title: Patients electing medical vs surgical treatment: emotional domain of the Rhinosinusitis Disability Index associates with treatment selection.
abstract: BACKGROUND
  The Rhinosinusitis Disability Index (RSDI) consists of multiple subdomains shown to be useful in studying chronic rhinosinusitis (CRS). The objective of this study was to determine if RSDI subdomain scores are associated with selection of treatment modality (endoscopic sinus surgery [ESS] or continued medical management [CMM]) in subjects with CRS.
  
  
  METHODS
  Patients with CRS were prospectively enrolled into a multi-institutional cohort study. Following an initial period of medical management, patients elected to undergo treatment with either ESS or CMM. Baseline RSDI total and subdomain scores were compared between patients electing different treatment modalities.
  
  
  RESULTS
  A total of 684 subjects were enrolled with 122 (17.8%) electing CMM and 562 (82.2%) electing ESS. When compared to patients undergoing CMM, patients electing ESS exhibited significantly higher mean baseline RSDI total scores (mean ± standard deviation [SD]: 48.1 ± 24.9 vs 40.1 ± 24.1; p = 0.001) and subdomain scores (emotional: 13.2 ± 9.1 vs 10.4 ± 8.3; p = 0.001; functional: 15.3 ± 8.9 vs 12.6 ± 8.4; p = 0.002; and physical: 19.6 ± 9.3 vs 17.1 ± 9.6; p = 0.007). Emotional subdomain scores were found to be the most associated with choice of treatment modality.
  
  
  CONCLUSIONS
  Patients with CRS electing ESS had worse baseline RSDI total and subdomain scores compared to those electing CMM. Although both rhinologic and nonrhinologic symptoms contributed to the selection of treatment modality, emotional symptoms appeared to exhibit the greatest influence on patient-centered treatment decisions.
authors.affiliation: Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Quinn
authors.initials: Q
authors.lastname: Orb
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health Science Center, Portland, OR.
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
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.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA.
authors.forename: Toby O
authors.initials: TO
authors.lastname: Steele
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Tennessee, Memphis, TN.
authors.forename: Steve T
authors.initials: ST
authors.lastname: Cox
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health Science Center, Portland, OR.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Jeremiah A
authors.initials: JA
authors.lastname: Alt
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004358:Drug Therapy; D004644:Emotions; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012220:Rhinitis / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D012225:Rhinoplasty; D012720:Severity of Illness Index; D012852:Sinusitis / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy
keywords: endoscopy; patient selection; quality of life; questionnaires; sinusitis