Outcomes of sinus surgery in ambulatory patients with immune dysfunction.
BACKGROUND
Previous outcomes studies of patients with chronic rhinosinusitis (CRS) have mostly excluded subjects with immunodeficiency or autoimmune disease. Although expert opinion suggests these patients are often refractory to therapy, outcomes after endoscopic sinus surgery (ESS) are not well delineated. We evaluated improvement in objective and quality of life (QoL) measures after ESS in adult patients treated in the ambulatory setting with immune dysfunction including immunodeficiency and autoimmune diseases.


METHODS
Patients with CRS associated with immune dysfunction (n = 22) were evaluated and matched 1:1 with control subjects from a prospective cohort in a nested case-control design. Preoperative computed tomography (CT) and pre-/postoperative endoscopic findings were recorded. Disease-specific QoL instruments (the Rhinosinusitis Disability Index [RSDI] and Chronic Sinusitis Survey [CSS]) were administered pre- and postoperatively.


RESULTS
Mean postoperative follow-up was similar for both cases (18.6 +/- 6.6 months) and controls (18.4 +/- 8.7 months). Preoperative CT and endoscopy scores (i.e., disease severity) were similar in both cases and controls. Postoperative endoscopy scores were significantly improved for both cases (p < 0.001) and controls (p = 0.012). Both groups had similar preoperative and postoperative scores on the CSS; however, control subjects reported significantly worse RSDI baseline scores. Immunodeficiency and autoimmune cases and CRS controls experienced significant improvement in QoL after surgery (p < or = 0.041).


CONCLUSIONS
Immunodeficiency and autoimmune cases, in the ambulatory setting, present with similar severity of disease when compared with controls with CRS. We found similar improvements in both objective and QoL outcomes for case subjects and control subjects, suggesting that patients with immune dysfunction may experience similar benefit from ESS.
Division Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road PV-01, Portland, OR 97239, USA.
Ayesha N
AN
Khalid
Jess C
JC
Mace
Timothy L
TL
Smith
D000328:Adult; D000818:Animals; D016022:Case-Control Studies; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007154:Immune System Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome