What is the change in cardinal symptoms of chronic rhinosinusitis (CRS) for those undergoing medical therapy versus surgery for management?
Background: CRS is an inflammatory disorder of the paranasal sinuses defined symptomatically as 12 weeks or more of two or more “cardinal symptoms,” including nasal obstruction, thick nasal discharge, facial pain/pressure, and reduction or loss of sense of smell. While numerous studies have described the impact of surgery on these symptoms, this study seeks to compare the impact of surgery with that of ongoing medical therapy alone.
Explore this issue:May 2015
Study design: Prospective cohort.
Setting: Academic tertiary facilities, including University of California, San Diego; Oregon Health and Science University in Portland; University of Utah in Salt Lake City; and the Medical University of South Carolina in Charleston.
Synopsis: Of a total of 342 patients enrolled, 69 (20.2%) elected medical therapy alone, while 273 (79.8%) elected surgery. Overall, those undergoing surgery experienced significantly better improvement in thick nasal discharge (odds ratio [OR] = 4.36), facial pain/pressure (OR = 3.56), and blockage/congestion (OR = 2.76). While no significant difference was seen with smell and taste abnormality between the groups (OR = 1.50, P = 0.306), those with polyps experienced a significantly greater likelihood of resolution of smell and taste abnormality following surgery (23.8% versus 4.0%, P = 0.026).
Bottom line: For patients with CRS, endoscopic sinus surgery results in significantly greater improvement in cardinal symptoms of CRS, including thick nasal discharge, facial pain/pressure, and nasal blockage/congestion when compared with ongoing medical therapy alone. For those with nasal polyps, significant improvement in smell and taste abnormality is also seen.
Reference: DeConde AS, Mace JC, Alt JA, et al. Investigation of change in cardinal symptoms of chronic rhinosinusitis after surgical or ongoing medical management. Int Forum Allergy Rhinol. 2015;5:36-45.
—Reviewed by Brent Senior, MD