In patients who have failed medical management for chronic rhinosinusitis (CRS), are there greater quality of life (QOL) outcome improvements with further medical therapy or endoscopic sinus surgery (ESS)?
Background: Although it is widely believed that QOL measures are improved with ESS, there is insufficient evidence in the literature comparing various treatments for CRS. This study evaluates outcomes in CRS patients who have failed initial appropriate medical therapy and have elected either to continue medical therapy or to undergo ESS with continued medical management.
Explore this issue:November 2011
Study design: Prospective, nonrandomized cohort study.
Setting: Multi-institutional study involving academic rhinology practices.
Synopsis: Adults were prospectively entered into the study (initial n=180) after they had failed medical therapy, with CT scan evidence of persistent sinus disease. In conjunction with their treating rhinologist, patients chose to pursue continued medical management (n=55) or ESS with continued medical therapy (n=75). All patients completed two disease-specific QOL surveys at baseline and at multiple treatment intervals: the Rhinosinusitis Disability Index (RSDI) and the Chronic Sinusitis Survey (CSS). Differences in antibiotic and oral steroid use and work or school productivity were recorded.
While both medically managed and surgery groups had significant improvements in QOL measures, surgery patients reported significantly greater improvement. In addition, surgery patients reported significantly fewer oral antibiotics and oral steroids and fewer missed days of work and school.
Bottom line: In patients who have failed medical management of CRS, significant improvement of QOL measures was seen in those who had continued medical management, but QOL measures improved to a greater extent in patients who underwent ESS.
Citation: Smith TL, Kern RC, Palmer JN, et al. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study. Int Forum Allergy Rhinol. 2011;1(4):235-241.
—Reviewed by John M. DelGaudio, MD