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Objectives: To develop and assess the validity of a novel allergy‐specific domain for the 22‐item sino‐nasal outcomes test (SNOT‐22), to provide a new tool that efficiently quantifies the impact of allergic rhinitis (AR) concurrent with chronic rhinosinusitis. Study Design: Prospective validation study. Setting: Tertiary care hospital and community‐based clinic. Methods: Proposed items were developed based on clinician and patient input, and further assessed via factor analysis and for internal consistency (n = 1987). Items were then additionally assessed for convergent and discriminant validity (n = 415), applying data from concurrent completions of the Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE), Mini‐Rhinoconjunctivitis Quality‐of‐Life Questionnaire (MiniRQLQ), and validated global health assessments. Assessments of intra‐rater reliability, responsiveness to change, and qualitative input were also performed. Results: Factor analysis demonstrated that proposed allergy items mapped to a single domain. Items were internally consistent (Cronbach α: 0.80 within domain, 0.91 within all SNOT). In assessments of convergent validity, domain scores were associated with MiniRQLQ (Spearman's ρ: 0.46, 95% confidence interval [CI]: 0.30‐0.59) and NOSE scores (0.36, 95% CI: 0.27‐0.44). The novel items also discriminated among clinical states: a 1‐point increase in domain score was associated with an 8.32 (95% CI: 5.43‐12.75) increase in the odds of prompting a visit for allergy‐related symptoms and a 1.52 (95% CI: 1.13‐2.05) increase in the odds of positive allergy testing. Intra‐rater reliability was substantial (Cohen's κ: 0.8, 95% CI: 0.8‐0.9), and responsiveness to change was demonstrated (mean difference: −0.6, 95% CI: −0.8 to −0.4). Conclusions: This novel domain is a valid, efficient measure of AR alongside rhinosinusitis. [ABSTRACT FROM AUTHOR]

Objectives: To assess: (1) the Eating Assessment Tool (EAT‐10) with item response theory (IRT) to determine which individual items provide the most information, (2) the extent to which dysphagia is measured with subsets of items while maintaining precise score estimates, and (3) if 5‐item scales have the differing discriminatory ability, as compared to the parent 10‐item instrument. Methods: Prospectively collected data from 2,339 patients who completed the EAT‐10 questionnaire during evaluation at a tertiary care otolaryngology clinic were utilized. IRT analyses provided discrimination and location parameters associated with individual questions. Residual item correlations were also assessed for redundant information. Based on these results, three 5‐item subsets were further evaluated using item information function curves. Areas under receiver‐operator characteristic curves (ROC‐AUC) were also calculated to evaluate the discriminatory ability for dysphagia‐related clinical diagnoses. Results: Item discrimination parameter estimates ranged from 1.71 to 5.46, with higher values indicating more information. Residual item correlations were determined within item pairs, and location parameters were calculated. Based on these data, in combination with clinical utility, three 5‐item subsets were proposed and assessed. ROC‐AUC analyses demonstrated no significant difference between the EAT‐5‐Alpha subset and the original 10‐item instrument for discriminating dysphagia as a primary diagnosis (0.88, 0.88). The EAT‐5‐Clinical subset outperformed the original 10 instruments in ROC‐AUC for aspiration. The EAT‐5‐Range subset was significantly associated with problems with thin liquids. Conclusions: IRT analyses distinguished three proposed 5‐item subsets of the EAT‐10 instrument, supporting shorter survey options, while still reflecting the impact of dysphagia without significant loss of discrimination. Level of Evidence: 3 (Diagnostic testing with consistently applied reference standards, partial blinding). Laryngoscope, 133:3327–3333, 2023 [ABSTRACT FROM AUTHOR]

Objective: While general health may be influenced by sinonasal symptoms, their effects may be overshadowed by comorbid states which may be more serious. To assess the validity of this postulate, we measured the extent to which sinonasal symptoms and concurrent conditions influenced general health. Study Design: Observational outcomes study. Setting: Academic medical center, community care sites. Methods: Adults with sinonasal symptoms completed the 22‐item Sinonasal Outcome Test, along with the Patient‐Reported Outcomes Measurement Information System global health short form. Comorbidities were categorized with the Deyo modification of the Charlson comorbidity index. Multivariate regression analyses were utilized to determine the relative impact of sinonasal symptoms and concurrent comorbid conditions on general health. Results: Data from 219 consecutive patients demonstrated that sinonasal symptoms were associated with significantly diminished general physical (β = −1.431, p <.001), mental (β = −1.000, p <.001), overall (β = −1.026, p <.001), and social health (β = −0.872, p =.003), regardless of the presence of potentially life‐threatening comorbid conditions. Comorbid conditions included cardiovascular disease, chronic obstructive pulmonary disease, connective tissue disease, peptic ulcer, diabetes mellitus, and hepatic disease. The effect of sinonasal symptoms was neither subsumed nor overshadowed by the effects of comorbid states. Nasal, ear, sleep, and psychological domain scores were also associated with general physical, mental, and global health while adjusting for the impact of comorbidities. Conclusion: Sinonasal symptoms have a substantial effect on general health which is not subsumed by the presence of potentially life‐threatening concurrent comorbidities. These data may help support the importance of funding and resource allocation for conditions causing sinonasal symptoms. [ABSTRACT FROM AUTHOR]

Objective: To offer pragmatic, evidence‐informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. Data Sources: PubMed, Cochrane Library, and American Academy of Otolaryngology–Head and Neck Surgery Foundation clinical practice guidelines. Review Methods: A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. Conclusions: Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High‐level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. Implications for Practice: Clinicians should bring an evidence‐informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long‐term effects. Alternate routes of corticosteroid administration—such as sprays, drops, inhalers, and intralesional injections—may be preferable for many disorders, particularly those that are self‐limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication‐related adverse effects. Clinicians who are conversant with high‐level evidence can achieve optimal outcomes and stewardship when prescribing SCS. [ABSTRACT FROM AUTHOR]