibiotics were mentioned by 70.5% of participants, nasal sprays prescribed by a doctor were reported by 67.3% and sinus medications in the form of tablets or pills were taken by 60.3%; all of those participants used the above-listed medication for a week [Table 2].
Regarding the past surgical history of our participants, we found that only 7.5% of the study population underwent sinus surgery during the last year. On the other hand, most (92.5%) did not undergo sinus surgery [Figure 1]. | Figure 1: Sinus surgery during the last year among the study participants
Click here to view |
Rhinosinusitis disability index and chronic sinusitis survey
Our findings demonstrated that the total number of RSDI items was 28. The most commonly affected domain was the physical domain, with a mean score of 15.9, followed by the emotional domain and the functional domain, with mean scores of 7.4 and 7.0, respectively.
In regard to CSS, we found that CSS Symptoms revealed the greatest impact of participants' QoL, with a mean score of 72.6. Total CSS and CSS medication had mean scores of 79.4 and 86.2, respectively [Table 3].
Correlation between rhinosinusitis disability index and chronic sinusitis survey
When assessing the effect of CRS on the physical, functional, and emotional subscales of the RSDI, we found that CSS symptoms had a moderate negative association with the domains of RSDI (−0.482), revealing the strongest negative association with the physical domain (−0.530) and weakest association with the emotional domain (−0.361). In comparison with other CSS symptoms, our findings showed that symptoms of nasal congestion and difficulty breathing via the nose had a relatively stronger negative association with RSDI (0.426).
Moreover, our results found that CSS medication showed a moderate negative association with RSDI (0.453). Medications such as antibiotics, nasal sprays prescribed by a doctor, and sinus medications in the form of tablets or pills all showed the strongest negative association with the physical domain when compared to other domains (0.285, 0.403 and − 0.429, respectively). Overall, sinus medications in the form of tablets or pills revealed the strongest negative effect with RSDI domains. Furthermore, we found that the CSS total score was-0.548, which demonstrated a strong negative association with RSDI [Table 4]. | Table 4: Correlation between rhinosinusitis disability index and chronic sinusitis survey
Click here to view |
| Discussion | | |
The current study aimed to assess the impact of CRS on patients' QoL in the Western Region, Saudi Arabia. CRS, which has an estimated frequency of 10.4%, is one of the most frequent chronic disorders and has a substantial influence on patients' QoL.[3] There are now several disease-specific QoL instruments available for assessing CRS. QoL instruments are often made up of several items that use Likert scales or continuous assessments of disease severity across several patient domains or disease-specific symptoms.[12] The RSDI, a standardized, statistically verified disease-specific tool, was used in this study to assess the impact of CRS on patients' QoL.
Our findings revealed that the majority of the research population experienced CRS symptoms for 1–2 weeks during the previous 8 weeks. This was higher than another study, which reported that the average number of lost productivity days in the previous 3 months due to CRS was 3.1, which is consistent with the findings of our study showing that the average number of absence days and lost productivity due to CRS in the previous 3 months was 3.30.[14] In terms of previous surgical history, we noticed that only 7.5% of the study population had sinus surgery in the previous year. On the other hand, the majority of participants (92.5%) did not undergo sinus surgery. A recent study in the United States found that patients who had original endoscopic sinus surgery were 2.1 times more likely to improve on the RSDI and 1.8 times more likely to improve on the CSS than those who had revision sinus surgery.[15]
Our results found that the most commonly affected domain was the physical domain, with a mean score of 15.9, followed by the emotional domain and functional domain, with mean scores of 7.4 and 7.0, respectively. This is supported by findings from another study, which found that those with the rhinological disease have lower physical scores, followed by functional scores and emotional ratings.[16] Furthermore, we discovered that the total CSS score was 79.4 (range 12.5–100). According to another study, the average total QoL score was 42, ranging from 5–69. The functional, emotional and physical domain means were 13 (range 0–27, SD 6), 13 (range 0–25), and 16 (range 2–32). These disparities are most likely attributable to differences in the sampling population and measurement equipment.
When we looked at the effect of CRS on the physical, functional, and emotional subscales of the RSDI, we discovered that CSS symptoms had a moderately unfavorable correlation with the RSDI categories (−0.482). An earlier systemic review found that RSDI was marginally linked with the CSS symptom scale, which is consistent with our findings. This systemic review, on the other hand, found no association with CSS medication, which contradicts our findings.[3] Several primary investigations and reviews have found that medical therapy of CRS improves HRQoL.[17],[18] Compared to other CSS symptoms, our data revealed that nasal congestion and difficulty breathing via the nose had a significantly larger negative correlation with RSDI (0.426). This finding was congruent with another study conducted in China, which found that the top five factors influencing health status were nasal obstruction, runny nose, loss of smell or taste, dizziness, and postnasal discharge.[19]
The study has one limitation in that it does not assess the impact of sinusitis on patients' perception of taste or smell. There is also the risk of recall bias. The restricted sample size may have had an impact on the generalizability of the results.
| Conclusion | | |
Overall, CRS can impact individuals physically, functionally, and emotionally. Further evaluation and research are needed to minimize the disability produced by CRS. Furthermore, a clinical comprehensive approach should be considered to relieve the impact on patients' QoL.
Recommendation
Our findings may also have important implications for the consideration of different treatment strategies for patients with CRS. Targeting CRS symptoms that are most associated with a general HRQL impairment may lead to the greatest cost utility in the treatment of CRS. Further longitudinal study is needed to determine whether focusing interventions on the subdomains most dominant for patients will optimize gains in QOL.
Acknowledgment
We would like to thank everyone who agreed to take part in the study and helped us get the result.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4]
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