Correlations Between Endoscopy Score and Quality of Life Changes After Sinus Surgery

Abstract

Objective To assess whether change in endoscopy score correlates with change in health-related quality of life (HRQOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Setting Tertiary rhinology clinic Patients One hundred two adult patients, with and without nasal polyposis, who elected to undergo ESS and were followed for 12 ± 2 months postoperatively. Intervention Patient characteristics and Lund-Mackay computed tomography scores were recorded preoperatively. Lund-Kennedy endoscopy scores and 2 HRQoL surveys, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were examined before and after surgery. Main Outcome Measures Postoperative changes in endoscopy score and HRQOL were examined using bivariate and multivariate analyses. Results Statistically significant improvements were found in endoscopy score (p<0.001) and for all total and subscale HRQoL measures (p<0.001). After controlling for baseline status and comorbid factors, improvement in endoscopy score significantly correlated with 12 month improvement on the total RSDI (p=0.01), the physical (p=0.01) and functional (p=0.02) subscales of the RSDI, and the symptom subscale of the CSS (p=0.003), but could explain only 25.5–36.6% of the linear variation for these HRQOL improvements. Conclusions For most patients, endoscopy scores and disease specific HRQOL significantly improved after endoscopic sinus surgery. Changes in endoscopy scores explain a portion of the improvement in HRQOL. For patients with CRS, improvements in disease specific HRQoL outcomes are complex, multidimensional constructs that cannot be entirely explained by surgical changes measured by endoscopic examination.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Unfortunately, at best, endoscopic scoring systems only weakly correlate with current QoL 64,67 and postoperative gains in QoL. 69 Although there is room for refinement of endoscopic scoring, endoscopic exams likely provide only a portion of the data required to accurately predict symptomatology.…”

“…75,1347 Despite this, clinicians see significant improvement in objective findings regardless of polyp status, indicating that ESS is important in bringing the objectively measured inflammatory processes under control. 69,75,1347 Patients with CRSwNP tend to have better baseline QoL relative to patients with CRSsNP; however, specific symptoms such as nasal airway obstruction and olfactory disturbance tend to dominate CRSwNP. 75,77,868,1347,1348 Interestingly, patients with CRSwNP have the greatest improvement in QoL following ESS despite their relatively better baseline QoL.…”

Quality of life after functional endoscopic sinus surgery in patients with chronic rhinosinusitis

“…By McNemar test* [11][12][13][14][15] Our study shows that most of the patients (40%) were among the age group 25-34 years, followed by age group 35-44 years (30%). This age distribution is comparable to study done in the USA in 2010 who found (30%) of patients belong to age group 21-30, and (27%) belongs to age group 31-40.…”

The Effect of Endoscopic Sinus Surgery on Quality of Life: A Prospective Clinical Study

“…The main goal in the treatment of a patient with CRS should be to decrease nasal blockage and nasal discharge complaints, which have a signifi• cant correlation with the life quality of the patient [11]. Objective and subjective methods can be used in the evaluation of treatment [7]. Although medical and surgical reduction of polyps, discharge, edema and crusting significantly improves the inflammatory process and the corresponding endoscopy score, these improvements can explain only a small percentage of the association with patient based HRQoL and sinonasal symptom burden.…”

“…There are limited numbers of papers about the impact of ESS on quality of life in the literature. It is important to use disease specific health related quality of life (HRQoL) surveys when determining the success of ESS [7]. The reliability of this survey must be proven.…”