Disfunción Social
7. CONCLUSIONES Y RECOMENDACIONES
The limitations encountered in this study, included
Participants’ understanding of the visual analogue scale scoring, which might be affected by the level of education.
Some participants’ recall of the frequency of their symptoms might not have been very accurate.
25
CHAPTER FIVE Results
A total of 110 patients diagnosed with chronic rhinosinusitis were recruited as the study group and 110 controls without nasal pathology were recruited as controls. They were age and sex matched.
5.1: Demographics
The mean age of the study group was 40.2 years (SD +/- 10.6, age range 19-65years), while for the control group it was 38.4 years (SD +/- 10.0, age range 18- 61years). The age group 31-40years had the highest incidence of CRS 43.6%, followed by those aged 41-50years (see Figure 1).Among the study group, 46.4% (n=51) were males and 53.6 %( n=59) were females giving a male: female ratio of 1:1.2. For the control group 45.5% (n=50) were males and 54.5
%( n=60) were females (Figure 2).
Figure 1: Bar chart showing age distribution of participants
2
14
48
31
10
5 1
22
45
26
15
1 0
10 20 30 40 50 60
≤20 years 21-30 years 31-40 years 41-50 years 51-60 years ≥ 61 years
Study Control
26
Figure 2: Bar chart showing sex distribution of participants
5.2 Nasal index
The mean nasal index of the study group was 82.3 (SD +/- 17.8) while for the control group it was 87.1 (SD +/- 16.3). The frequency of distribution of the nasal indices of participants showed that majority of the study group had mesorrhine nasal type (47.3%), while among the control group majority (60.9%) had the platyrrhine type (p>0.05) (see table 1).
Table 1: Cross tabulation of the nasal index of participants Nasal Index Study n(%) Control n(%) Total n(%) Leptorrhine 9 (8.2) 5(4.5) 14 ( 6.4) Mesorrhine 52 (47.3) 38 (34.5) 90 (40.9) Platyrrhine 49 (44.5) 67 (60.9) 116 (52.7) Total n(%) 110 (100.0) 110 (100.0) 220 (100.0) Chi-square= 3.218, p=0.52
44 46 48 50 52 54 56 58 60
male female
study control
27
5.3: Correlation of quality of life score with nasal index
The mean quality of life score was 6.9 (SD +/- 2.3) and the score range was 1-10. More than two-thirds (70.9%, n=78) of the study group reported that CRS had a negative impact on their quality of life while for one third (29.1%, n=32) it had no impact. There was no difference in the QOL scores between the sexes (p>0.05) (table 2).
Table 2: Cross tabulation of QOL score and sex of the study group Quality of life
score
Sex Total n(%)
Male n(%) Female n(%)
No impact 18 (35.3) 14 (23.7) 32 (29.1) Negative Impact 33 (64.7) 45 (76.3) 78 (70.9) Total n(%) 51 (100.0) 59 (100.0) 110 (100.0) P=0.18
Among those with the leptorrhine nasal index, majority reported that CRS had no impact on their quality of life while for the mesorrhine and platyrrhine groups majority of the
participants reported negative impact (p<0.05) (see table3).
Table 3: Cross tabulation of quality of life score and nasal index
Quality of life score
Nasal Index Total n(%) Leptorrhine
n(%)
Mesorrhine n(%)
Platyrrhine n(%)
No impact 8(88.9) 12 (23.1) 12 (24.5) 32 (29.0) Negative impact 1(11.1) 40 (76.9) 37 (75.5) 78 (71.0) Total n(%) 9 (100.0) 52 (100.0) 49 (100.0) 110 (100.0) P= 0.000
28
Correlation of quality of life score and nasal index of the study group showed that there was a weak, significant but positive correlation between the nasal index and quality of life score of the study group ( r= 0.269 p<0.05 at 5% level of significance).
