title: The effects of endoscopic sinus surgery on level of fatigue in patients with chronic rhinosinusitis.
abstract: BACKGROUND
  Fatigue is a common symptom of chronic rhinosinusitis (CRS), but the response of fatigue to endoscopic sinus surgery (ESS) is rarely studied.
  
  
  METHODS
  A prospective, open cohort of adult patients undergoing ESS for CRS was studied using 10-cm fatigue visual analog scales (VASs), Lund-MacKay computed tomography (CT), and Lund-Kennedy nasal endoscopy scoring.
  
  
  RESULTS
  Two hundred seventy-two patients, followed for a mean (+/-SD) of 16.5 +/- 8.5 months after ESS, noted significant fatigue improvement with an effect size defined as large by Cohen (0.8 [95% CI, 0.5-1.3]). Neither preoperative CT scores nor preoperative endoscopy scores correlated with preoperative fatigue severity. Compared with the mean preoperative fatigue score (6.1 +/- 2.9 cm), preoperative fatigue was more severe in women (6.9 +/- 2.6 cm; p < 0.001) patients with depression (7.7 +/- 2.4 cm; p < 0.001) and patients with fibromyalgia (7.9 +/- 2.2 cm; p = 0.013), but less severe in patients with nasal polyposis (5.4 +/- 3.2 cm; p = 0.009). Significantly greater postoperative reduction in fatigue was noted in patients with fibromyalgia when compared with study patients without fibromyalgia (effect size = 1.8 [95% CI, 1.6-2.2]; p > 0.001) with final fatigue severity scores similar to the entire study group. Similarly, patients with severe fatigue (n = 112; mean VAS score, 8.8 +/- 0.8 cm) showed a more pronounced improvement than patients less severely fatigued (n = 160; mean VAS score 4.2 +/- 2.4 cm; effect size = 2.2 [95% CI, 2.0-2.9]; p > 0.001).
  
  
  CONCLUSIONS
  Fatigue improves after ESS, with significantly greater improvement in patients with fibromyalgia and in patients that are more severely fatigued at presentation.
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 97239, USA.
authors.forename: Nathan B
authors.initials: NB
authors.lastname: Sautter
authors.forename: Jess
authors.initials: J
authors.lastname: Mace
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Chester
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004724:Endoscopy; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D012220:Rhinitis / Q000150:complications / Q000601:surgery*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000150:complications / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome