Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi‐institutional study

Smith, Timothy L.; Kern, Robert C.; Palmer, James N.; Schlosser, Rodney J.; Chandra, Rakesh K.; Chiu, Alexander G.; Conley, David B.; Mace, Jess C.; Fu, Rongwei; Stankiewicz, James A.

doi:10.1002/alr.20063

Cited by 76 publications

(97 citation statements)

References 20 publications

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“…In one of the prospective, multi institutional studies done by Timothy L. Smith et al, demonstrated the improvement in quality of life (QOL) in both medically treated and surgically treated patients, with CRS though patients treated surgically experienced significantly more improvement in disease specific QOL. 20 Thus, we found most of our outcomes were in good conjunction with earlier studies over medical versus surgical treatment of CRS with polyposis.…”

Section: -12supporting

confidence: 77%

Evaluation of the medical and surgical management of chronic rhinosinusitis with polyposis

Modgil

2016

Int J Otorhinolaryngol Head Neck Surg

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Background: Chronic rhinosinusitis (CRS) is a group of disorders characterized by inflammation of the mucosa of the nose and paranasal sinuses of at least 12 consecutive weeks duration. Surgical intervention may be required if severe symptoms of obstruction and infection prove medical treatment to be ineffective. Little is known about the outcomes of patients electing to continue medical management or the comparative effectiveness of continued medical therapy with FESS. Methods: The study was conducted on 126 adult patients in the age group of 18-55 who fulfilled the CRS criteria with nasal polyposis. All patients were medically treated for the CRS, and observed after 3 weeks. In case the treatment was not effective; they were scheduled for FESS intervention and further observed after another 6 weeks. The improvement of the patients was measured by Visual analogue score, nasal endoscopy score and saccharine test. Results: Males between 41-50 were the most common patients with CRS. There was a significant improvement in the VAS score, nasal endoscopy score after 3 weeks of medical treatment. In 88% of patients the saccharine score was normal showing that this was not an effective measure for assessing the improvement. Conclusions: Medical treatment was found to be sufficient to treat most symptoms of CRS with nasal polyposis (grade 1 and 2). Surgery should only be done in refractory cases. Selection of those patients who will benefit from surgery should be based on the patient's symptoms and not on the examiner's polyp score. Quality of life is not proportional to polyp size (Upto grade 2).

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Section: -12supporting

confidence: 77%

Evaluation of the medical and surgical management of chronic rhinosinusitis with polyposis

Modgil

2016

Int J Otorhinolaryngol Head Neck Surg

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“…As in Smith et al, medical therapy was determined by the treating physician and customized to the patients' symptoms and disease process. 5 The study outcome cannot exclude patient benefit from postoperative medical management, although it should be emphasized that all patients were refractory to medication when entering the study.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of in-office endoscopic sinus surgery with balloon sinus dilation

Albritton¹,

Casiano²,

Sillers

2012

am j rhinol allergy

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“…1131,1148,1342,1343,1345 These benefits were reflected in substantially greater QoL improvements as well as decreased used of antibiotics, oral corticosteroids, and reduced absenteeism in the group treated surgically. 43,1131,1148,1342,1343,1345 Finally, a modeling based economic evaluation demonstrates that an ESS strategy has a higher probability of being the more cost-effective intervention in patients with refractory CRS compared to continuing with medical therapy alone. 1346 The most recent Cochrane review highlights the lack of high-quality RCTs, which are insufficient to draw firm conclusions.…”

Section: Xf Surgery For Crswnp and Crssnp: Outcomesmentioning

confidence: 97%

“…1340 Patients undergoing revision surgery, regardless of polyp status, also experience significant improvement, though the magnitude of improvement is slightly less than primary surgery patients, likely because of a selection bias of more severe inflammatory disease in those requiring revision surgery. 77,1341,1342 Health utility measurements (how patients value their current state of health) of CRS with and without polyposis demonstrate substantial reduction in health utility comparable to those with moderate asthma, end-stage renal disease, or Parkinson's disease. 46,49 Significant health utility improvements are seen with ESS and are comparable to those seen with joint replacement surgery and coronary angioplasty.…”

Section: Xf Surgery For Crswnp and Crssnp: Outcomesmentioning

confidence: 99%

“…751,1344 However, the included trials evaluated patients who had not failed a trial of appropriate medical therapy prior to randomization. Smith et al 1131,1148,1342 published subsequent nonrandomized, real-world, multicenter observational studies and have demonstrated significant benefits of ESS over continued medical therapy in patients who have failed an initial trial of appropriate therapy. This AMT typically included at least culture-directed or broad spectrum antibiotics, INCS, and in most cases, a trial of oral corticosteroids.…”

Section: Xf Surgery For Crswnp and Crssnp: Outcomesmentioning

confidence: 99%

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International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

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554

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi‐institutional study

Abstract: Patients electing ESS experienced significantly higher levels of improvement in several outcomes. Further investigation with a larger cohort is warranted as treatment selection bias may confound the magnitude of improvement experienced with each treatment.

Cited by 76 publications

References 20 publications

Evaluation of the medical and surgical management of chronic rhinosinusitis with polyposis

Evaluation of the medical and surgical management of chronic rhinosinusitis with polyposis

Feasibility of in-office endoscopic sinus surgery with balloon sinus dilation

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

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