Clinical outcomes of chronic rhinosinusitis in response to medical therapy: results of a prospective study.
BACKGROUND
Little information exists regarding the outcome of medical management of chronic rhinosinusitis (CRS) in adults. The aim of this study was to examine whether baseline patient demographics, symptoms, objective findings, or treatment strategies were associated with improved CRS outcomes over time.


METHODS
Eighty-four new patients with CRS were evaluated and medically treated for up to 12 months. Patients completed monthly health status questionnaires. The average change of symptom scores using the Sino-Nasal Outcome Test plus one additional symptom--sense of smell (SNOT-20+1)-was the primary outcome measure.


RESULTS
Overall, patients experienced a modest improvement in SNOT-20+1 scores (delta = -0.61; p< 0.0001), but this did not reach the predetermined level of a clinically meaningful effect (delta = -0.80). Baseline facial pain or facial pressure was negatively associated with outcome (p = 0.048 and 0.029, respectively) and did not correlate with extent of disease by sinus CT scoring. Other factors, including nasal discharge, hyposmia, cough, nasal polyps, and sinus CT severity, did not predict outcomes. The use of either oral antibiotics or oral steroids was associated with trends toward improved outcomes only when sinus-specific symptoms alone were considered.


CONCLUSIONS
The majority of CRS patients receiving medical treatment show modest improvement over time in SNOT-20+1 scores. Facial pain or facial pressure at entry are negatively associated with outcomes and may reflect causes other than CRS. These findings highlight the limitations of current medical treatment for CRS and the need for novel treatment strategies.
Hessler
Jill L
JL
Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Piccirillo
Jay F
JF
Fang
David
D
Vlahiotis
Anna
A
Banerji
Aleena
A
Levitt
Robert G
RG
Kramper
Maggie A
MA
Thawley
Stanley E
SE
Hamilos
Daniel L
DL
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012220:Rhinitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D012903:Smell / Q000502:physiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents