Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis

Salma S Al Sharhan; Mohammed H Al Bar; Shahad Y Assiri; Assayl R AlOtiabi; Deemah M Bin-Nooh; Fozia K AlSugair; Nada F AlRashidi; Abdulmalik S AlSaied; Amal A Alghamdi

doi:10.1186/s12893-021-01269-1

Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis

BMC Surg. 2021 Jun 8;21(1):288. doi: 10.1186/s12893-021-01269-1.

Authors

Salma S Al Sharhan¹, Mohammed H Al Bar², Shahad Y Assiri², Assayl R AlOtiabi², Deemah M Bin-Nooh², Fozia K AlSugair², Nada F AlRashidi², Abdulmalik S AlSaied², Amal A Alghamdi³

Affiliations

¹ Department of Otorhinolaryngology, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia. Ssalsharhan@iau.edu.sa.
² Department of Otorhinolaryngology, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia.
³ Division of Epidemiology and Biostatistics, Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia.

Abstract

Background: Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients.

Methods: This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS.

Results: The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value = < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value = < 0.001); ear/facial symptoms (t-test = 6.34, p-value = < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value = < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = - 2.16, df = 66, p = 0.035).

Conclusion: Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life.

Level of evidence: Prospective observational.

Keywords: Chronic rhinosinusitis; Nasal polyps; Pattern of symptoms; Quality of life.

Publication types

Observational Study

MeSH terms

Chronic Disease
Endoscopy
Humans
Nasal Polyps*
Prospective Studies
Quality of Life
Rhinitis* / complications
Rhinitis* / surgery
Sinusitis* / surgery
Treatment Outcome