Rhinitis and rhinosinusitis encompass several diseases with a high incidence rate and chronic character (1–3). Rhinitis is a heterogeneous disorder, defined as inflammation of the lining of the nose, characterized by one or more of the following symptoms: nasal congestion, nasal discharge, sneezing and itching (4). Rhinosinusitis (including nasal polyps) is defined as inflammation of the nose and the paranasal sinuses characterized by two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip), ±facial pain/pressure, ±reduction or loss of smell; and either endoscopic signs of polyps and/or mucopurulent discharge primarily from middle meatus and/or; oedema/mucosal obstruction primarily in middle meatus and/or CT changes showing mucosal changes within the ostiomeatal complex and/or sinuses (5). In the USA, the term sinusitis is still widely used, for example by the FDA. In Europe, the term rhinosinusitis is used as sinusitis rarely occurs without rhinitis (6). Although the mentioned symptoms of rhinitis and rhinosinusitis are not life threatening, multiple studies indicated that they are associated with a dramatic reduction in quality of life (QOL) (7, 8). For example, Bousquet reported a significant impairment in eight of nine QOL dimensions of the Short form 36 (SF-36) in patients with perennial rhinitis compared with healthy subjects (9). For rhinosinusitis, van Agthoven reported SF-36 QOL scores all well below population norm scores (10). Wee et al. reported a (significantly) worse QOL relative to patients with diabetes mellitus, rheumatism, myocardial infarction or migraine, also assessed with the SF-36 (11). These findings indicate the importance of QOL in rhinitis and rhinosinusitis patients. However, controversy has surrounded defining QOL and measuring it reliably in these patient groups.
One definition of QOL is offered by the World Health Organization: ‘QOL includes psychological and social functioning as well as physical functioning and incorporates positive aspects of well-being as well as negative aspects of disease or infirmity’. Health-related quality of life (HRQL) focuses on the part of QOL that is influenced by health: the functional effects of an illness and its treatment on a patient, as perceived by the patient (12). To measure HRQL, questionnaires have been developed to provide a standardized, quantified and summarized version of the patients’ physical symptoms and the functional and psychosocial consequences of the disease and treatment. Traditionally, QOL studies have focussed on assessment of generic QOL. The generic HRQL questionnaires, such as the SF-36, allow comparison among patients with different diseases (11). However, generic instruments may be unresponsive to small – but to the patient important – changes in HRQL. Juniper (13) was the first to publish the development of disease-specific HRQL instruments for rhinitis and Piccirillo (14) was the first regarding rhinosinusitis. In recent years, multiple other HRQL questionnaires have been developed specifically for rhinitis and rhinosinusitis. Several reviews described HRQL questionnaires concerning rhinitis and/or (rhino)sinusitis (15–22). Despite these laudable efforts, little attention has been paid to the quality of the psychometric properties of these questionnaires. As good properties are the key to the successful use of questionnaires, the current review was undertaken to assess the quality of the disease-specific HRQL questionnaires specific for rhinitis and rhinosinusitis for adults.