Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery

Abstract

The predictive value of olfaction for quality of life (QoL) recovery after endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) is still underestimated. The aim of this study was to explore the proportion of patients suffering from CRS who experience clinically significant QoL improvement after ESS and identify pre-operative clinical phenotypes that best predict surgical outcomes for QoL, focusing mainly on the role of patients' olfaction. One hundred eleven patients following ESS for CRS and 48 healthy subjects were studied. Olfactory function was expressed by the combined "Threshold Discrimination Identification" score using "Sniffin' sticks" test pre-treatment and 12 months after treatment. All subjects completed validated, widely used QoL questionnaires, specific for olfaction (Questionnaire of Olfactory Deficits: QOD), for assessing psychology (Beck Depression Inventory: BDI) and for general health (Short Form-36: SF-36). Statistically significant improvement of olfactory function by 41.8% and of all QoL questionnaires scores (all p < 0.001) was observed on the 12-month follow-up examination. Clinically significant improvement for QoL was measured in a proportion of 56.8% of patients on QOD, 64.9% on SF-36 and 49.5% on BDI scales results. Although olfactory dysfunction, nasal polyps, female gender, high socio-economic status and non-smoking habits were significantly associated with better QoL results, multivariate logistic regression analysis revealed that only olfactory dysfunction and nasal polyps were independent predictors significantly associated with higher likelihood of clinically significant improvement in all QoL questionnaire results. Olfactory dysfunction and nasal polyps were independent pre-operative predictors for surgical outcomes with regard to QoL results.

Efficacy of ESS in chronic rhinosinusitis with and without nasal polyposis: a Danish cohort study

“…A positive olfactory function result of ESS in CRS patients was also confirmed by a recent Greek study [7].…”

“…ESS for patients with CRS is considered a well-established surgical method in cases where medical therapy fails [6]. Still only few studies gather the results of both quality of life measures and olfactory function after ESS in CRS patients diagnosed according to the criteria of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) [7,8], and no studies provide results specific for the CRSsNP subgroup.…”

Burden of Illness: A Systematic Review of Depression in Chronic Rhinosinusitis

“…The greatest improvement in depression-specific outcomes seems to be in those with olfactory dysfunction and nonsmokers. The impact of nasal polyps was beneficial to depression outcomes in one study of patients with CRS with nasal polyposis, 22 whereas another study found increased odds of achieving a minimal clinically important difference in patients with CRS without nasal polyposis. 17 The data that support depression-specific improvement are limited, and most studies were not designed to investigate this outcome in a comprehensive fashion.…”

“…17 Four studies examined depression-specific outcomes after CRSspecific medical or surgical therapy, and all found improvement in depression. 11,16,17,22 These studies aimed to determine whether treatment of CRS specifically would impact comorbid depression secondarily. Overall, there are limited data, but it seems that treatment of CRS results in a mean improvement in depression scores.…”

New Discoveries Regarding Endotypes of Chronic Rhinosinusitis with Nasal Polyp

“…Results are presented by EQ-5D QoL dimension, EQ-5D index score and EQ-VAS score. Using model 1 and adjusting for demographic characteristics, we identified several categories with significant differences in the CRS participants, including mobility, usual activities, pain/discomfort, and anxiety/depression ( ported [18]. This difference in gender experience of QoL was addressed by Mendolia-Loffredo et al [19].…”