title: Symptom-based presentation of chronic rhinosinusitis and symptom-specific outcomes after endoscopic sinus surgery.
abstract: BACKGROUND
  Very few studies have comprehensively examined specific symptom outcomes of endoscopic sinus surgery (ESS). The purpose of this study was to define the individual symptoms of a cohort of patients with medically refractory chronic rhinosinusitis (CRS) using visual analog scale (VAS) scores as well as report symptom-based outcomes after ESS.
  
  
  METHODS
  Patients with medically refractory CRS presenting for surgical management were asked to evaluate baseline symptoms using 10-cm VAS measures. Participants were asked to rank their most debilitating symptoms in descending order. VAS scores were assessed postoperatively at 3, 6, 12, and 18 months. The Kruskal-Wallis test was used to assess improvement in mean symptom VAS scores at each of the postoperative time points.
  
  
  RESULTS
  Nasal congestion elicited the highest preoperative VAS score with an average of 6.5, followed by fatigue (6.0), headache (5.8), decreased sense of smell (5.5), nasal drainage (5.5), and facial pain-pressure (5.5). Headache was the most commonly reported disabling condition. Follow-up data after ESS was available for 207 patients. Average VAS scores for 6 of 7 symptoms showed significant and sustainable postoperative improvement at 3, 6, 12, and 18 months after surgery (p < 0.001). Improvement in VAS score for headache was not statistically significant (p > 0.700).
  
  
  CONCLUSIONS
  This study indicates that patients with medically refractory CRS presenting for surgery complain of associated symptoms with great frequency. ESS results in both statistically and clinically significant improvements in six of seven symptoms. Headache, which was the most highly ranked disabling symptom, did not show significant improvement from baseline.
authors.affiliation: Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
authors.forename: Jess
authors.initials: J
authors.lastname: Mace
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods*; D005157:Facial Pain / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010147:Pain Measurement; D011184:Postoperative Period; D011788:Quality of Life; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012903:Smell / Q000502:physiology*; D016896:Treatment Outcome