Lack of correlation between patient reported location and severity of facial pain and radiographic burden of disease in chronic rhinosinusitis

Falco, Jeffrey J.; Thomas, Andrew J.; Quin, Xuan; Ashby, Shaelene; Mace, Jess C.; DeConde, Adam S.; Smith, Timothy L.; Alt, Jeremiah A.

doi:10.1002/alr.21797

Cited by 19 publications

(21 citation statements)

References 42 publications

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“…Somewhat unexpectedly, higher endoscopic and radiologic scores did not correlate with higher ETDQ‐7 scores. This finding appears consistent with prior studies showing poor correlations between subjective and objective measures of disease severity in CRS . Thus, the lack of severe endoscopic or radiologic findings in patients with CRS should not rule out suspicion for ETD.…”

Section: Discussionsupporting

confidence: 91%

The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis

Tangbumrungtham

Patel

Thamboo

et al. 2017

Int Forum Allergy Rhinol

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Section: Discussionsupporting

confidence: 91%

The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis

Tangbumrungtham

Patel

Thamboo

et al. 2017

Int Forum Allergy Rhinol

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“…Nasal polyposis trended toward lower pain levels on POD3 in the univariate model ( P = 0.071), which continued to be a nonsignificant predictor in the multivariate analysis. This finding is similar to a prior study that showed no difference in pain severity at baseline between CRSwNP and CRSsNP subgroups …”

Section: Discussionsupporting

confidence: 91%

Preoperative quality‐of‐life measures predict acute postoperative pain in endoscopic sinus surgery

et al. 2019

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Objectives Recent increases in opioid‐related mortality have prompted a critical evaluation of postoperative pain management across all specialties. However, successfully limiting narcotic overprescription requires perioperative identification of patients who are at risk for high postoperative pain. Unfortunately, quality data to guide practice patterns are lacking. We therefore prospectively investigated several possible predictive factors of postoperative pain after endoscopic sinus surgery (ESS). Methods Sixty‐four consecutive patients undergoing ESS were enrolled. Baseline 22‐item SinoNasal Outcomes Test (SNOT‐22) and Short‐Form 8 (SF‐8) scores were obtained. Pain scores were collected postoperatively using a numeric rating scale. Spearman correlations and univariate linear regression models were used to investigate relationships between postoperative pain, patient factors, and SNOT‐22/SF‐8 domain scores. Multivariate linear regression was then performed to control for potential confounding variables. Results Day‐of‐surgery pain scores were significantly correlated with the SF‐8 role‐physical domain (Rs = 0.32, P = 0.04). Whereas SF‐8 pain scores were initially nonsignificant, at postoperative day 3 (POD3) the preoperative SF‐8 pain score became correlated with self‐reported pain (Rs = 0.39, P = 0.02). SNOT‐22 total and subdomain scores were not associated with pain scores at any time point. Multivariate linear regression modelling identified baseline SF‐8 role‐physical and pain scores, smoking status, and undergoing a modified Lothrop procedure as significant independent predictors of POD3 pain (adjusted R2 = 0.359, P < 0.0001). Conclusion Baseline patient‐reported global quality‐of‐life measures are associated with postoperative pain after ESS. Large multicenter studies are necessary to validate these findings and investigate additional factors associated with postoperative pain following ESS. Level of Evidence 2c Laryngoscope, 129:1274–1279, 2019

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“…The magnitude of improvement in olfaction with implants in this study exceeded that seen in prior MFNS trials for NPs and was similar to that seen with surgery, indicating clinical significance . The failure to improve facial pain/pressure scores is not surprising because this symptom is more closely associated with CRSsNP, and its association with CRS in general has been questioned …”

Section: Discussionmentioning

confidence: 90%

A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps

Kern

Stolovitzky²,

Silvers

et al. 2018

Int Forum Allergy Rhinol

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BackgroundTopical intranasal corticosteroid sprays (INCSs) are standard treatment for nasal polyps (NPs), but their efficacy is reduced by poor patient compliance and impaired access of drug to the sinus mucosa. A corticosteroid‐eluting sinus implant was designed to address these limitations in patients with recurrent polyposis after sinus surgery by delivering 1350 μg of mometasone furoate (MF) directly to the ethmoid sinus mucosa over approximately 90 days.MethodsA randomized, sham‐controlled, double‐blind trial was undertaken in 300 adults with refractory chronic rhinosinusitis with NPs (CRSwNP), who were candidates for repeat surgery. Eligible patients were randomized (2:1) and underwent in‐office bilateral placement of 2 implants or a sham procedure. All patients used the MF INCS 200 μg once daily. Co‐primary efficacy endpoints were the change from baseline in nasal obstruction/congestion score and bilateral polyp grade, as determined by an independent panel based on centralized, blinded videoendoscopy review.ResultsPatients treated with implants experienced significant reductions in both nasal obstruction/congestion score (p = 0.0074) and bilateral polyp grade (p = 0.0073) compared to controls. At day 90, implants were also associated with significant reductions in 4 of 5 prespecified secondary endpoints compared to control: proportion of patients still indicated for repeat sinus surgery (p = 0.0004), percent ethmoid sinus obstruction (p = 0.0007), nasal obstruction/congestion (p = 0.0248), and decreased sense of smell (p = 0.0470), but not facial pain/pressure (p = 0.9130). One patient experienced an implant‐related serious adverse event (epistaxis).ConclusionSignificant improvements over a range of subjective and objective endpoints, including a reduction in the need for sinus surgery by 61%, suggest that MF sinus implants may play an important role in management of recurrent NP.

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Lack of correlation between patient reported location and severity of facial pain and radiographic burden of disease in chronic rhinosinusitis

Cited by 19 publications

References 42 publications

The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis

The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis

Preoperative quality‐of‐life measures predict acute postoperative pain in endoscopic sinus surgery

A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps

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