Endoscopic sinus surgery for chronic rhinosinusitis: 22‐item Sino‐Nasal Outcome Test 5‐year results

Abstract

Background Currently, limited data exist as to long‐term disease‐specific outcomes after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). In this report, we present outcomes data collected over 5 years in a large prospective cohort of patients who underwent surgical treatment for CRS. Methods Patients who completed the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) before ESS were asked to complete the same survey at yearly intervals for 5 years thereafter. The impact of patients’ demographics and clinical characteristics on clinical outcome was measured using mixed effects modeling for univariate and multivariable analysis. Multivariable logistic regression threshold analyses were also performed. Results Among the 925 patients enrolled in the study, the SNOT‐22 was completed after ESS by 641 patients (69.3%) at 1 year and 338 patients (36.5%) at 5 years. The mean preoperative SNOT‐22 score of 48.5 (standard error [SE], 0.69) improved at all subsequent yearly time‐points, including 5 years (mean, 25.8; SE, 1.08; p < 0.0001). SNOT‐22 scores over time were impacted by nasal polyps (p < 0.001), environmental allergies (p = 0.010), diabetes (p = 0.032), and preoperative Lund‐Mackay score (p < 0.001). Conclusion Endoscopic sinus surgery appears to be effective at improving the quality of life of patients with CRS for both the short and long term. The successful outcome of such surgery, however, is influenced by a variety of clinical factors, which should be taken into account by clinicians who are considering surgical treatment of CRS for select patients.

Minimal Radiographic Mucosal Thickness or Opacification Criterion for Sinus‐Specific Endoscopic Sinus Surgery for Chronic Rhinosinusitis

“…26 Sinus-specific opacification has also been shown to not be correlated with CRS symptomatology. 27 Although the evidence has been conflicting, 28,29 some studies have shown that greater radiographic CRS disease severity may be associated with better outcomes after ESS [30][31][32] and one retrospective study has suggested that symptoms/ revision ESS rate may not be improved by ESS beyond affected sinuses. 33 In comparison, other studies have shown patients with minimal radiographic evidence of sinus disease but who have medically recalcitrant symptoms of suspected sinonasal origin can experience significant improvement in QOL from ESS.…”

The Impact of Gender on Long‐Term Quality of Life After Sinus Surgery for Chronic Rhinosinusitis

“…15 Endoscopic sinus surgery (ESS) is a well-established treatment option for CRS that has broadly been shown to produce durable, long-term improvements in quality of life. [16][17][18][19] Within-subject comparisons have demonstrated that the large majority of females and males experience significant quality of life improvements after ESS, 7,9,20 although up to 20% of patients may require additional surgery within 5 years of the primary operation. 21,22 Moreover, female gender has repeatedly been identified as a risk factor for ESS revision.…”

Association of ethnicity and time to surgery among patients with chronic rhinosinusitis

“…Chronic rhinosinusitis (CRS) is a condition that affects millions of people worldwide and has a detrimental impact on quality of life similar to diseases such as heart failure and chronic obstructive pulmonary diseases 1,2 . Endoscopic sinus surgery (ESS) has revolutionized CRS management and offers high rates of quality of life improvement and symptom severity reduction in patients who do not respond to medical therapy 3–5 . However, the decision to undergo ESS is complex and multifactorial.…”

“…medical therapy. [3][4][5] However, the decision to undergo ESS is complex and multifactorial. Despite meeting candidacy for surgery, patients may delay undergoing ESS for a variety of reasons.…”