Novel Questionnaire Shows Promise in Determining HRQOL for CRS With Nasal Polyps

The nasal polyposis quality of life (NPQ) questionnaire was shown to be valid, reliable, and sensitive to individual changes in evaluating the health-related quality of life of patients with chronic rhinosinusitis with nasal polyps.

The nasal polyposis quality of life (NPQ) questionnaire may serve as the first tool to accurately assess the health-related quality of life (HRQOL) burden of chronic rhinosinusitis with nasal polyps (CRSwNP), according to study findings published in Healthcare.

As the most severe subtype of CRS, CRSwNP can be difficult to treat and has a high recurrence rate, despite available medical treatment and surgery. These factors contribute to a considerable impact on HRQOL, noted researchers, for which there is no disease-specific tool to examine this burden among patients.

Prior studies using the 36-Item Short Form (SF-36) questionnaire, a generic measure that allows for the assessment of health status in patients and healthy subjects, indicated that patients with CRSwNP had worse scores in all SF-36 domains except for physical functioning when compared with the general population.

“The burden of troublesome symptoms (nasal blockage, loss of smell, rhinorrhea, and sneezing), the presence of comorbid diseases (chronic rhinosinusitis, asthma, aspirin sensitivity), the necessity of long-term medical therapies, the need for surgical treatment, and the changes to habits and lifestyle all negatively impact physical, emotional, and social aspects of daily life,” explained researchers.

They sought to develop and validate a specific questionnaire to assess HRQOL in patients affected by CRSwNP. The subsequent NPQ questionnaire was developed using data of consecutive patients with CRSwNP aged 18 and older who visited the Otorhinolaryngology and Personalized Medicine, Asthma and Allergy units at the Humanitas Research Hospital, Italy, between September 2018 and May 2020.

The development and validation of the NPQ occurred in 2 separate steps involving different groups of patients, in which an initial list of 40 items was given to 60 patients with CRSwNP during a 2-month period (mean [SD] age, 41.4 [8.3] years).

The 27 most significant items were then selected and converted into questions distributed during the validation step involving 107 patients (mean [SD] age, 52.9 [12.4]) who were assessed twice with a 4-week interval between visits. At both visits, patients filled in the NPQ, the visual analogue scale (VAS), and sino-nasal outcome test (SNOT-22).

“At visit 2, patients completed the same questionnaires as at visit 1 and a 7-point Global Rating Scale to assess any change in health status…The questionnaire was validated by assessing internal structure, consistency, and validity. Responsiveness and sensitivity to changes were also evaluated.”

The NPQ revealed a 5-dimensional structure and high levels of internal consistency (Cronbach’s alpha coefficient, 0.95). Furthermore, convergent validity (Spearman’ coefficient, r = 0.75; P < .01), discriminant validity (sensitivity to VAS score), and reliability in a sample of patients with a stable health status (Interclass correlation coefficient, 0.882) were all shown to be satisfactory, with responsiveness to clinical changes also accomplished.

The minimal important difference of CRSwNP impact on quality of life obtained with the receiver operating characteristics analysis was found to be 7.

“This tool should yield data to improve our ability to effectively monitor the burden of disease and treatment on patients with CRSwNP,” concluded the study authors.


Baiardini I, Paoletti G, Mariani A, et al. Nasal polyposis quality of life (NPQ): development and validation of the first specific quality of life questionnaire for chronic rhinosinusitis with nasal polyps. Healthcare (Basel). 2022;10(2):253. doi:10.3390/healthcare10020253

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