Follow-Up Adherence Is Associated with Outcomes After Endoscopic Sinus Surgery

2020 ◽  
Vol 129 (7) ◽  
pp. 707-714
Author(s):  
Sarek A. Shen ◽  
Aria Jafari ◽  
Jesse R. Qualliotine ◽  
Adam S. DeConde
Keyword(s):  
Postoperative Period ◽  
Endoscopic Sinus Surgery ◽  
Nasal Symptom ◽  
Sinus Surgery ◽  
Psychological Dysfunction ◽  
Clinical Adherence ◽  
Sinonasal Outcome Test ◽  
The Impact ◽  
Snot 22

Background: Clinical follow-up after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) allows for assessment of the sinonasal cavity, debridement, and tailoring of medical therapies. Frequency and timing of postoperative clinical visits is debated, but the impact of adherence on disease-specific outcomes is not well understood. In this longitudinal study, we assessed the association between follow-up adherence and quality of life (QOL) outcomes in the 12 months after ESS. Methods: A retrospective review of patients undergoing ambulatory ESS for CRS between 11/2016 and 1/2018 was performed. We assessed sociodemographic characteristics, radiographic severity, and QOL utilizing the 22-item sinonasal outcome test (SNOT-22). Patients were categorized as “non-adherent,” “moderately-adherent,” and “fully-adherent” to a 1-, 3- and 5-week postoperative visit schedule. Results: A total of 166 patients met the inclusion criteria. Of these, 55 (33.1%) were fully-adherent, 105 (63.2%) were moderately-adherent, and 6 (3.6%) were non-adherent within the 6 weeks following ESS. In the immediate postoperative period, fully-adherent patients demonstrated worse QOL (SNOT-22: 31.2 ± 23.1 vs 27.5 ± 17.6, P = .047). This cohort also had greater psychological dysfunction at baseline and 12-months ( P < .05) after ESS. Extra-nasal symptom scores increased at a lower rate in the fully-adherent cohort (0.12 vs 1.29 points per 6 months, P = .038), as did ear/facial symptoms (1.17 vs 3.05 points per 6 months, P = .044). Conclusion: Despite worse symptom severity in the immediate postoperative period, patients who are more adherent to the follow-up schedule demonstrated slower return of symptoms in the extra-rhinological and ear-facial domains. These findings suggest that clinical adherence and management may impact the long-term evolution of ESS outcomes.

scholarly journals Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salma S. Al Sharhan ◽  
Mohammed H. Al Bar ◽  
Shahad Y. Assiri ◽  
Assayl R. AlOtiabi ◽  
Deemah M. Bin-Nooh ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
T Test ◽  
Sinus Surgery ◽  
Symptom Improvement ◽  
P Value ◽  
Psychological Dysfunction ◽  
Significant Difference ◽  
The Mean ◽  
Snot 22

Abstract Background Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients. Methods This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS. Results The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value =  < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value =  < 0.001); ear/facial symptoms (t-test = 6.34, p-value =  < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value =  < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = − 2.16, df = 66, p = 0.035). Conclusion Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life. Level of evidence Prospective observational.

Does Olfaction Improve After Endoscopic Sinus Surgery?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P74-P74
Author(s):  
Jamie R. Litvack ◽  
Jess Collin Mace ◽  
Timothy L Smith
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Linear Regression Analysis ◽  
Olfactory Dysfunction ◽  
Sinus Surgery ◽  
Multivariate Linear Regression Analysis ◽  
Co Morbidity ◽  
Long Term Follow Up ◽  
The Impact

Objective No large, prospective, multi-institutional cohort studies have objectively examined the impact of surgery on olfaction with long-term follow-up. The aim of this study was to objectively examine the impact of endoscopic sinus surgery (ESS) on olfactory dysfunction (hyposmia) would benefit from ESS, whereas patients with severe olfactory dysfunction (anosmia) would not. Methods In this prospective, multi-institutional cohort study, 111 patients presenting for ESS for treatment of CRS were examined pre-operatively and at 6 and 12 months postoperatively. Demographic, co-morbidity and Smell Identification Test (SIT) data were collected at each time point. Univariate and multivariate analyses were performed. Results The prevalence of gender-adjusted olfactory dysfunction prior to surgery was 67.5%: 50.4% of patients were hyposmic and 17.1% were anosmic. Surprisingly, hyposmic patients did not significantly improve after surgery (baseline, 6 month, 12 month mean SIT scores: 28.8, 30.0, 29.5). In contrast, patients with anosmia significantly improved after ESS (baseline, 6 month, 12 month mean SIT scores: 9.3, 21.3, 21.7; p=0.001); furthermore, improvement was sustained at 12-month follow-up (p=0.001). Multivariate linear regression analysis showed that baseline olfactory category and nasal polyposis were significantly associated with improvement in postoperative olfactory function (p=0.035, p=0.002), whereas age, gender, and disease-severity as measured by CT and endoscopy scores were not. Conclusions Contrary to our hypothesis, patients with severe olfactory dysfunction significantly improved after ESS and sustained improvement over time, whereas patients with mild olfactory dysfunction did not.

