OBJECTIVES-1. To measure the proportion of patients with chronic rhinosinusitis (CRS) who experience clinically significant improvement after endoscopic sinus surgery (ESS) in a prospective, multi-institutional fashion. 2. To identify preoperative characteristics which predict clinically significant improvement in quality of life (QOL) after ESS. STUDY DESIGN-Prospective, multi-institutional cohort study SETTING-Academic tertiary care centers SUBJECTS & METHODS-302patients with CRS from three centers were enrolled between July 2004 and December 2008 and followed for an average of 17.4 months postoperatively. Preoperative patient characteristics, computed tomography (CT) scan, endoscopy score and pre-and postoperative quality of life (QOL) were collected. Univariate and multivariate analyses were performed.

Background Little is known regarding the epidemiology of chronic rhinosinusitis (CRS) in racial and ethnic minorities in the United States(US). Objective Comprehensively evaluate the current prevalence of chronic rhinosinusitis (CRS) across various treatment settings in order to identify possible disparities in health care access and utilization between racial and ethnic populations. Methods The NHIS, NAMCS, and NHAMCS database registries were extracted to identify the national prevalence of CRS in race/ethnic populations and resource utilization in ambulatory care settings. Systematic literature review identified studies reporting treatment outcomes in minority patients electing endoscopic sinus surgery(ESS). Data was supplemented using a multi-institutional cohort of patients undergoing surgical treatment. Results National survey data suggests CRS is a significant health condition for all major race/ethnic groups in the US, accounting for a sizable portion of office, emergency, and outpatient visits. Differences in insurance status, work absenteeism, and resource utilization were found between race/ethnic groups. Despite its prevalence, few published studies include information regarding minority patients with CRS. Most(90%) cohort studies did not provide details of race/ethnicity for ESS outcomes. Prospective cohort analysis demonstrated that minority surgical patients accounted for only 18%, as compared to national census estimates(35%). Conclusions Chronic rhinosinusitis is an important health condition for all major race/ethnic groups in the US. Significant differences may exist across racial and ethnic categories with regard to CRS health status and healthcare utilization. Given current demographic shifts in the US, specific attention should be given to understanding CRS within the context of racial and ethnic populations.

INTRODUCTIONDecreased sense of smell is a common problem affecting approximately 61-69% of patients with chronic rhinosinusitis (CRS) and is one of the four signs and symptoms used to diagnose CRS. 1 Olfactory impairment negatively impacts patients' quality of life and ability to function safely in day to day life. 2 Despite being a common complaint in the setting of sinusitis, relatively little objective data is available regarding the impact of endoscopic sinus surgery (ESS) on olfactory function. Much of the olfactory literature is based on subjective reports of olfactory function, which do not accurately assess objective olfactory impairment. 3-4 A small number of prospective studies with objective olfactory outcomes have been performed with mixed results. 3, 5-10 The use of different olfactory measures and definitions of improvement have added confusion to the interpretation of results. Additionally, the majority of studies report short-term follow up of 6 months or less and do not account for long-term changes that may occur in the post-operative period.In this multi-institutional, prospective cohort study, the impact of ESS on olfactory impairment in patients with CRS was objectively examined over 6 month and 12 month follow up. We hypothesized that patients with mild olfactory impairment (hyposmia) would benefit from ESS whereas patients with severe olfactory impairment (anosmia) would not. MATERIALS & METHODS Study Population and Data CollectionStudy subjects were recruited from three tertiary care centers over a three-year period as part of a multi-institutional prospective cohort study. All patients had a diagnosis of CRS based on All study protocols and informed consent were collected and approved by the Institutional Review Boards at each study site. Measurement of Olfactory FunctionThe SIT from Sensonics, Inc., an objective measure of olfactory function, was administered to patients. 15 The SIT is a validated 40 question forced-choice test (total score: 0-40) with high test-retest reliability (r > 0.90) and is highly correlated with more sophisticated measures of olfactory dysfunction (r> 0.80). 16-17 Absolute SIT scores were categorized into olfactory severity categories based on robust gender-adjusted, normative data (normosmics: men with SIT scores 34-40 and women with SIT scores 35-40; microsmics/hyposmics: men with SIT scores 19-33 and women with SIT scores 19-34; anosmics: men and women with SIT scores 6-18). 15 Patients with SIT scores 0-5 were categorized as malingering and removed from the analyses (n=4). Age was not part of the classification system and was included as a covariate and adjusted for in the analyses. Statistical AnalysesAll statistical analyses were performed using SPSS v.16.0 statistical software (SPSS Inc., Chicago, IL). Baseline demographics, clinical factors, and changes in mean 12-month postoperative SIT scores were compared across preoperative olfactory diagnostic categories using the Kruskal-Wallis test and Chi-square analyses where appropriate. A two-tailed p-value ≤...

