title: Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitis.
abstract: BACKGROUND
  The decision to continue medical therapy or recommend endoscopic sinus surgery (ESS) can be challenging in patients with refractory chronic rhinosinusitis (CRS). The objective of this study was to evaluate continued medical therapy vs ESS for patients with refractory CRS who have severe reductions in baseline disease-specific quality of life (QoL).
  
  
  METHODS
  This was a prospective longitudinal crossover study between August 2011 and June 2013. All patients were >18 years old, diagnosed with CRS based on guideline recommendations, failed initial medical therapy and elected ESS. While waiting for ESS, all patients received continued medical therapy. The preoperative waiting period outcomes (continued medical therapy) were compared to the postoperative outcomes. The primary outcome was change in disease-specific QoL (22-item Sinonasal Outcome Test [SNOT-22]). Secondary outcomes were change in endoscopic grading (Lund-Kennedy score), medication consumption, and work days missed in the preceding 90 days.
  
  
  RESULTS
  Thirty-one patients were enrolled. Mean baseline SNOT-22 score was 57.6. After a mean of 7.1 months of continued medical therapy, there was a worsening in SNOT-22 score (57.6 to 66.1; p = 0.006). After ESS, with a mean postoperative follow-up of 14.6 months, there was a significant improvement in SNOT-22 score (66.1 to 16.0; p < 0.001). There was also a significant improvement in endoscopic grading (p < 0.001) coupled with a reduction in both work days lost (p < 0.001) and medication consumption (p < 0.01).
  
  
  CONCLUSIONS
  Results from the study suggest that ESS is a more effective intervention compared to continued medical therapy for patients with refractory CRS who have severe reductions in their baseline disease-specific QoL.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Smith
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
mesh_terms: D000328:Adult; D000368:Aged; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D018592:Cross-Over Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D012220:Rhinitis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012852:Sinusitis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018926:Anti-Allergic Agents
keywords: chronic rhinosinusitis; endoscopic sinus surgery; medical therapy; quality of life; sinusitis