Quality of Life and Impact of Endoscopic Sinus Surgery in Adult Patients With Cystic Fibrosis

2019 ◽  
Vol 33 (4) ◽  
pp. 413-419 ◽  
Author(s):  
Maria S. Lazio ◽  
Paolo Luparello ◽  
Giuditta Mannelli ◽  
Giovanni P. Santoro ◽  
Silvia Bresci ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Endoscopic Sinus Surgery ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Conventional Medical Therapy ◽  
Chronic Rhino Sinusitis ◽  
The Impact ◽  
Snot 22

Background Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasian population. Due to its pathological mechanism, chronic rhino sinusitis (CRS) associated or not with nasal polyposis usually occurs in adults and affects close to one-half of all CF patients. The goal of our work was to evaluate the impact of endoscopic sinus surgery (ESS) in the quality of life (QoL) of the CF patients and demonstrate an improvement of the functional outcomes in the patients undergoing the surgical procedure rather than in the not treated ones. Methodology: We studied 54 adult patients affected by CF. Lund–Kennedy, Lund–Mackay scores, and Sino-Nasal Outcome Test-22 (SNOT-22) were analyzed. Results Twenty-two (40.7%) of the 54 CF patients underwent ESS. This group presented more likely complaints consistent with CRS. Lund–Kennedy and Lund–Mackay scores appeared higher in the ESS group: 10 (range of 6–12) and 16 (range of 12–20), respectively. SNOT-22 showed median values for non-ESS and ESS group of 17.5 (range of 3–68) and 44 (range of 10–73), respectively. Conclusions ESS represents the best option to improve clinical QoL of CF patients who do not response to conventional medical therapy.

Effect of Endoscopic Sinus Surgery on Olfaction: A Prospective Analysis

2016 ◽  
Vol 9 (3) ◽  
pp. 115-119 ◽  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
Olfactory Dysfunction ◽  
Sinus Surgery ◽  
Prospective Analysis ◽  
Realistic Assessment ◽  
Olfactory Impairment ◽  
The Impact

ABSTRACT Objective To examine the impact of endoscopic sinus surgery (ESS) on olfactory impairment in patients with chronic rhinosinusitis (CRS) and nasal polyposis over intermediate- to long-term follow-up. Study design Prospective, cohort study. Conducted in a tertiary care center over a period of 2 years (August 2014-July 2016). Materials and methods A total of 42 patients presenting for ESS were examined preoperatively and at 1st, 3rd, 6th, and 12th week postoperatively. Demographic, comorbidity, and olfactory scores were collected at each point of time. Sniffin Sticks test was used to assess the olfaction of the patients. Results Olfactory scores in anosmic patients significantly improved after ESS at 3-month follow-up. Only few hyposmic patients improved after surgery and others did not show any change. Among normosmic patients, 80% showed no change after surgery, whereas 20% became hyposmic postoperatively. None of the normosmics became anosmic after surgery. Conclusion Patients with severe olfactory dysfunction significantly improved after ESS, whereas patients with mild olfactory dysfunction did not. A realistic assessment of effects of ESS on olfaction could be derived. This will help in counseling the patients undergoing ESS in future. Olfactory impairment is an important patient safety and quality-of-life issue for patients with CRS and one that requires continued research. How to cite this article Mohanty S. Effect of Endoscopic Sinus Surgery on Olfaction: A Prospective Analysis. Clin Rhinol An Int J 2016;9(3):115-119.

scholarly journals Using postoperative SNOT-22 to help predict the probability of revision sinus surgery

2016 ◽  
Vol 54 (2) ◽  
pp. 111-116
Author(s):  
Luke Rudmik ◽  
Zachary M Soler ◽  
Claire Hopkins
Keyword(s):  
Postoperative Management ◽  
Low Risk ◽  
Sinus Surgery ◽  
Increased Risk ◽  
Revision Sinus Surgery ◽  
History Of ◽  
Sinonasal Outcome Test ◽  
Prospective Longitudinal ◽  
Snot 22

Background: There is a need to develop a patient-level strategy to identify those at higher risk of requiring revision ESS since this may assist clinicians in tailoring their postoperative management. This study evaluated whether identifying changes in the post- operative 22-item Sinonasal Outcome Test (SNOT-22) can help identify patients at increased risk of needing revision sinus surgery for refractory chronic rhinosinusitis (CRS). Methods: 668 CRS patients undergoing primary ESS with complete 60-month follow-up were evaluated in this prospective, longitudinal cohort study. Outcomes were evaluated in an unselected cohort and a low-risk cohort, which was comprised of patients without a history of asthma or aspirin sensitivity. Results: Failing to achieve an improvement of greater than one minimal clinically important difference (MCID; 9 points) at 3 months after primary ESS and a deterioration of greater than one MCID (ie. >9 points) from the 3- to 12-month follow-up periods was associated with an increased risk of revision ESS in both the unselected and low-risk CRS cohorts. Conclusion: Outcomes from this study suggest that identifying MCID changes in the SNOT-22 score within 12 months after primary ESS can identify patients at increased risk for needing revision surgery.

Indications and Outcomes for Patients With Limited Symptoms Undergoing Endoscopic Sinus Surgery

2020 ◽  
Vol 34 (4) ◽  
pp. 502-507
Author(s):  
Arifeen S. Rahman ◽  
Peter H. Hwang ◽  
Rahul Alapati ◽  
Yan Lin ◽  
Jayakar V. Nayak ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Elective Surgery ◽  
Sinus Surgery ◽  
Point Reduction ◽  
Disease Characteristics ◽  
Clinical Presentations ◽  
Life Improvement ◽  
Sinonasal Outcome Test ◽  
Snot 22

Background Previous research have suggested that chronic rhinosinusitis (CRS) patients with lower symptomatic scores, demonstrated by a 22-item Sinonasal Outcome Test (SNOT-22) score <20, may not achieve meaningful quality of life improvement following endoscopic sinus surgery (ESS). However, indications for ESS are continuing to be defined and many low SNOT-22 scoring patients still undergo elective surgery for CRS and other benign sinonasal pathologies. The outcomes for these patients have not been previously studied. Objectives We sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS. Methods We screened 2829 ESS procedures from 2010–2018 to identify patients with a preoperative SNOT-22 score <20. We reviewed disease characteristics, preoperative Lund–Mackay (LM) scores, and pre- and postoperative SNOT-22 scores in patients with at least 3 months’ follow-up. Results Of all surgical ESS patients screened, 114 had low preoperative SNOT-22 scores (4.0%). Indications for these surgeries included CRS (50.0%), odontogenic sinus disease (11.4%), mucocele (10.5%), recurrent acute sinusitis (7.0%), fungal ball (5.3%), and silent sinus syndrome (4.4%). Specifically, among CRS patients, 45.6% had pulmonary comorbidities and/or systemic immunodeficiencies. Moreover, 100% of CRS patients with nasal polyps and 73.1% of CRS without polyps had LM scores >5. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction ( P < .001) postoperatively, whereas those with scores between 10 and 14 had a 5.4 point reduction ( P < .001), and preoperative scores <9 resulted in no significant decrease in postoperative symptom scores ( P = .98). Overall, there was a 3.3 point SNOT-22 reduction among all patients at 3 months postoperatively ( P < .001). Conclusion Patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores.

scholarly journals Assessment of Nasal Airflow and Pain, Safety and Cost of an Improvised Nasal Airway (Nasogastric) Tube After Endoscopic Sinus Surgery

2020 ◽  
Vol 35 (2) ◽  
pp. 22
Author(s):  
Josephine Grace Rojo ◽  
Rachel Zita Ramos
Keyword(s):  
Pain Score ◽  
Postoperative Period ◽  
Nasogastric Tube ◽  
Endoscopic Sinus Surgery ◽  
Nasal Packing ◽  
Sinus Surgery ◽  
Nasal Airway ◽  
Nasal Airflow ◽  
Significant Difference ◽  
Group A

