title: Quality-of-life outcomes after sinus surgery in allergic fungal rhinosinusitis versus nonfungal chronic rhinosinusitis.
abstract: BACKGROUND
  Given the differences in pathophysiology between allergic fungal rhinosinusitis (AFRS) and other chronic rhinosinusitis (CRS) subgroups, it remains unclear about whether these patients respond differently to a combination of surgical and medical treatments.
  
  
  OBJECTIVE
  To evaluate differences in quality-of-life (QoL) outcomes for a cohort of patients who underwent endoscopic sinus surgery (ESS) for CRS.
  
  
  METHODS
  This retrospective review included patients with CRS who underwent ESS between 2010 and 2013. QoL was measured by using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, SNOT-22 scores before ESS and at 1, 3, 6, 9, and 12 months after ESS. Groups tested were CRS with nasal polyposis, CRS without nasal polyposis (CRSsNP), and patients with AFRS. A linear mixed- effects regression model was used to calculate the adjusted mean QoL differences.
  
  
  RESULTS
  Among the 250 patients included, 61.6% had CRS with nasal polyposis (n = 154), 28.8% had CRSsNP (n = 72), and 9.6% had AFRS (n = 24). Significant differences were seen in SNOT-22 scores between pre- and postoperative visits and between the etiologic subgroups (p < 0.001). Multivariate analysis revealed significantly greater improvement in QoL for patients with AFRS in comparison with those with CRSsNP at the 9-month follow-up (change in SNOT-22 score, 22.6 [95% confidence interval, 1.2-44.1]; p < 0.0) and the 12-month follow-up (change in SNOT-22 score, 20.2 [95% confidence interval, 0.5-39.9]; p < 0.04).
  
  
  CONCLUSIONS
  Patients with AFRS experienced a more-prolonged QoL benefit from surgical and targeted medical intervention compared with those with CRSsNP, which may reflect the severity of inflammation that they presented with compared with other CRS subtypes.
authors.affiliation: Department of Ear Nose and Throat, James Paget University Hospital, Lowestoft Road, Gorleston-on-Sea, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Masterson
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Egro
authors.forename: Jessica
authors.initials: J
authors.lastname: Bewick
authors.forename: Sally E
authors.initials: SE
authors.lastname: Erskine
authors.forename: Alan
authors.initials: A
authors.lastname: Clark
authors.forename: Amin R
authors.initials: AR
authors.lastname: Javer
authors.forename: Carl M
authors.initials: CM
authors.lastname: Philpott
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002908:Chronic Disease; D015331:Cohort Studies; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005658:Fungi / Q000276:immunology*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D009298:Nasal Polyps / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D011788:Quality of Life; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D012225:Rhinoplasty; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole