Abstract
BackgroundThis study sheds important light on the association between sino-nasal symptoms and global quality of life in patients with chronic rhinosinusitis waiting for endoscopic sinus surgery. Using patient-reported information collected pre-operatively, the primary objective was to report on patients’ pre-surgical sino-nasal symptoms and their association with self-reported pain and depression. The secondary objective was to report on levels of depression and pain among patients in the sample reporting severe sleep problems.MethodsThis is a cross-sectional study of patient-reported outcomes collected prospectively from a cohort of 261 patients assigned to the wait list for elective endoscopic sinus surgery in a large urban region of Canada.ResultsYounger patients and patients with other medical comorbidities were most likely to report significant symptoms of chronic rhinosinusitis and substantial associated pain and depression. In the primary analyses, patients reporting significant symptoms of chronic rhinosinusitis were more likely to report moderate depression or high pain (p < 0.01). Subsequently, chronic rhinosinusitis patients with severe sleep problems were 82% likely to report moderate or severe depression and pain.ConclusionPreoperative management of depression and pain may be considered in order to improve the health-related quality of life of patients waiting for ESS. As depression and pain were highly prevalent, patients with severe sleep problems may be candidates for prioritized access.
Highlights
This study sheds important light on the association between sino-nasal symptoms and global quality of life in patients with chronic rhinosinusitis waiting for endoscopic sinus surgery
There were no significant differences between study participants and patients that did not participate on the characteristics of age or gender which would have indicated selection bias; see Additional file 1 for a summary of participants and non-participants
Patient Health Questionnaire (PHQ-9) scores of ten above and Pain intensity (PEG) scores of three and above are associated with moderate depression and high pain, respectively are important domains which have been previously reported to be inadequately measured by the Sino-Nasal Outcomes Test-22 (SNOT-22) [21], though the effects of which have been suggested elsewhere [11, 13]
Summary
This study sheds important light on the association between sino-nasal symptoms and global quality of life in patients with chronic rhinosinusitis waiting for endoscopic sinus surgery. Using patient-reported information collected pre-operatively, the primary objective was to report on patients’ pre-surgical sino-nasal symptoms and their association with self-reported pain and depression. The syndrome of chronic rhinosinusitis (CRS) is a heterogeneous cluster of sino-nasal symptoms associated with mucosal inflammation. Many patients with CRS eventually fail pharmacological intervention and progress to endoscopic sinus surgery (ESS) for treatment. This is problematic for many provincial health care systems, where demand for elective (scheduled) surgery outstrips supply which, in turn, results in substantial wait times for CRS patients. Wait times are not unique to ESS, as Canada lags many of its peer countries in access to specialized care [5] – despite significant investments, Hanna et al Journal of Otolaryngology - Head and Neck Surgery (2017) 46:23 wait times for elective surgery continue to be a major policy issue for provincial governments [6,7,8]
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