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Endoscopic sinus surgery improves cognitive dysfunction in patients with chronic rhinosinusitis
Author(s) -
Alt Jeremiah A.,
Mace Jess C.,
Smith Timothy L.,
Soler Zachary M.
Publication year - 2016
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.21820
Subject(s) - medicine , chronic rhinosinusitis , cognition , sinusitis , quality of life (healthcare) , endoscopic sinus surgery , physical therapy , psychiatry , surgery , nursing
Background Patients with chronic rhinosinusitis (CRS) have been found to have cognitive deficit, as identified using the Cognitive Failures Questionnaire (CFQ), but the exact etiology of cognitive decline is unknown. In this study we aimed to determine whether improvement in concomitant inflammation and disease burden in CRS, using endoscopic sinus surgery (ESS), improves cognitive deficit. We also sought to identify comorbid conditions that effect improvement likelihood. Methods Study participants (n = 247) with and without nasal polyposis (CRSwNP, CRSsNP) were prospectively enrolled in this multi‐institutional, observational outcomes study. Pre‐ and postoperative cognitive dysfunction was evaluated using the CFQ instrument. Quality of life (QOL) and disease burden was also evaluated using the Rhinosinusitis Disability Index (RSDI), the 22‐item SinoNasal Outcome Test (SNOT‐22), nasal endoscopy, computed tomography, and the 2‐item Patient Health Questionnaire (PHQ‐2). Results Average CFQ total scores improved significantly ( p = 0.012) after ESS for patients with follow‐up (n = 141). Participants with CRSwNP (n = 51) reported significant postoperative improvements in mean CFQ total scores ( p = 0.002) and CFQ distractibility and blunders domain scores ( p ≤ 0.006). No significant postoperative improvement for any average CFQ score was found in CRSsNP ( p > 0.086). The magnitude of postoperative improvement in CFQ total and domain mean scores was statistically similar between CRSsNP and CRSwNP ( p > 0.115). Depressive disorder, identified using PHQ‐2 screening, was the only comorbid condition significantly associated with measurable cognitive deficit ( p < 0.001). Conclusions Patients with CRS have measurable cognitive decline, and ESS may modestly improve cognitive deficit/CFQ scores. Future investigations are needed to further elucidate the underlying mechanisms responsible for cognitive deficit in patients with CRS and significant associations with depression.