What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts

Abstract

Objectives Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. Methods A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. Results According to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. Conclusions According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2). Graphical abstract

Validity and reliability of a french version of the olfactory disorders questionnaire

“…In future studies, authors may use the smell identification test (UPSIT) in addition to TDI to strengthen the olfactory evaluation. The Fr-ODQ could be used in many future French studies from France, Belgium or Canada in which authors will investigate smell function in common conditions, including chronic rhinosinusitis with or without polyps [ 16 , 17 ], or COVID-19 [ 18 ]. The main strengths of this study are the realization of TDI evaluations, allowing the confirmation of the olfactory dysfunction and the evaluation of ‘responsiveness to change’ parameter.…”

The application of enhanced recovery after surgery (ERAS) in chronic rhinosinusitis patients undergoing endoscopic sinus surgery: A systematic review and meta-analysis

“…In the ERAS program, preoperative counseling, preoperative training, effective postoperative analgesia, early feeding, and early mobilization have a positive action on shortening the duration of hospitalization. It is well-known that CRS not only damages the patient’s health but also brings severe financial burdens on their families [ 6 ]. There is no doubt that shortened LOS is beneficial to reducing hospitalization expenses.…”

“…However, patients who receive ESS might also have a poor prognosis due to a variety of complicating factors [ 4 ]. Some patients still reported no improvement in postoperative symptoms and even serious mental illness [ 3 , 6 , 7 ]. It follows that only paying attention to ESS treatment itself may be insufficient.…”

Remission: Does it already exist in chronic rhinosinusitis with nasal polyposis?

“…A consensus statement from tertiary Canadian rhinologists has previously combined symptomatic and endoscopic assessments to define success after ESS, with ‘optimal’ results reported as absence of symptoms and normal appearance of the sinus mucosa on sinonasal endoscopy [ 5 ] with continued medical therapy. However, it was unclear how often, or even whether, this ‘optimal’ outcome could be achieved.…”