Outcomes of Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis: A Longitudinal Study
DOI:
https://doi.org/10.61919/jhrr.v5i10.1879Keywords:
chronic rhinosinusitis, endoscopic sinus surgery, SNOT-22, quality of life, depression, adherence, Lund-KennedyAbstract
Background: Chronic rhinosinusitis (CRS) has a large symptom burden. Endoscopic sinus surgery (ESS) has been employed often in the treatment of medically unresponsive CRS. However, there has been a scarcity of information about the long-term results of ESS in the South Asian community and the role of psychological and behavioral factors. Objective: The objectives of this study are to assess the results of symptom, quality of life, and endoscopic control of ESS in patients suffering from CRS at a tertiary care center in Lahore and to determine the predictors of poor postoperative outcomes. Methods: This observational study prospectively followed 120 consenting adults undergoing ESS for CRS at Mumtaz Hospital Lahore over a period of 12 months. Baseline evaluation consisted of patient demographics, co-existing illnesses, SNOT-22, visual analogue scales (VAS), Brief Smell Identification Test (BSIT), and Lund-Kennedy/Lund-Mackay Nasal Obstruction Scores. Poor response was defined as SNOT-22 <9 points and/or SNOT-22 at 12 months ≥30. A PHQ-9 score of ≥10 was used to diagnose depression. Symptom and endoscopic assessments at the 3rd and 6th months and at the end of the 12th month were done. Multi-variable regression. Results: SNOT-22 symptoms showed improvement from 54.6 ± 15.8 to 24.9 ± 12.2 at the sixth month (p < 0.001), and there was no change at the twelfth month. The Lund-Kennedy scores decreased from 7.6 ± 3.1 to 2.2 ± 1.6 (p < 0.001). Poor outcome was predicted by depression (20%) and non-adherence to the schedule of follow-ups (33%) (adjusted OR: 2.6 and 2). Conclusion: ESS resulted in large and durable gains in quality of life and endoscopic findings concerning CRS symptoms, but the presence of depression at baseline and poor postoperative care rates of adhering to treatment had a profoundly attenuating impact.
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