title: Endoscopic sinus surgery improves cognitive dysfunction in patients with chronic rhinosinusitis.
abstract: Patients with chronic rhinosinusitis (CRS) have been found to have cognitive deficit, as identified using the Cognitive Failures Questionnaire (CFQ), but the exact etiology of cognitive decline is unknown. In this study we aimed to determine whether improvement in concomitant inflammation and disease burden in CRS, using endoscopic sinus surgery (ESS), improves cognitive deficit. We also sought to identify comorbid conditions that effect improvement likelihood.
  
  
  
  Study participants (n = 247) with and without nasal polyposis (CRSwNP, CRSsNP) were prospectively enrolled in this multi-institutional, observational outcomes study. Pre- and postoperative cognitive dysfunction was evaluated using the CFQ instrument. Quality of life (QOL) and disease burden was also evaluated using the Rhinosinusitis Disability Index (RSDI), the 22-item SinoNasal Outcome Test (SNOT-22), nasal endoscopy, computed tomography, and the 2-item Patient Health Questionnaire (PHQ-2).
  
  
  
  Average CFQ total scores improved significantly (p = 0.012) after ESS for patients with follow-up (n = 141). Participants with CRSwNP (n = 51) reported significant postoperative improvements in mean CFQ total scores (p = 0.002) and CFQ distractibility and blunders domain scores (p ≤ 0.006). No significant postoperative improvement for any average CFQ score was found in CRSsNP (p > 0.086). The magnitude of postoperative improvement in CFQ total and domain mean scores was statistically similar between CRSsNP and CRSwNP (p > 0.115). Depressive disorder, identified using PHQ-2 screening, was the only comorbid condition significantly associated with measurable cognitive deficit (p < 0.001).
  
  
  
  Patients with CRS have measurable cognitive decline, and ESS may modestly improve cognitive deficit/CFQ scores. Future investigations are needed to further elucidate the underlying mechanisms responsible for cognitive deficit in patients with CRS and significant associations with depression.
authors.affiliation: Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Jeremiah A
authors.initials: JA
authors.lastname: Alt
authors.affiliation: Rhinology and Skull Base Division, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.affiliation: Rhinology and Skull Base Division, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D060825:Cognitive Dysfunction / Q000601:surgery*; D004724:Endoscopy; D006801:Humans; D008875:Middle Aged; D009298:Nasal Polyps / Q000601:surgery*; D010256:Paranasal Sinuses / Q000601:surgery*; D011788:Quality of Life; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*
keywords: chronic disease; chronic pain; cognition; quality of life; rhinitis; rhinosinusitis; sinusitis; sleep