Nonetheless, “we do surgery to improve a patient’s quality of life, not the appearance of their sinuses,” said Timothy Smith, MD, director of the Oregon Sinus Center, Oregon Health and Science University, Portland.
But David Kennedy, MD, professor of rhinology at the University of Pennsylvania Medical Center and Veterans Administration Hospital in Philadelphia, puts a higher weight on the endoscopy readings. His goal is resolution of the disease and getting the mucosa to settle down and become stable; on the research side, his team studies the underlying persistent inflammation.
—David Kennedy, MD
Dr. Kennedy said there are two things that are important in identifying outcome after ESS: the extent of disease and patients who continue to smoke. In a study (Laryngoscope. 1998;108(2):151-157) in which researchers enrolled 120 patients and followed them for eight years, Dr. Kennedy and his colleagues found that more smokers than nonsmokers needed revision surgery. Based on these findings and his personal experience, Dr. Kennedy said he refuses to do elective sinus surgery unless the patient has quit smoking for approximately six weeks prior to surgery. He will operate on smokers if there are complications of the sinusitis or a neoplasm.