Objectives-To measure the prevalence of and identify clinical characteristics associated with poor olfactory function in a large cohort of patients with chronic rhinosinusitis (CRS).Study Design-Multi-institutional, cross sectional analysis.Methods-An objective measure of olfactory dysfunction, the Smell Identification Test (SIT), demographic data, clinical factors and co-morbidity data were collected from a cohort of 367 patients who presented with CRS at three tertiary care centers. Data was analyzed using univariate and multivariate analyses.Results-Sixty-four percent of men and women aged 18 to 64 had olfactory dysfunction whereas 95% of patients ≥ 65 years had olfactory dysfunction (p<0.001); no significant difference was noted by gender. By multivariate logistic regression analysis, patients with nasal polyposis (OR 2.4, 95% confidence interval (CI) 1.3, 4.2; p=0.003) and patients ≥ 65 years (OR 10.0, 95% CI 2.3, 43.7; p=0.002) were at increased risk of hyposmia. Patients with nasal polyposis (OR 13.2, 95% CI 5.7, 30.7; p<0.001), asthma (OR 4.2, 95% CI 1.8, 9.8; p=0.001), ≥ 65 years (OR 15.6, 95% CI 2.3, 104.9; p=0.005), and smokers (OR 7.6, 95% CI 1.8, 31.6; p=0.005) were at increased risk of anosmia.Conclusions-Poor olfactory function is common in patients with CRS. Age, nasal polyposis, smoking, and asthma were significantly associated with olfactory dysfunction in patients with CRS. Neither prior endoscopic sinus surgery nor a history of allergic rhinitis was associated with olfactory dysfunction. Septal deviation and inferior turbinate hypertrophy were associated with normal olfactory function.

Background Olfactory dysfunction is deemed to be a significant contributor to poor quality of life (QOL). However, little is known about the relationship of olfactory testing to other measures of disease burden in patients with chronic rhinosinusitis (CRS). Objective In this study, we examine the relationship of olfactory function to computed tomography (CT) scores, endoscopy scores, and QOL measures in patients with CRS. Methods A multi-institutional, cross-sectional analysis of 367 patients was performed. Several objective measures were collected: the Smell Identification Test, Lund-MacKay CT score, Lund-Kennedy endoscopy score, two validated disease-specific QOL instruments, the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey, and a general health-related QOL instrument, the Medical Short Form-36. Analysis of variance was performed. Correlation coefficients were calculated. Results Patients with olfactory dysfunction had significantly worse mean endoscopy scores (normosmics: 4.16 (± 3.97); hyposmics: 6.26 (± 4.21); anosmics: 9.61 (± 4.48); p<0.001) and significantly worse CT scores (normosmics: 9.11 (± 5.40); hyposmics: 11.16 (± 5.96); anosmics: 17.62 (± 5.37); p<0.001). Endoscopy scores were moderately correlated with olfactory scores (r= -0.46, 95% CI -0.38, -0.54; p<0.001). CT scores were moderately correlated with olfactory scores (r= -0.53, 95% CI -0.45, -0.60; p<0.001). Olfactory function was not correlated with disease-specific or general health-related QOL measures. Conclusions Although previous studies have suggested that olfactory impairment is associated with poor QOL, this study found no such correlation. In contrast, olfaction scores correlated well with other objective measures of CRS, namely endoscopy and CT scores.

Depressed patients with CRS present similarly but have worse pre- and postoperative HRQoL scores and experience similar disease-specific QoL improvements from sinus surgery compared with other CRS patients. Sinus surgery is not effective in alleviating the effect of depression on disease-specific HRQoL, and it is likely that comorbid depression and CRS are operating on independent disease pathways. Additional research and hypothesis testing using continuous, objective measures is warranted.

Patients with RARS were more often primary surgical patients and underwent less extensive surgery than their CRS counterparts. Both groups reported improved QOL after surgery.

OBJECTIVE-To prospectively measure the prevalence and effect of symptomatic depression on chronic rhinosinusitis (CRS) patients' quality of life (QOL), disease-severity, and outcomes of endoscopic sinus surgery (ESS). STUDY DESIGN-Prospective cohort studySETTING-Academic, tertiary care center SUBJECTS AND METHODS-Seventy-six patients with CRS were enrolled prior to ESS and followed post-operatively for a mean of 13.3 months(SD 5.5). Lund-MacKay CT score, LundKennedy endoscopy score, Patient Health Questionnaire-9 (PHQ-9), 2 disease-specific QOL instruments (Rhinosinusitis Disability Index [RSDI] and Chronic Sinusitis Survey [CSS]), and one general QOL instrument (Medical Outcomes Study Short Form-36 [SF-36]) were measured. Differences in outcome scores were analyzed using univariate and multivariate analyses. CONCLUSION-CRS patients with depression had worse baseline QOL than other CRS patients, but experienced comparable postoperative improvement in QOL after ESS. Interestingly, depression severity significantly improved after ESS. RESULTS-Only