Response Shift in Quality of Life After Endoscopic Sinus Surgery for Chronic Rhinosinusitis

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Background Functional endoscopic sinus surgery (FESS) was historically predicated on targeted widening of narrow anatomic structures that caused post-obstructive persistent sinus inflammation. It is now clear that chronic rhinosinusitis (CRS) is a multi-factorial disease with subsets of patients which may require a more extensive surgical approach. This study compares quality-of-life (QOL) and disease severity outcomes after FESS based on the extent of surgical intervention. Methods Participants with CRS were prospectively enrolled into an on-going, multi-institutional, observational, cohort study. Surgical extent was determined by physician discretion. Participants undergoing bilateral frontal sinusotomy, ethmoidectomy, maxillary antrostomy, and sphenoidotomy were considered to have undergone ‘complete’ surgery, while all other participants were categorized as receiving ‘targeted’ surgery. Improvement was evaluated between surgical subgroups with at least 6-month follow-up using the 22-item Sinonasal Outcome Test (SNOT-22) and the Brief Smell Inventory Test (BSIT). Results 311 participants met inclusion criteria with 147 subjects undergoing complete surgery and 164 targeted surgery. A higher prevalence of asthma, ASA sensitivity, nasal polyposis, and a history of prior sinus surgery (p≤0.002) was present in participants undergoing complete surgery. Mean improvement in SNOT-22 (28.1[21.9] vs. 21.9[20.6];p=0.011) and BSIT (0.8[3.1] vs 0.2[2.4];p=0.005) was greater in subjects undergoing complete surgery. Regression models demonstrated a 5.9[2.5] greater relative mean improvement on SNOT-22 total scores with complete surgery over targeted approaches (p=0.016). Conclusions Complete surgery was an independent predictor of greater postoperative SNOT-22 score improvement, yet did not achieve clinical significance. Further study is needed to determine the optimal surgical extent.

Section: Methodsmentioning

confidence: 99%

Outcomes of complete vs targeted approaches to endoscopic sinus surgery

DeConde

Suh

Mace

et al. 2015

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“…Five distinct symptom domains of the SNOT-22 have been previously described and include rhinologic symptoms (range: 0–30), extra-nasal rhinologic symptoms (range: 0–15), ear/facial symptoms (range: 0–25), psychological dysfunction (range: 0–35), and sleep dysfunction (range: 0–25). 13 …”

Section: Methodsmentioning

confidence: 99%

Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments

DeConde

Mace

Ashby

et al. 2015

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Background Prior investigations into facial pain associated with chronic rhinosinusitis (CRS) have yielded important results, but have yet to utilize pain-specific outcome measures. This study seeks to characterize facial pain associated with CRS using validated pain-specific instruments. Methods Adults with CRS were enrolled into a prospective, cross-sectional study along with control participants presenting with non-CRS diagnoses. Facial pain was characterized in both groups using the Brief Pain Inventory Short Form (BPI-SF) and the Short-Form McGill Pain Questionnaire (SF-MPQ). CRS-specific measures of disease were measured including the Sinonasal Outcome Test-22 (SNOT-22), nasal endoscopy, and computed tomography scoring. Results Patients were comprised of CRS with nasal polyposis (CRSwNP; n=25), CRS without nasal polyposis (CRSsNP; n=30), and control participants (n=8). Subjects with CRSwNP and CRSsNP were less likely to be pain free than controls (16.0%, 6.7% and 62.5% respectively, p=0.001) and carried greater burden of pain as measured by the BPI-SF and SF-MPQ than controls (p=0.002 and p=0.017, respectively). Pain in CRS was most commonly located around the eyes and characterized as ‘throbbing’ and ‘aching’. Nasal polyp status was not associated with differences in character, severity, or location of pain. Conclusions Subjects with CRS have a greater burden of facial pain relative to control subjects across several standardized pain measures. Further, facial pain in CRS significantly correlated to QOL and CRS-specific disease severity measures. Study across larger cohorts using standardized pain measures is warranted to clarify the association of facial pain with chronic rhinosinusitis.

“…Sinus-specific QoL was assessed using the 22-item Sinonasal Outcome Test (SNOT-22) 13 . For each subject, CT scans were reviewed in blinded fashion and graded according to Lund-Mackay staging system.…”

Section: Methodsmentioning

confidence: 99%

Impact of postoperative endoscopy upon clinical outcomes after endoscopic sinus surgery

Schlosser

Storck

Smith

et al. 2015

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Background After endoscopic sinus surgery (ESS), endoscopy is used to gauge surgical success and clinical outcomes. Prior studies have not examined this topic prospectively using validated outcome metrics across multiple institutions. Methods A multi-institutional, prospective study of patients with chronic rhinosinusitis (CRS) who underwent ESS completed the SinoNasal Outcome Test (SNOT-22), missed productivity and medication usage questionnaires 6 months postoperatively. Lund-Kennedy endoscopy scoring (LKES) was performed with reviewers blinded to patient-reported data. A control cohort of non-CRS patients was recruited for comparison. Results Complete data was available on 183 CRS patients and 48 non-CRS control patients. Approximately 50% of patients achieve perfect or near perfect endoscopy (LKES 0-2) after ESS. Postoperative endoscopy correlated with total SNOT-22 scores (r=0.278, p<0.001), with the strongest correlations to rhinologic and extra-nasal subdomains in the nasal polyp cohort. Improved postoperative endoscopy was associated with decreased antibiotic and oral steroid usage, but had little association with missed productivity. Among patients who achieved near perfect postoperative endoscopy, those with nasal polyps had SNOT-22 scores that were similar to non-CRS control patients (mean SNOT-22 17.7 and 16.3, respectively). However, CRS patients without nasal polyps remained more symptomatic than non-CRS controls and CRS with nasal polyp patients despite nearly perfect endoscopy (mean SNOT-22 21.6). Conclusions Postoperative endoscopy correlates with SNOT-22 and medication usage in CRS patients. Polyp patients who achieve near perfect endoscopy have similar symptoms to healthy controls, however, non-polyp patients with near perfect endoscopy still have rhinologic and extra-nasal symptoms that are worse than healthy controls.