ABSTRACT Objective: To compare subjective nasal airflow and overall pain score (as well as safety and added cost of) using an improvised nasal airway tube (nasogastric tube) versus nasal packing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods:Design: Quasi - Experimental Prospective Cohort StudySetting: Tertiary Government Training HospitalParticipants: Twenty-six (26) consecutive patients aged 18 to 77 years old diagnosed with CRSwNP who underwent ESS were alternately assigned to an experimental group (A) of 13, where an improvised nasal airway (nasogastric) tube was placed in addition to the nasal pack or a control group (B) of 13 with nasal packing alone. Results: There was a significant difference in subjective nasal airflow between experimental (A) and control (B) groups during the immediate postoperative period where the mean subjective airflow was 8.07 and 0.00 over 10.00, respectively. No significant difference was noted between the groups in terms of age, gender, severity of polyposis and overall pain score. No complications such as bleeding, Toxic Shock Syndrome, vestibular or alar injury and septal necrosis were noted immediately post-op and after one week follow-up in both groups. An approximate cost of PhP 25 was added to group A. Conclusion: An improvised nasal airway using a nasogastric tube provides adequate airflow without additional pain in the immediate postoperative period. It is safe to use and an affordable option for patients in need of nasal airway stents residing in areas where a preformed nasal packing with incorporated tube stent is not available.

Predictive value of SNOT-22 on additional opiate prescriptions after endoscopic sinus surgery

2018 ◽  
Vol 8 (9) ◽  
pp. 1021-1027 ◽  
Author(s):  
Sarek A. Shen ◽  
Aria Jafari ◽  
David Bracken ◽  
John Pang ◽  
Adam S. DeConde
Keyword(s):  
Predictive Value ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Snot 22

Change in symptomatology score after functional endoscopic sinus surgery in cases of chronic rhinosinusitis

2021 ◽  
Vol 11 (41) ◽  
pp. 34-40
Author(s):  
Pragya Rajpurohit ◽  
Ishwar Singh ◽  
Ravi Meher
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Full Range ◽  
Change Score ◽  
Physical Symptoms ◽  
Clinical Encounter ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Percentage Decrease ◽  
Snot 22

Abstract BACKGROUND. Chronic rhinosinusitis (CRS) is one of the most common health problems in adults, which not only causes physical symptoms, but also results in functional and emotional impairment. The aim of the present study was to investigate the effect of functional endoscopic sinus surgery (FESS) on SNOT-22 in cases of chronic rhinosinusitis. MATERIAL AND METHODS. A total of 50 patients, between 18-60 years of age, who had taken treatment for CRS but found no improvement, were enrolled in the study. Before surgery, all patients were asked to fill the SNOT-22 form, the CT score was evaluated, and FESS was performed. A reevaluation with SNOT-22 questionnaire was performed 10 days, 1 and 3 months after surgery. The preoperative and postoperative scores and change score were calculated. RESULTS. The initial preoperative mean score was 39.96±13.41. The percentage decrease in symptom score on the 10th day, the first and third month postoperatively was 42%, 74% and 91% respectively. Males had scored higher as compared to females. There was no correlation between the CT score and SNOT-22 score. Rhinological symptoms scored more than 74% in chronic rhinosinusitis cases. CONCLUSION. SNOT-22 can be used in routine clinical practice to inform clinicians about a full range of problems associated with chronic rhinosinusitis. Responses on the instrument can help focus the clinical encounter. It can also aid researchers in assessing the degree and effect of rhinosinusitis on health status, QoL and to measure treatment response.

The Effects of Endoscopic Sinus Surgery on Voice Characteristics in Chronic Rhinosinusitis Patients

2019 ◽  
Vol 128 (12) ◽  
pp. 1129-1133
Author(s):  
Danny B. Jandali ◽  
Ashwin Ganti ◽  
Inna A. Husain ◽  
Pete S. Batra ◽  
Bobby A. Tajudeen
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Tertiary Care ◽  
Voice Quality ◽  
Upper Airway ◽  
Sinus Surgery ◽  
Perceptual Evaluation ◽  
Snot 22

Objectives: Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed. Methods: Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms. Results: 18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p = .005) and VHI (10-4.7, p < .001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p < .001). Conclusions: Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality.

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