5.4: Association of severity of symptoms with nasal index
The commonest symptom of CRS reported by the study group was nasal blockage (80.0%, n=88) (see table 4). About half (53.6%) of the study group had symptoms of moderate severity (see figure 3). There was a significant association between the severity of symptoms of chronic rhinosinusitis with nasal index (p<0.05). Half (51.9%) of the mesorrhine group had severe symptoms while more than half (61.2%) of the platyrrhine group had moderate symptoms (see table 5).
Table 4: Symptoms of CRS reported by participants
Symptoms of CRS Frequency (n=110)* Percentage (%)
Nasal Blockage 88.0 80.0
Nasal discharge 66.0 60.0
Post- nasal drip 41.0 37.2
Pain in the face 33.0 30.0
Headaches 58.0 52.7
Loss of smell 48.0 43.6
*some patients had more than one symptom
29
Figure 3: Pie chart showing severity of symptoms of CRS of the study group
Table 5: Severity of symptoms of CRS and nasal index
Severity of symptoms
Nasal index Total n(%) Leptorrhine
n(%)
Mesorrhine n(%)
Platyrrhine n(%)
Mild 2 (22.2) 2 (3.8) 0 (0.0) 4 (3.6) Moderate 6 (66.6) 23 (44.2) 30 (61.2) 59 (53.6) Severe 1 (11.1) 27 (51.9) 19 (38.7) 47 (42.7) Total n(%) 9 (100.0) 52 (100.0) 49 (100.0) 110 (100.0) Chi-square= 15.320 p=0.000
4, 3.6%
59, 53.6%
47, 42.7%
mild moderate severe
30
5.4: Association between the frequency of symptoms of CRS (past 2 years) and nasal index
Table 6: Frequency of symptoms of CRS and nasal index
Frequency of symptoms of CRS
Nasal index Total n(%) Leptorrhine
n(%)
Mesorrhine n(%)
Platyrrhine n(%)
Once 4 (44.4) 6 (11.5) 8 (16.3) 18 (16.4)
Two times 1 (11.1) 6 (11.5) 1 (2.0) 8 (7.3)
Three times 1 (11.1) 2 (3.8) 2 (4.1) 5 (4.5)
Four times 1 (11.1) 5 (9.6) 2 (4.1) 8 (7.3)
Five times 1 (11.1) 2 (3.8) 2 (4.1) 5 (4.5)
> Six times 1 (11.1) 31(59.6) 34 (69.1) 66 (60.0) Total n(%) 9 (100.0) 52(100.0) 49 (100.0) 110(100.0) Chi- square= 15.837 p=0.104
More than half of those with mesorrhine and platyrrhine type of nose reported having symptoms more than six times in the past two years while majority of those with leptorrhine type of nose had symptoms just once (p>0.05) (see table 6).
5.5: Relationship between the most disturbing symptom and nasal index
The commonest ‘most disturbing’ symptom of CRS reported was nasal blockage (figure 4).
For the leptorrhine group the commonest most disturbing symptom was headaches while for both the mesorrhine and leptorrhine groups it was nasal blockage, however there was no
31
significant relationship between the most disturbing symptom reported and the nasal index of the study group (p>0.05) (see table 7).
Figure 4: Bar chart showing most disturbing symptom of CRS among the study group.
Table 7: Showing the ‘most disturbing’ symptom of CRS and nasal index
Most disturbing symptom
Nasal index Total Leptorrhine
n(%)
Mesorrhine n(%)
Platyrrhine n(%)
Nasal Blockage 2 (22.2) 27 (51.9) 31 (63.3) 60 (54.5) Nasal discharge 0 (0.0) 5 (9.6) 2 (4.1) 7 (6.4) Post nasal drip 1 (11.1) 8 (15.4) 5 (10.2) 14 (12.7) Headaches 4 (44.4) 6 (11.5) 5 (10.2) 15 (13.6) Pain in the face 2 (22.2) 3 (5.8) 5 (10.2) 10 (9.1) Loss of smell 0 (0.0) 3 (5.8) 1 (2.0) 4 (3.6) Total n(%) 9 (100.0) 52 (100.0) 49 (100.0) 110 (100.0) Chi-square= 17.443 p=0.134
60
7
14 15
10
4 0
10 20 30 40 50 60 70
nasal blockage
Nasal discharge
post nasal drip
headaches pain in the face
loss of smell
most disturbing symptoms
32 CHAPTER SIX Discussion
Chronic rhinosinusitis has been shown to have a negative impact on the health related quality of life of those who suffer it and this can be affected by a number of factors. The possible effect of nasal index on the QOL of adult Nigerians who suffer from CRS is what was investigated in this study.
