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Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitis
Author(s) -
Smith Kristine A.,
Smith Timothy L.,
Mace Jess C.,
Rudmik Luke
Publication year - 2014
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21366
Subject(s) - medicine , chronic rhinosinusitis , guideline , refractory (planetary science) , quality of life (healthcare) , endoscopic sinus surgery , medical therapy , surgery , physics , nursing , pathology , astrobiology
Background The decision to continue medical therapy or recommend endoscopic sinus surgery (ESS) can be challenging in patients with refractory chronic rhinosinusitis (CRS). The objective of this study was to evaluate continued medical therapy vs ESS for patients with refractory CRS who have severe reductions in baseline disease‐specific quality of life (QoL). Methods This was a prospective longitudinal crossover study between August 2011 and June 2013. All patients were >18 years old, diagnosed with CRS based on guideline recommendations, failed initial medical therapy and elected ESS. While waiting for ESS, all patients received continued medical therapy. The preoperative waiting period outcomes (continued medical therapy) were compared to the postoperative outcomes. The primary outcome was change in disease‐specific QoL (22‐item Sinonasal Outcome Test [SNOT‐22]). Secondary outcomes were change in endoscopic grading (Lund‐Kennedy score), medication consumption, and work days missed in the preceding 90 days. Results Thirty‐one patients were enrolled. Mean baseline SNOT‐22 score was 57.6. After a mean of 7.1 months of continued medical therapy, there was a worsening in SNOT‐22 score (57.6 to 66.1; p = 0.006). After ESS, with a mean postoperative follow‐up of 14.6 months, there was a significant improvement in SNOT‐22 score (66.1 to 16.0; p < 0.001). There was also a significant improvement in endoscopic grading ( p < 0.001) coupled with a reduction in both work days lost ( p < 0.001) and medication consumption ( p < 0.01). Conclusion Results from the study suggest that ESS is a more effective intervention compared to continued medical therapy for patients with refractory CRS who have severe reductions in their baseline disease‐specific QoL.