title: Investigation of change in cardinal symptoms of chronic rhinosinusitis after surgical or ongoing medical management.
abstract: BACKGROUND
  Chronic rhinosinusitis (CRS) has been defined as inflammation of the paranasal sinuses lasting at least 12 weeks with corresponding 2 or more "cardinal symptoms" that include: (1) nasal obstruction; (2) thick nasal discharge; (3) facial pain/pressure; and (4) reduction or loss of sense of smell. Although prior studies have investigated symptoms of CRS after sinus surgery, none have compared the outcomes of these specific symptoms to ongoing medical therapy.
  
  
  METHODS
  Patients with CRS were prospectively enrolled into a multi-institutional, comparative effectiveness, cohort study. Subjects elected either continued medical management or endoscopic sinus surgery (ESS). Baseline characteristics and objective clinical findings were collected. Cardinal symptoms of CRS were operationalized by 4 questions on the 22-item Sino-Nasal Outcome Test (SNOT-22). Symptom improvement was evaluated in subjects with at least 6-month follow-up.
  
  
  RESULTS
  A total of 342 subjects were enrolled, with 69 (20.2%) electing continued medical management, whereas 273 (79.8%) elected ESS. Subjects electing surgical therapy were more likely to have a higher baseline aggregate SNOT-22 score (44.3 (18.9) vs 53.6 (18.8); p < 0.001). All subjects improved across all cardinal symptoms; however, subjects undergoing ESS were significantly more likely (p ≤ 0.013) to experience improvement in thick nasal discharge (odds ratio [OR] = 4.36), facial pain/pressure (OR = 3.56), and blockage/congestion of nose (OR = 2.76). Subjects with nasal polyposis were significantly more likely to report complete resolution of smell/taste following ESS compare to medical management (23.8% vs 4.0%; p = 0.026).
  
  
  CONCLUSIONS
  Across a large population, surgical management is more effective at resolving the cardinal symptoms of CRS than ongoing medical management with the exception of sense of smell/taste.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: DeConde
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.forename: Jeremiah A
authors.initials: JA
authors.lastname: Alt
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
authors.forename: Richard R
authors.initials: RR
authors.lastname: Orlandi
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D002170:Canada; D002908:Chronic Disease; D015331:Cohort Studies; D004724:Endoscopy; D005157:Facial Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009093:Mucus / Q000378:metabolism; D015508:Nasal Obstruction / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D009666:Nose / Q000187:drug effects / Q000276:immunology* / Q000601:surgery; D000857:Olfaction Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D012220:Rhinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D012720:Severity of Illness Index; D012852:Sinusitis / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents
keywords: Sinusitis; diagnosis; endoscopy; quality of life; therapy