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The Socioeonomic Impact of Chronic Rhinosinusitis Study (SoCCoR)

Chief Investigator : Carl Philpott
Research Ethics Committee : North Scotland REC1
Research Ethics Committee number : 13/NS/0045

Study summary :  Chronic Rhinosinusitis (CRS) is swelling of the lining of the nose and the sinuses for more than 12 weeks and it is thought to affect 11% of people. Numerous CRS-related NHS encounters occur each year with patients relying heavily on over the counter remedies and thus having a major impact on a person's wallet. There are findings suggesting that CRS patients take more time off work to cope with the symptoms of their illness than other patients which may lead to either a reduction in household income or a cost borne by employers and the economy as a whole. This study aims to estimate how often patients see any health service professionals, what patients spend out of their own pockets and how much time they lose from work because of their symptoms. Volunteers (including healthy controls) will be asked to record new data over 6 months for these factors. Patients will be recruited from hospital clinics in England. This study will develop and use an in-depth questionnaire to ask patients about the types of treatments they bought and any travel costs from going to see their doctors. Gathering this information will allow us to look at the impact of CRS on patients and the NHS, as well as the effect of age, gender, and wealth on patients' treatment and spending, helping to indicate any areas of health inequality and access to services.

Eustachian Tube Dysfunction Chronic Rhinosinusitis Study

Chief Investigator : Carl Philpott
Research Ethics Committee : London - Bromley
Research Ethics Committee number : 13/LO/1379

Study summary : Chronic rhinosinusitis (CRS) is a disorder where swelling/infection of the nose and sinuses causes symptoms of nasal blockage, a runny nose, headaches and a poor sense of smell. The tube that connects the ear to the back of the nose can also become involved in this process (Eustachian tube dysfunction - ETD) and although patients with this disorder often complain about it, the extent of the problem and the effect of any treatment has yet to be studied. This study will therefore ask patients with CRS to undergo two measurements before and after sinus surgery - ear drum compliance (tympanometry) and nasal airflow/resistance (rhinomanometry). As a comparison, patients undergoing nasal surgery (septoplasty) where swelling/infection of the nose and sinuses is not present will also be invited to undergo the same measurements. If patients with CRS are found to have a significant problem with ETD then it will help direct treatment to alleviate this and will help doctors who treat CRS to be more aware of the problem.

An Analysis of the Pedigrees and Genetic Profile of Patients and Families of Patients with Cholesteatoma

Chief Investigator : Carl Philpott
Research Ethics Committee : East of England - Cambridge
Research Ethics Committee number : 16/EE/0131
Funders: Rosetrees Foundation and the Royal College of Surgeons of England

Study summary : A clinical observation that a form of ear disease called cholesteatoma appears to run in families has been made in East Anglia. Cholesteatoma is chronic and potentially serious cause of deafness where there is destruction of the delicate structures of the ear and is treated by ear surgery. We are seeking to identify family pedigrees and subsequently to collect blood samples for genetic analysis. The aim of this study is to identify a genetic basis for the disease. We will identify families from clinical records and through the network of the British Society of Otology. We will approach these families to ask for their consent to provide family trees and subsequently blood samples. The latter will be used for a form of analysis known as genome sequencing which will provide information on any significant variants that are associated with the clinical trait.

PhD Studentship: Exploring Endotypes in Chronic Rhinosinusitis

Chief Investigator: Carl Philpott
Research Ethics Committee: East Midlands - Leicester Central Research Ethics Committee
Research Ethics Committee number: 16/EM/0468 
Funder: Sir Jules Thorn Trust

Study summary : Chronic rhinosinusitis (CRS) is a chronic inflammatory disease where swelling in the nose and sinuses produces a common set of symptoms including blockage, discharge, facial pressure and loss of smell. Despite affecting 1 in 10 people in the UK, the understanding of its aetiology is somewhat rudimentary. Furthermore, CRS is an umbrella term with two main recognised phenotypes and potentially many more endotypes with as yet undefined biological signatures that may indicate the potential for personalised medical and surgical treatment.

This PhD project will explore the differing pathophysiology of the CRS phenotypes, investigating the possibility of specific immunological signatures. Using retrospectively and prospectively collected samples of nasal polyps, mucosa and mucus from CRS patients at the James Paget Hospital, the student will work in the Biomedical Research Centre (BMRC), UEA to test cytokine responses in cell cultures and determine a core set of inflammatory biomarkers for CRS. In addition the PhD student will also investigate the CRS patients’ clinical parameters and outcomes from the existing patient database.

PREDICT PD - the 1000/100/100 pilot study

Chief Investigator : Professor Gavin Giovannoni
Research Ethics Committee : 
Research Ethics Committee number :
Funder: Parkinsons UK 

Study summary : A number of risk factors have been reported before the onset of overt motor signs indicative of PD. These include anosmia, RBD, constipation, and depression. Smoking and use of caffeine, alcohol, and some NSAIDs have been suggested to reduce risk. Individually, most factors convey only a modest effect on overall risk, but may summate with considerable predictive power.

The main objective is to determine whether a combination of risk factors for Parkinson's disease (PD) can identify subjects at high risk by testing for anosmia and REM sleep behavioural disorder (RBD).

MACRO qualitative research (workstream 1c)

Chief Investigator: Carl Philpott & Claire Hopkins
Research Ethics Committee: Office for research ethics committees Northern Ireland
Research Ethics Committee number: 16/NI/0197
Funder: NIHR Programme Grant for Applied Research

Study summary : 

More than 1 in 10 UK adults report symptoms of Chronic Rhinosinusitis (CRS). These symptoms include a blocked and runny nose, loss of smell, facial pain, tiredness and breathing problems, such as asthma being worse. Studies have shown that CRS can have a greater impact on quality of life than heart disease and back pain. Each year more than 600,000 adults are treated for CRS by their doctor. They attend an average of four appointments per year and are prescribed a variety of different drugs. Most patients will receive antibiotics and often repeated courses of antibiotics, even though primary care guidance does not support this, because of the dangers of antibiotic resistance and side effects. Over 120,000 patients attend hospital each year, with around 40,000 then undergoing surgery, as they have not experienced any improvement from their medication; however the evidence concerning the role of surgery is still unclear.

Doctors’ uncertainty about the treatment and management of CRS is also seen in other qualitative research which found that patients were also frustrated with their treatment and the variations in treatment offered. As very few studies have explored the concerns of patients with CRS, and none have explored doctors’ views and experiences of treating and managing CRS there is a need to conduct further exploratory research in this area. The aims of this qualitative study are to explore through telephone interviews with CRS patients, GPs and ENT specialists the experience of living with CRS. To also explore the experience of seeking medical advice and treatment and management options for CRS and to explore views of two trial designs. This qualitative study is part of a larger programme of research to establish which treatments work best for adults with CRS and will inform the design of future controlled trial.