Surgical treatment of chronic recurrent rhinosinusitis: a preliminary report.
OBJECTIVE
The objective of this study was to determine if endoscopic sinus surgery (ESS) is effective in the management of chronic recurrent rhinosinusitis (CRRS).


METHODS
A consecutive series of patients with CRRS diagnosed according to stringent criteria was prospectively examined before and at least 1 year after ESS. Paranasal sinus computed tomography scans were staged and ESS was performed targeting radiographic disease and the ostiomeatal complex. Preoperative and postoperative disease severities in terms of symptom scores, medicine utilization, and resource factors were assessed using the rhinosinusitis symptom inventory (RSI). Improvements in RSI symptom domains, medical and economic resource factors were determined using effect sizes and statistical comparison before and after ESS.


RESULTS
Nineteen patients (mean age, 42.3 years) completed the study with a mean follow up of 19.1 months. The mean Lund score was 3.42 (standard deviation, 4.09). Statistically significant decreases in nasal (-36.1), facial (-28.4), oropharyngeal (-34.6), systemic (-24.7), and total (-31.9) RSI symptom domain scores were observed (all P < .003) with effect sizes ranging from 0.87 to 1.63 (strong surgical effect). Statistically significant decreases in antihistamine use (-30%, P = .031), number of workdays missed as a result of CRRS (-1.9, P = .035), and number of acute infectious episodes (-2.5, P = .006) were also observed. However, declines in weeks of antibiotic use (-2.8 weeks, P = .293) and number of antibiotic courses (-1.7, P = .118) were not significant.


CONCLUSIONS
Patients with CRRS may substantially benefit both symptomatically and medically from ESS. Although surgery should be used cautiously in treating CRRS, further trials of ESS for CRRS are warranted.
Bhattacharyya
Neil
N
Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA. neiloy@massmed.org
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004724:Endoscopy; D005005:Ethmoid Sinus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012220:Rhinitis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D018582:Sick Leave; D012852:Sinusitis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D006634:Histamine H1 Antagonists