Sinus Surgery Eases Rhinosinusitis Symptoms
By Michael Smith, North American Correspondent, MedPage Today
Published: January 01, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Endoscopic sinus surgery significantly improved quality of life for more than 70% of people with chronic rhinosinusitis, researchers found.
The surgery reduced disability and improved quality of life, according to Timothy Smith, MD, of Oregon Health & Science University in Portland, and colleagues.
The finding — from a prospective multi-institution study — confirms previous results from small, single-institution studies, Smith and colleagues wrote in the January issue of Otolaryngology – Head and Neck Surgery.
Chronic rhinosinusitis affects up to 16% of Americans, with annual direct costs of $4.3 billion, the researchers noted. That includes about 500,000 surgical procedures a year.
Research has shown that endoscopic sinus surgery improved outcomes for a majority of patients, but many studies were limited by retrospective design and unvalidated outcomes. For previous prospective studies, small sample size was a limiting factor.
To address those limitations, the researchers enrolled 438 patients at three sites between July 2004 and December 2008. Patients were evaluated before and after surgery, using CT scanning, endoscopy score, and both the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey.
After loss to follow-up, results from 302 patients — with an average of 17.4 months of postoperative follow-up — were analyzed for this study, Smith and colleagues said.
- On average, patients improved by 15.8% (or 18.9 points) on the Rhinosinusitis Disability Index, which was significant at P<0.001.
- The average improvement on the Chronic Sinusitis Survey was 21.2% (or 21.2 points), also significant at P<0.001.
- Patients significantly improved general quality of life (at P<0.001) on all eight subscales of the Medical Outcomes Study Short Form-36.
- Among patients with poor baseline quality of life, 71.7% of patients experienced clinically significant improvement on the Rhinosinusitis Disability Index and 76.1% on the Chronic Sinusitis Survey.
- Compared with patients undergoing revision surgery, those having primary surgery were 2.1 times more likely to improve on the Rhinosinusitis Disability Index and 1.8 times more likely to improve on the Chronic Sinusitis Survey. The differences were significant at P=0.006 and P=0.02, respectively.
Other than primary versus revision surgery, “very few patient factors were found to be predictive of outcomes” in multivariate models, the researchers wrote, although a post-hoc analysis suggested mucosal inflammation may play a role.
The study “confirms the importance of functional endoscopic sinus surgery as a tool in the armamentarium of physicians” treating patients with chronic rhinosinusitis, according to Jordan Josephson, MD, a sinus specialist at Lenox Hill Hospital in New York City, who was not involved in the research.
Josephson said in an e-mail that chronic rhinosinusitis is “one limb” of what he has called chronic airway-digestive inflammatory disease, which he believes also includes allergies, asthma, snoring, sleep apnea, and gastroesophageal reflux.
The current study, he said, is one of the “first steps to elucidating this very complex inflammatory disease.”