Long-term outcome analysis of endoscopic sinus surgery for chronic sinusitis.
BACKGROUND
The purpose of this study was to determine long-term subjective outcome of endoscopic sinus surgery (ESS) for chronic sinusitis (CS) and to evaluate prognostic indicators for surgical treatment failure.


METHODS
This is a prospective study of patients who underwent ESS for CS. Symptom assessment was performed using a visual analog scale at a pretreatment interview and then at regular intervals post-ESS for up to a 3-year period. The indicators for symptom scoring were nasal obstruction, facial pain, postnasal drip, anterior discharge, and anosmia/hyposmia.


RESULTS
Data analysis indicates that ESS improves symptom scoring early on, but the effects begin to dissipate over time. Anosmia/hyposmia is the most severe symptom overall for all patient subgroups and recurs to a greater degree 3 years postoperatively in Samter's Triad sufferers (p = 0.006), asthmatic patients (p = 0.002), and those with a worse CT scan at presentation (p = 0.04). In addition, Triad sufferers who complain of nasal obstruction and anterior nasal discharge have a significant recurrence of their symptoms postoperatively (p = 0.04 and 0.001, respectively).


CONCLUSIONS
Individuals must be warned that ESS may not be a long-term solution for CS because of its chronic nature. Patients are relieved of their symptoms initially; however, these tend to recur over a 3-year period. Samter's Triad is the strongest determinant of long-term treatment failure. Asthma also is a determinant of treatment failure, which lends credence to the notion of combined airway disease. Allergy was not a strong determinant of treatment failure in our study.
Young
Jonathan
J
McGill University, Montreal, Quebec, Canada. jonathan.young@mail.mcgill.ca
Frenkiel
Saul
S
Tewfik
Marc A
MA
Mouadeb
Debbie A
DA
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012852:Sinusitis / Q000601:surgery*; D016896:Treatment Outcome