6.1: DEMOGRAPHICS
The male to female ratio of the participants with CRS in this study (1:1.2) showed a slight female preponderance. This is similar to the finding in the study by Adoga A. and Ma’an N.29 who reported 1: 1.5 and da Lilly-Tariah O.B7 who reported 1:1.4. However Amodu E J et al reported a slight male preponderance65.
6.2: NASAL INDEX
This study found that almost half of the study group (47.3%, n=52), were of the mesorrhine type of nose while more than half (60.9%, n=67) of the control group were of the platyrrhine type of nose (p>0.05). Nasal index was not found to significantly differ between the two groups and none of the studies reviewed investigated this association. Hence no particular nasal index is peculiar to adult Nigerians with CRS.
Of all the participants studied, 52.7% had platyrrhine nose, 40.9% had mesorrhine nose and 6.4% had leptorrhine. This differs from the finding by Jimoh et al, in a study done at Ilorin, of 70.5% platyrrhine nose, 26.7% mesorrhine and 2.8% leptorrhine66. The reason for the disparity might be because there is more ethnic diversity in Abuja than at Ilorin.
33
6.2: QUALITY OF LIFE SCORE OF CRS AND NASAL INDEX
This study found that CRS had a negative impact on the HRQOL of 71% (n=78) of participants in the study group. This is similar to the finding in the study by Lim M. et al67 where 75.8% (n=88) reported that their symptoms affected their QOL and they employed the same QOL instrument as this study i.e VAS scoring. The study by Marambai P.B et al13 also reported a reduction in the QOL of patients with CRS using a different instrument , SNOT 22.
Among the study group there was a significant association between nasal index and QOL score. For those with leptorrhine nose, majority reported that CRS had no impact on their QOL. However among those with mesorrhine nose, 76.9% (n=40) reported that CRS had a negative impact and for those with platyrrhine nose, 75.5% (n=37) reported negative impact (p<0.05). Correlation of the QOL score and nasal index was significant and positive
(r=0.269, p<0.05) hence the bigger the nasal index of an adult Nigerian with CRS, the higher the QOL score and hence the more the negative impact on the QOL. The null hypothesis therefore stands rejected.
None of the studies reviewed during the course of this study investigated this association, however the reason for this finding might be due to the fact that a nose with a higher nasal index will have a greater surface area and hence tendency to secrete more mucus discharge and more sensation of nasal obstruction and rhinorrhoea. Such individuals are likely to report a higher symptom score, however further studies are needed to investigate this assumption.
6.3: SEVERITY OF SYMPTOMS AND NASAL INDEX
Among the study group, 3.6% (n=4) had mild symptoms, 53.6% (n=59) had moderate symptoms and 42.7% (n=47) had severe symptoms. Hence more than half had moderate
34
symptoms (p<0.05). This is very similar to the finding by Olowosusi et al68 who reported that majority of the participants in their study had moderate disease (54.4%, n=80). Amodu EJ et al65 reported that 26.7% (n=16) had mild symptoms, 40.0% (n=24) had moderate symptoms while 33.3% (n=20) had severe symptoms, in their study too majority had moderate
symptoms. Also Lim et al 67reported that 19.8% (n=23) had mild symptoms, 46.6% (n=54) had moderate symptoms and 33.6% (n=39) had severe symptoms . The disparity in the findings of these studies may be explained by the subjective nature of the instrument used in measuring the symptom severity.
There was a significant association between the severity of symptoms of CRS reported and the different nasal indices. Majority of those who have leptorrhine nose had moderate symptoms (66.6%, n=6), half of those with mesorrhine nose had severe symptoms (51.9%, n=27) and majority of those with platyrrhine nose had moderate symptoms (p<0.05). Amodu EJ et al65 reported that there was no association between CRS symptom severity score and anatomical variations of the nose however the nasal index was not one of the anatomical variations investigated in that study.
6.4: FREQUENCY OF SYMPTOMS OF CRS AND NASAL INDEX
This study found that majority of those with leptorrhine nose in the study group reported that they had symptoms only once in the past two years while majority of those with mesorrhine and platyrrhine nasal types had symptoms six or more times in the past two years (p> 0.05).
Hence the frequency of symptoms of CRS has no association with the nasal index. None of the studies reviewed in the course of writing this study reported on this association.
35
6.5: THE ‘MOST DISTURBING SYMPTOM’ AND NASAL INDEX
The commonest most disturbing symptom of CRS reported in this study was nasal blockage (54.5%, n=60) and the second commonest was headaches. This is different from the finding in the study by Soler Z.M et al69 where headache was reported as the most disturbing symptom. For Wan L et al70 they found that nasal discharge was most disturbing for those who have CRS without nasal polyps and altered sense of smell for CRS patients with nasal polyps. This study however did not differentiate between those who have CRS with nasal polyps and those without nasal polyps. There was no significant relationship between the most disturbing symptom and nasal index (p>0.05). Again none of the studies reviewed reported on this association.
Since nasal index has been shown to be associated with the HRQOL of patients with CRS in this study, investigating its effect on the outcome of treatment of this group of patients is the future of this study.
36
CHAPTER SEVEN
Conclusions and Recommendations
The following conclusions are based on the findings in this study and are as follows
1. There is a significant positive correlation between nasal index and the total HRQOL score of adults with CRS.
2. There is an association between nasal index and symptom severity of patients with CRS.
3. There is no association between nasal index and frequency of CRS symptoms.
4. There is no significant relationship between the most disturbing symptom of CRS and nasal index.
Recommendations
These are based on the conclusions in this study and include
1. Nasal index measurement can be included as a domain in one of the instruments for the evaluation of HRQOL of patients with CRS.
2. More studies into the relationship between nasal index of patients with CRS and their HRQOL using other QOL instruments are recommended.
37 REFERENCES
1. Ressel G. Practice Guidelines: Sinus and Allergy Health Partnership Releases Report on Adult Chronic Rhinosinusitis. Am Fam Physician. 2004;69(9):2248–2249.
2. Blackwell D., Collins J., Coles R. Summary health statistics for U.S adults: National Health Interview Survey 1997. Vital Heal. Stat10. 2002;205:1–109.
3. Hasten D, Fokkens WJ, Bachert C, et al. Chronic rhinosinusitis in Europe- an underestimated disease. A GA(2)LEN study. Allergy. 2001;66(9):1216–23.
4. Iseh K., Makusidi M. Rhinosinusitis : A retrospective analysis of clinical pattern and outcome in north western Nigeria. Ann Afr Med. 2010;9(1):20–26.
5. Ezeanolue B., Mgbor N. The Running Nose : A review of Rhinorrhoea from non-neoplastic diseases at the otolaryngology clinic of the University of Nigeria Teaching Hospital, Enugu. J. Coll. Med. 1999;4(2):90–92.
6. Mgbor NC, Ezeanolue BC. A review of sinusitis: Aetiology, Complications and Management. J Coll Med. 2000;5(2):108–112.
7. Da Lilly-Tariah OB. Pattern of Clinical Features Of Chronic Simple Rhinosinusitis In Port Harcourt. Niger J Clin Pr. 2006;9(2):142–146.
8. Ogunleye AO, Nwaorgu OGB, Lasisi AO, Ijaduola GT. Trends of sinusitis in Ibadan , Nigeria . West Afr J Med. 1999;18(4):298–302.
9. Fokkens WJ, Lund VJ, Mullol J. European Position Paper on Rhinosinusitis and Nasal Polyps. Rhinology. 2012;50(Supplement 23):1–298.
38
10. Alobid I, Bernal-Sprekelsen M, Mullol J. Chronic rhinosinusitis and nasal polyps : the role of generic and specific questionnaires on assessing its impact on patients quality of life.
Allergy. 2008;63(10):1267–1279.
11. Alobid I, Benítez P, Bernal-Sprekelsen M, et al. Nasal polyposis and its impact on quality of life: comparison between the effects of medical and surgical treatments. Allergy.
2005;60(4):452–8.
12. Senior BA, Glaze C, Benninger MS. Use of the Rhinosinusitis Disability Index ( RSDI ) in Rhinologic Disease. Am J Rhinol. 2001;15(1):15–20.
13. Marambaia PP, Lima MG, Santos KP, Gomes AM, Sousa MM de, M E Marques DM.
Evaluation of the quality of life of patients with chronic rhinosinusitis by means of the SNOT-22 questionnaire. Braz J Otorhinolaryngol. 2013;79(1):54–58.
14. DietzdeLoos DA, Segboer CL, Gevorgyan A, Fokkens WJ. Disease-Specific Quality-of-Life Questionnaires in Rhinitis and Rhinosinusitis : Review and Evaluation. Curr Allergy Asthma Rep. 2013;13(2):162–170.
15. Wijk RG van. Quality of Life, should we bother? Allergy. 2003;58:284–286.
16. Lin SY, Reh DD, Navas-Acien A. Allergic rhinitis , chronic rhinosinusitis , and symptom severity : a population-based study. Int Forum Allergy Rhinol. 2012;2(1):51–6.
17. Katle EJ, Hart H, Kjaergaard T, Kvaloy JT, Steinsvag SK. Nose- and sinus-related quality of life and GERD. Eur Arch Otorhinolaryngol. 2012;269(1):121–5.
39
18. Reh DD, Lin SY, Clipp SL, Irani L, Alberg AJ, Navas-acien A. Secondhand tobacco smoke exposure and chronic rhinosinusitis : A population-based case – control study. Am J Rhinol Allergy. 2009;23(6):562– 7.
19. Shejbal D, Vagić D, Stevanović S, Koić E, Kalogjera L. Impact of posttraumatic stress disorder on sinonasal symptoms and quality of life in patients with chronic rhinosinusitis . Patient Prefer Adherence. 2012;6:847–52.
20. Kilty SJ, Bosse Y, Cormier C, Endam LM, Desrosiers MY. Polymorphism in the SERPINA1 (Alpha-1-Antitrypsin) gene are associated with severe chronic rhinosinusitis unnresponsive to medical therapy. Am J Rhinol Allergy. 2010;24(1):e4–e9.
21. Rudmik L, Smith TL. Quality of Life in Patients with Chronic Rhinosinusitis. Curr Allergy Asthma Rep. 2011;11(B):247–252.
22. Oladipo GS, Fawehinmi HB, Suleiman YA. The Study Of Nasal Parameters ( Nasal Height , Nasal Width , Nasal Index ) Amonst The Yorubas Of Nigeria. Internet J. Biol.
Anthropol. 2009;3(2).
23. Williams P, Dyson M, Dussak JE, et al. Skeletal System. In: Grey’s Anatomy. 3rd ed.
Edinburg: Churchill Livinstone; 1995:609–12.
24. Porter JP, Olson KL. Analysis of the African American female nose. Plast Reconstr Surg J. 2003;111(2):620–6.
25. Risley H. The People of India. 2nd ed. (Crook W, ed.). London: W. Thacker & Co;
1969:395–399.
40
26. Eccles R, Doddi N. The relationship between nasal index and nasal airway resistance , and response to a topical decongestant. Rhinology. 2011;49(5):583–586.
27. Hall RL, Hall DA. Geographic variation of native people along the pacific coast. Hum.
Biol. J. 1995;67(3):407–26.
28. Oladipo GS, Oyakhire MO, Ugboma H. Anthropometric Studies of Nasal Indices of the Ekpeye and Ikwerre Ethnic Groups in Nigeria. Asian J Med Sci. 2010;2(4):167–169.
29. Adoga A., Ma’an N. The Epidemiology and Economic Impact of Rhinosinusitis in Jos, North Central Nigeria. J Clin. Res Bioeth. 2011;2:116.
30. Fasunla AJ, Nwaorgu OGB. Adult Chronic Rhinosinusitis : Spectrum of Clinical features and management in a Tertiary Health Institution and Literature Review. East Cent. Afr J Surg. 2011;16(1):12–18.
31. Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: Estabilishing definitions for clinical research and patient care. J Allergy Clin Immunol. 2004;115(6):155–212.
32. Benninger MS. Adult chronic rhinosinusitis: Definitions, diagnosis, epidermiology and pathophysiology. Otolaryngol Head Neck Surg. 2003;129(03):S1–S32.
33. Lanza D., Kennedy DW. Adult Rhinosinusitis Defined. Otolaryngol Head Neck Surg.
1997;117(3 (part 2)):S1–7.
34. Collins J., Blackwell D., Tonthat L, Shashy R., Moore E., Weaver A. Prevalence of selected chronic conditions: United States 1990-1992 summary health statistics for the US population. Vital Heal. Stat 10. 1997;130(194):1–89.
41
35. Shashy RG, More EJ, Weaver A. Prevalence of Chronic Sinusitis Diagnosis in Olmsted County Minnesota. Arch Otolaryngol Head Neck Surg. 2004;130(3):320–323.
36. Ahsan S., Jumans S, Nunez D. Chronic rhinosinusitis: a comparative study of disease occurrence in North of Scotland and Southern Carribean otolaryngology outpatient clinics over a month period. Scott Med J. 2004;49(4):130–3.
37. Pilan RR, Pinna FR, Bezerra TF, et al. Prevalence of chronic rhinosinusitis in Sao Paulo.
Rhinology. 2012;50(2):129–138.
38. Gordts F, Clement P., Buisseret T. Prevalence of sinusitis signs in a Non- ENT population. ORL J Otorhinolaryngol Relat Spec. 1996;58(6):315–9.
39. Kim YS, Kim NH, Seong SY, Kim RK, Lee G, Kim KS. Prevalence & risk of chronic rhinosinusitis in Korea. Am J Rhinol Allergy. 2011;25(3):e117–e121.
40. Cho Y, Choi S-H, Park KH, et al. Prevalence of Otolaryngologic Diseases in South Korea : Data from the Korea National Health and Nutrition Examination Survey 2008. Clin Exp Otorhinolaryngol. 2010;3(4):183–193.
41. Calman KC. Quality of life in cancer patients- a hypothesis. J Med Ethics. 1984;10:124–
127.
42. Piccirillo JF, Merritt MG, Richards ML. Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test ( SNOT-20 ). Otolaryngol Head Neck Surg. 2002;126(1):41–
47.
43. Lund VJ. Health related quality of life in sinonasal disease. Rhinology. 2001;39:182–186.
42
44. Schipper H, Clinch J, Powell V. Definition and conceptual issues. In: Spilker B, ed.
Quality of life assessment in clinical trials. New York: Raven Press Ltd; 1990:11–24.
45. Ware JE, Sherbourne CD. The MOS 36 Item Short Form Health Survey (SF-36) I.
Conceptual framework and item selection. Med Care J. 1992;30:473–483.
46. Piccirillo JF, Edwards D, Haiduk A, Yonan C, Thawley S. Psychometric and Clinimetric Validity of the 31-ltem Rhinosinusitis Outcome Measure. Am J Rhinol. 1995;9(6):297–306.
47. Gliklich R., Metson R. Effect of sinus surgery on quality of life. Otolaryngol Head Neck Surg. 1997;177(1):12–17.
48. Benninger MS. The development of the Rhinosinusitis Disability Index. Arch Otolaryngol Head Neck Surg. 1997;123:1175–1179.
49. Lund VJ, Holmstrom M, Scadding GK. Functional endoscopic sinus surgery in the management of chronic rhinosinusitis . An objective assessment. J Laryngol Otol.
1991;105(October):832–835.
50. Bhattacharyya N. The economic burden and symptom manifestations of chronic rhinosinusitis. Am J Rhinol. 2003;17:27–32.
51. Atlas S., Metson R., Singer D. Validity of a new health related QOL instrument for patients with CRS. Laryngoscope. 2005;115:846–54.
52. Revicki D, Leidy NK, Brennan DF, Thompson C, Togias A. Development and
prelimnary validation of the multiatribute Rhinitis Symptom Utility Index. Qual. Life Resp J.
1998;7:693–702.
43
53. Leong SC, Eccles R. A systematic review of the nasal index and the significance of the shape and size of the nose in rhinology. Clin Otolaryngol. 2009;34(3):191–8.
54. Daniel B. Racial anthropolgy and genetics of Lebanese. www.nasalindexof lebanese.com.
2000:1–2.
55. Oladipo GS, Udoaka AI, Afolabi EO, Bob-Manuel IF. Nasal Parameters Of Itsekiris And Urhobos Of Nigeria. Internet J. Biol. Anthr. 2009;3(1):1–6.
56. Oladipo GS, Olotu JE, Suleiman Y. Anthropometric Studies of Cephalic Indices of the Ogonis in Nigeria. Asian J Med Sci. 2009;1(2):15–17.
57. Oladipo GS, Olabiyi A., Oremosu AA, Noronha CC. Nasal indices among major ethnic groups in southern Nigeria. Sci Res Essay. 2007;2(1):20–22.
58. Oladipo GS, Eroje MA, H B Fahwehinmi HB. Anthropometric comparison of nasal indices between Andoni and Okrika tribes of Rivers State , Nigeria. Int J Med Med Sci.
2009;1(4):135–137.
59. Anibor E, Etetafia MO, Eboh DE, A O. Anthropometric study of the nasal parameters of the Isokos in Delta State of Nigeria. Ann Bio Res. 2011;2(6):408–413.
60. Umar MBT, Ojo SA, Asala SA, Hambolu JO. comparism of cephalometric indices btw hausas & yoruba ethnic groups of nigeria. Res J Med Sci. 2011;5(2):83–89.
61. Taura MG. Cephalometry of the hausa tribe of Kano state. A prelimnary study. 2002.
62. Umar MBT, Singh R, Shugabu AI. Cephalometric Indicies among Nigerians. J App Sci.
2006;6(4):939–942.
44
63. Commission NP. Legal Notice on Publication of 2006 Census Final Results. Fed. Repub.
Niger. Off. Gaz. 2009;96(2):B1–42.
64. Araoye MO. Research methodology with statistics for health and social sciences. Ilorin Nigeria: Nathadex; 2004:115–124.
65. Amodu EJ, Fasunla AJ, Akano AO, Olusesi AD. Chronic rhinosinusitis : correlation of symptoms with computed tomography scan findings. Pan Afri Med J. 2014;18:40.
66. Jimoh R.O, Alabi S. B, Aremu K.S, Salihu A.M OO. Rhinometry: Spectrum of Nasal profile among Nigerian Africans. Brazillian J. Otorhinolaryngol. 2011;77(5):589–593.
67. Lim M, Lund VJ, Lew-gor S, et al. The relationship between subjective assessment instruments in chronic rhinosinusitis. Rhinol. 2007;45:144–47.
68. Olowosusi O, Asoegwu C, Olagunju A, Nwawolo C. A cross-sectional evaluation of the correlation between disease severity and quality of life in chronic rhinosinusitis patients in Nigeria. Eur Arch Otorhinolaryngol. 2014:26.
69. Soler Z, Mace J, Litvack J, Smith T. Chronic rhinosinusitis, race, and ethnicity. Am. J.
Rhinol. Allergy. 2012;26(2):110–116.
70. Wan L, Shi N, Wang Y, Liu Z, Cui Y. Symptomatic characteristics of chronic
rhinosinusitis patients and symptom-specific outcomes after endoscopic sinus surgery. LIn Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2009;23(17):781–3.
45
APPENDIX I
Data Sheet
Part 1: Questionnaire for the study of Correlates between nasal index and HRQOL of