Objective and subjective evaluation of endoscopic nasal surgery outcomes.
BACKGROUND
Chronic rhinosinusitis (CRS) symptoms include nasal obstruction, rhinorrhea, and facial pain associated with rhinosinusitis disability. When resistance to medical treatment is associated with endonasal anomalies, endoscopic nasal surgery (ENS) can be proposed. However, objective and subjective assessment criteria regarding the evaluation of ENS outcomes remain unclear. The aims of this study were to evaluate the correlation between the inflammation in the nasal mucosa, objective recordings of nasal airway resistance (NAR), subjective evaluation of symptom intensity, and the impact of ENS on patient-perceived rhinosinusitis disability.


METHODS
Sixty-one consecutive patients (35 men and 26 women; mean age, 37.5 years) suffering from CRS were monitored at 4 months and 2 years after ENS. All middle turbinate mucosa were analyzed for the density of nonspecific inflammatory cells. All patients scored their own subjective rhinosinusitis symptoms and complaints of rhinosinusitis disability. An active anterior rhinomanometry was performed.


RESULTS
A good correlation was observed between subjective and objective NAR (p < 0.001). We found a significant correlation between the density of inflammatory cells in the nasal mucosa, subjective nasal obstruction, and the rhinosinusitis disability score (p < 0.001). Recurrent CRS was seen only in subjects with moderate to severe inflammation of the middle turbinate mucosa sampled at the first surgical intervention. Subjective rhinosinusitis symptoms, objective NAR, and rhinosinusitis disability improved significantly after ENS.


CONCLUSIONS
The degree of inflammation seems to be a good prognostic indicator regarding CRS recurrence. Long-term outcome after ENS for CRS showed significant improvement in subjective rhinosinusitis-specific symptoms, objective NAR, and rhinosinusitis disability.
Giger
Roland
R
Laboratory of Experimental Rhinology, Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital, Geneva, Switzerland.
Landis
Basile Nicolas
BN
Zheng
Chunquan
C
Malis
Didier-David
DD
Ricchetti
Alma
A
Kurt
Anne-Marie
AM
Morel
Denis R
DR
Lacroix
Jean Silvain
JS
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology; D015508:Nasal Obstruction / Q000209:etiology / Q000473:pathology; D009666:Nose / Q000601:surgery*; D011788:Quality of Life; D012008:Recurrence; D012220:Rhinitis / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D025363:Rhinomanometry; D012852:Sinusitis / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome