Comparison of Mean Change in SNOT-22 Score After Continued Medical Therapy Versus Endoscopic Sinus Surgery in Treating Refractory Chronic Rhinosinusitis: A Randomized Controlled Trial
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Abstract
Background: Previous studies have indicated that patients whose medical therapy for chronic rhinosinusitis fails and subsequently undergo sinus surgery tend to exhibit improved outcomes compared to those who persist with medical therapy alone. However, these investigations typically present average outcomes for entire cohorts, thereby overlooking the possibility that specific subsets of patients may experience varying degrees of benefit from a particular treatment modality.
Objective: The objective of the study was to compare the mean change in SNOT-22 scores among patients with refractory chronic rhinosinusitis who were treated with either continued medical therapy or endoscopic sinus surgery (ESS).
Methods: A randomized controlled trial was conducted from the 25th of February 2019 to the 24th of August 2019 at the Department of ENT, Sir Ganga Ram Hospital, Lahore. Sixty patients aged between 15 and 55 years, regardless of gender, and diagnosed with refractory chronic rhinosinusitis were included in the study. Exclusion criteria comprised known psychiatric illness, recent upper respiratory tract infection, and the presence of massive nasal polyposis. Participants in Group A were administered medical therapy, including the antibiotic amoxyclav, oral and nasal spray steroids, and decongestants, for a duration of three weeks. In contrast, participants in Group B underwent ESS performed by a consultant surgeon. All patients were regularly monitored post-treatment, and changes in their SNOT-22 scores were assessed after a three-month period.
Results: The mean ages of patients in Groups A and B were 29.44 ± 8.28 years and 30.12 ± 9.09 years, respectively. The mean duration of the disease was recorded at 3.31 ± 1.37 months. The sample comprised 41 males (68.33%) and 19 females (31.67%), resulting in a male-to-female ratio of 2.16:1. Post-treatment SNOT-22 scores and the observed changes in scores for Group A were 63.37 ± 5.80 and 2.17 ± 5.24, respectively. In comparison, the corresponding values for Group B were 19.43 ± 4.58 and 43.90 ± 7.26, respectively, with the difference being statistically significant (p-value < 0.0001).
Conclusion: The study concluded that endoscopic sinus surgery significantly improves SNOT-22 scores in patients with refractory chronic rhinosinusitis, in comparison to continued medical therapy.
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