Machine-Learning Points at Endoscopic, Quality of Life, and Olfactory Parameters as Outcome Criteria for Endoscopic Paranasal Sinus Surgery in Chronic Rhinosinusitis.

Jörn Lötsch,Jürgen Pade,Petros Petridis,Constantin A Hintschich,Thomas Hummel

doi:10.3390/jcm10184245

Abstract

Chronic rhinosinusitis (CRS) is often treated by functional endoscopic paranasal sinus surgery, which improves endoscopic parameters and quality of life, while olfactory function was suggested as a further criterion of treatment success. In a prospective cohort study, 37 parameters from four categories were recorded from 60 men and 98 women before and four months after endoscopic sinus surgery, including endoscopic measures of nasal anatomy/pathology, assessments of olfactory function, quality of life, and socio-demographic or concomitant conditions. Parameters containing relevant information about changes associated with surgery were examined using unsupervised and supervised methods, including machine-learning techniques for feature selection. The analyzed cohort included 52 men and 38 women. Changes in the endoscopic Lildholdt score allowed separation of baseline from postoperative data with a cross-validated accuracy of 85%. Further relevant information included primary nasal symptoms from SNOT-20 assessments, and self-assessments of olfactory function. Overall improvement in these relevant parameters was observed in 95% of patients. A ranked list of criteria was developed as a proposal to assess the outcome of functional endoscopic sinus surgery in CRS patients with nasal polyposis. Three different facets were captured, including the Lildholdt score as an endoscopic measure and, in addition, disease-specific quality of life and subjectively perceived olfactory function.

Highlights

Chronic rhinosinusitis (CRS) has an estimated prevalence in the European population ranging from 6.9 to 27.1% [1]
Of the patients enrolled at baseline before surgery, one woman was excluded from data analysis because of lack of testing in most parameters and baseline and absence from the second test
The present analyses provided a ranked proposal of criteria against which to evaluate the consequences of functional endoscopic sinus surgery in CRS patients with nasal polyposis

Summary

Introduction

Chronic rhinosinusitis (CRS) has an estimated prevalence in the European population ranging from 6.9 to 27.1% [1]. Olfactory loss in the CRS subtype with nasal polyps (CRSwNP) has mechanical causes, as polyps, mucosal edema, or pus can obstruct the olfactory cleft and impede access of odor molecules to the olfactory epithelium [4]. First-line therapies for CRS include nasal irrigation and topical steroids [7]. When this fails, functional endoscopic nasal sinus surgery is the common treatment for persistent CRS, especially in CRSwNP, which has been shown to significantly improve specific symptoms as well as quality of life [8]. The regression analysis provided merely statistical significances of olfactory measures without ranking them clearly among different measures such as endoscopic scores

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Discussion

Conclusion