Endoscopic Sinus Surgery Improves QoL in Patients with Minimal Disease

Will endoscopic sinus surgery (ESS) provide an improved quality of life (QoL) for patients with medically recalcitrant chronic rhinosinusitis (CRS) who have minimally affected computed tomography (CT) scans of the paranasal sinuses?

Background: Although most otolaryngologists have encountered patients with symptoms and endoscopic findings suggestive of CRS, CT evaluation may demonstrate minimal mucosal disease in some patients. In this setting, there is often a reluctance to perform ESS, especially when previous studies have shown a correlation between disease severity and symptom improvement.

Study design: Prospective, multicenter cohort study.

Setting: Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.

Synopsis: At three academic tertiary care centers, patients with CRS were enrolled between January 2001 and April 2009 after electing ESS. They were categorized as low-stage CT CRS (Lund-Mackay >3; n = 17) and high-stage CT CRS (Lund-Mackay >3; n = 207). On the primary outcome measures of QoL, the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey (CSS), patients with low-stage CT CRS showed a significant improvement across all disease-specific scores, with the exception of the CSS medication usage subscale. The improvements in what the authors called “carefully selected patients with low-stage CT CRS” were comparable to those patients with high-stage CT CRS. Limitations of the study included the arbitrary dichotomization of low-stage CT as 0-3, the possibility of a different pathological entity as compared to non-opacifying inflammation, and the fact that two of the 17 patients were isolated unilateral sinus pathology.

Bottom line: ESS is associated with improved QoL in carefully evaluated and selected patients with low-stage CT CRS.

Citation: Rudmik L, Mace J, Smith T. Low-stage computed tomography chronic rhinosinusitis: What is the role of endoscopic sinus surgery? Laryngoscope. 2011;121(2):417-421.

—Reviewed by Sue Pondrom