Conflicting Evidence on Tobacco’s Effect on ESS Outcomes

Dr. Krzeski said the conflicting study results on the effect of smoking on ESS outcomes could relate to the variety in study designs. “More uniform groups (inclusion/exclusion criteria), which are more difficult to obtain, would probably solve the problem,” he said, The uniform groups, he said, would consist of patients who do not have underlying disease as well as patients with a disease entity, such as aspirin hypersensitivity, that would predispose them to recurrence. “When speaking of the necessity of reoperation these problems need to be estimated,” he added.

Dr. Reh and his colleagues have unpublished data suggesting that otolaryngologists are “very bad about discussing smoking with patients.”

Educational Efforts with Smokers

While everyone agrees that smokers should be counseled to stop for numerous health reasons, Dr. Reh and his colleagues have unpublished data suggesting that both primary care doctors and otolaryngologists are “very bad about discussing smoking with patients and counseling them to stop.”

Otolaryngologists interviewed for this article, however, all said they counsel patients to stop smoking and, most often, refer smokers back to their primary care physicians to find the program that best suits them. All were unaware of any studies that had found a “best” smoking cessation program for their patients.

“I don’t believe there is a cookbook recipe for smoking cessation,” said Oregon’s Dr. Smith. “Often it involves different interventions for different patients, depending upon their psychosocial situation. For some people, this means pharmaceutical intervention, for others, a social support group or efforts to address issues in their lives that prevent them from quitting. I think the best you can do is to help a patient become familiar with smoking cessation programs that are available in your community.”

“Sometimes people can’t be convinced to stop,” said Dr. Kountakis. “Smoking is one of the most difficult habits to break. It’s a severe addiction.”

Dr. Kountakis said his dilemma is how to help patients who refuse to quit. “When sinus surgery is necessary, I operate to improve their quality of life,” he said. “I, in no way, support their continued smoking and insist that they participate in smoking cessation programs.”

Dr. Schlosser said a patient’s tobacco addiction shouldn’t affect the surgeon’s decision to operate. “If a smoker is going to get better, even if they continue to smoke, why not offer them a treatment that will improve their quality of life?” he said.

Dr. Smith said most patients with sinusitis have quit smoking by the time they are considering surgery. For example, in one of his studies with 784 chronic rhinosinusitis patients, only 8 percent were smokers (Int Forum Allergy Rhinol. 2011;1(3):145-152).

A Novel Educational Tool

James N. Palmer, MD, director of rhinology at the University of Pennsylvania in Philadelphia, uses visual argument to help convince his smoking patients to stop. He shows them pictures of nasty bacterial biofilms that are associated with scar formation and encouragement of re-infection.