title: Low-stage computed tomography chronic rhinosinusitis: what is the role of endoscopic sinus surgery?
abstract: OBJECTIVE
  To measure the change in quality-of-life (QoL) after endoscopic sinus surgery (ESS) in patients with medically recalcitrant chronic rhinosinusitis (CRS) and minimally affected computed tomography (CT) scans of the paranasal sinuses.
  
  
  METHODS
  Prospective, multicenter cohort study at three academic, tertiary care centers.
  
  
  METHODS
  A total of 778 patients with CRS were enrolled between January 2001 and April 2009 after electing ESS. For the purposes of this analysis, patients with nasal polyposis, history of prior sinus surgery, or follow-up <6 months were excluded. Final study patients were categorized as low-stage CT CRS (Lund-Mackay ≤3; n = 17) and high-stage CT CRS (Lund-Mackay >3; n = 207). Primary outcome measures included two disease-specific QoL instruments: the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey.
  
  
  RESULTS
  In patients with low-stage CT CRS, a statistically significant improvement was found across all disease-specific QoL scores (all P ≤ .012), with the exception of the CSS medication usage subscale (P = .073). These QoL improvements were comparable to those in patients with high-stage CT CRS.
  
  
  CONCLUSIONS
  Some patients will present with CRS that is refractory to medical therapy even though their CT demonstrates relatively minimal disease. Based on the results of this study, ESS is associated with improved QoL in patients with low-stage CT CRS and can provide significant benefit to carefully selected patients with minimally affected CT scans.
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: Luke
authors.initials: L
authors.lastname: Rudmik
authors.forename: Jess
authors.initials: J
authors.lastname: Mace
authors.forename: Timothy
authors.initials: T
authors.lastname: Smith
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011788:Quality of Life; D012852:Sinusitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed