Symptom outcomes after endoscopic sinus surgery for chronic rhinosinusitis.
OBJECTIVE
To determine the effectiveness of endoscopic sinus surgery (ESS) for individual symptoms, medication use, and related factors in patients with chronic rhinosinusitis (CRS).


METHODS
Nonrandomized, prospective, clinical trial.


METHODS
Adult patients with medically refractory CRS were examined before ESS with the Rhinosinusitis Symptom Inventory to catalog major and minor symptoms, medication use, physician visits, and missed workdays due to CRS. After a minimum 6-month follow-up after ESS, patients were examined to determine response to therapy. After computation of Rhinosinusitis Symptom Inventory domains, comparisons were conducted and effect sizes were computed for the change in symptoms after surgery.


RESULTS
One hundred adults completed the examination, with a mean follow-up of 19.0 months. Before surgery, the mean major symptom scores ranged from 2.5 to 3.5 (Likert scale, from 0 [symptom absent] to 5 [maximum severity]) and the minor symptom scores ranged from 0.8 to 2.8. After surgery, statistically significant decreases in major and minor symptoms were noted (P<.001 for all). The largest effect sizes were noted for the decreases in facial pressure, congestion, nasal obstruction, rhinorrhea, and headache (absolute value of effect size >0.85 for all). Similarly, large effect sizes were noted for decreases in symptoms in the nasal (-1.30), facial (-1.13), and total (-1.25) symptom domains of the Rhinosinusitis Symptom Inventory. Medication use actually increased for topical nasal corticosteroids, but decreased for prescription antihistamines. A mean reduction of 1.1 antibiotic courses (mean decrease of 2.3 weeks taking antibiotics) was noted after ESS.


CONCLUSIONS
Endoscopic sinus surgery provides significant symptom relief for the nasal and facial symptoms associated with CRS. Patients will often still require topical nasal corticosteroids for the management of their CRS, but can expect decreases in antibiotic requirements after ESS.
Bhattacharyya
Neil
N
Division of Otolaryngology, Brigham and Women's Hospital, and the Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA. neiloy@massmed.org
D000041:Absenteeism; D000328:Adult; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D011184:Postoperative Period; D011446:Prospective Studies; D012220:Rhinitis / Q000188:drug therapy / Q000601:surgery*; D012852:Sinusitis / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome