Predictive Factors and Outcomes in Endoscopic Sinus Surgery for Chronic Rhinosinusitis

Quality-of-life outcomes after endoscopic sinus surgery: How long is long enough?

Improved Quality of Life (QOL) Outcomes in Patients With Head-and-Neck Squamous Cell Carcinoma (HNSCC) Treated With Intensity Modulated Radiation Therapy (IMRT) Compared to 3-dimensional Conformal Radiation Therapy (3D-CRT): Evidence From a Prospective Randomized Study

Conclusion: Endoscopic sinus surgery (ESS) treatment has achieved good long-term results in patients in South China with fungal ball rhinosinusitis. Gender (female), age (young), nasal polyps, allergy, high Lund-Mackay scores, prior sinus surgery and diabetes mellitus affect patients' outcomes. Objective: To evaluate objective testing and quality of life (QOL) outcomes of patients with fungal ball rhinosinusitis before and after ESS in South China and to determine preoperative factors that predict surgical outcomes. Methods: We retrospectively analyzed the outcomes for 330 patients with fungal ball rhinosinusitis after ESS. QOL was assessed using Sinonasal Outcome Test−20 (SNOT-20), Short Form-36 (SF-36) questionnaires and visual analogue scale (VAS). Objective testing was evaluated by Lund-Kennedy endoscopic scoring system. Prognostic factors were determined based on the QOL scores and Lund-Kennedy scores after ESS using a multivariate linear regression. Results: ESS significantly improved the objective testing and QOL outcomes in patients with fungal ball rhinosinusitis (p < 0.05). Objective outcome: postoperative Lund-Kennedy scores were significantly worse in patients with nasal polyps, allergy and high Lund-Mackay scores (p < 0.05). QOL outcomes: postoperative SF-36 scores were adversely affected by gender (female), age (young), nasal polyps, allergy and prior sinus surgery (p < 0.05); postoperative VAS scores were adversely affected by gender (female), nasal polyps, allergy and diabetes mellitus (p < 0.05).

As the population ages, the mean age of patients with chronic rhinosinusitis (CRS) likely will increase as will the frequency of endoscopic sinus surgery (ESS) in the older population. The purpose of this study was to compare symptom presentation, CT scores, endoscopy scores, and quality of life (QOL) measures in patients >60 years of age as compared with younger patients. A prospective cohort of 18 patients >60 years and 121 patients < or =60 years undergoing ESS for CRS were studied. Patient factors, symptom severity, and CT scores were examined preoperatively. Endoscopy and QOL scores were compared pre- and postoperatively between the two groups. The prevalence of allergies, polyps, asthma, aspirin sensitivity, and revision surgery was similar in each age group. There was no statistically significant difference in the visual analog scale scores of symptom severity in each age group. Older patients had scores that were similar to younger patients with regard to CT (13.11 versus 11.63; p = 0.419), preoperative endoscopy (8.22 versus 7.96; p = 0.828), postoperative endoscopy (3.06 versus 4.82; p = 0.100), and change in endoscopy (-5.17 versus -3.15; p = 0.083). Older patients had similar preoperative, postoperative, and change scores when compared with younger patients on the Rhinosinusitis Disability Index (-15.33 versus -20.63; p = 0.318) and Chronic Sinusitis Survey (14.35 versus 23.11; p = 0.126). Older patients with CRS present with symptoms and patient factors that are comparable with younger patients and have a similar degree of improvement on endoscopy scores and QOL measures after ESS.

Sex has been demonstrated to affect outcome in many diseases. Our current aim is to investigate the relationship between sex and outcomes of endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Forty-four males and 73 females undergoing ESS for CRS with a mean follow-up of 1.4 years were evaluated prospectively. Computed tomography (CT), endoscopy, and quality of life (QOL) assessment was performed. Univariate analyses were performed to evaluate whether sex was predictive of outcome. Multiple logistic regression analysis was performed to evaluate sex association with patient factors predictive of outcome. Although no sex differences in CT and endoscopy were observed (CT, P=.107 and endoscopy, P>.1), females consistently scored worse than males on disease-specific QOL pre- and postoperatively. Importantly, there was no effect of sex on improvement/change scores for the QOL instruments. PREDICTIVE MODELS AND MULTIPLE LOGISTIC REGRESSION ANALYSIS: Sex was not found to be predictive of QOL or endoscopic outcome. Female sex was, however, associated with acetylsalicylic acid (ASA) intolerance and depression, both factors that have been associated with poorer outcome. Despite similarities in objective disease measures, females report significantly worse QOL scores pre- and postoperatively. Postoperative improvement did not differ by sex, nor was sex predictive of postoperative outcome. Sex differences in QOL reflect sex differences in ASA intolerance and depression, both more prevalent in females.

Influence of body mass index on quality of life in atrial fibrillation patients undergoing catheter ablation

The impact on quality of life (QoL) of bilateral inferior turbinate reduction (BITR) performed in the setting of endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) has been a point of controversy. The aim of this study was to determine whether addition of BITR to ESS is associated with improved QoL when compared with ESS alone. This study presented findings a multi-institutional, retrospective analysis of a prospective open cohort of patients electing ESS for failed medical management of CRS. QoL parameters were compared between patients who underwent ESS alone vs those who underwent ESS with BITR. A total of 571 patients with CRS who elected to undergo ESS were identified. Sixty-one of these patients also underwent concurrent BITR, whereas 510 patients underwent ESS without BITR. Mean length of follow-up was 15.1 months. Comparison between baseline and last postoperative QoL, olfaction, and endoscopic scores revealed significant improvement in both groups. Overall, BITR surgery was not significantly associated with clinically significant incremental improvement in QoL in either the polyp or non-polyp group. Nevertheless, statistically significant improvement was noted for the nasal congestion/blockage symptom in polyp patients (p = 0.006) and in primary surgery patients (p = 0.027) who underwent BITR. BITR in the setting of ESS for CRS is not associated with significant incremental improvement in overall QoL vs ESS alone. However, BITR in polyp and primary surgery patients undergoing ESS appears to offer a significant incremental improvement in nasal congestion/blockage symptoms compared with ESS alone. Future studies are warranted to better corroborate these findings.

To assess polysomnogram (PSG) results and global and disease-specific quality of life (QOL) in children with obstructive sleep apnea (OSA), before and after adenotonsillectomy, and to assess the association between PSG findings and QOL. Prospective observational study. We performed overnight PSG using standardized techniques and assessed disease-specific and global QOL using validated instruments. Follow-up was assessed at 1 year. We compared QOL outcomes between children who underwent adenotonsillectomy and children who did not. A large tertiary care children's hospital. Children with sleep-disordered breathing who were suspected of having OSA. Adenotonsillectomy. We evaluated PSG parameters, disease-specific QOL, and global QOL. We enrolled 47 children, 31 of whom met PSG criteria for OSA. Disease-specific and global QOL were not significantly different between children with OSA and children without. Global QOL was significantly worse for children with OSA than healthy children on several subscales: general health perception, behavior, and parental impact-emotional. Children who underwent adenotonsillectomy had significant improvements in QOL scores and PSG parameters (apnea-hypopnea index, P = .004; minimum saturation, P = .004). We found significantly larger QOL changes in children who underwent surgery compared with children without surgery (subscales: infections, P = .01; airway, P = .002; swallowing, P = .02; and behavior, P = .03). No strong association was identified between QOL scores and PSG parameters. Children with OSA and sleep-disordered breathing have significantly worse QOL than healthy children. However, the association between PSG findings and QOL was only moderate. Children with OSA treated with adenotonsillectomy demonstrated large improvements in disease-specific and global QOL as well as PSG parameters.

The purpose of this study is to use unsupervised cluster methodology to identify phenotype and mucosal eosinophilia endotype subgroups of patients with medical refractory chronic rhinosinusitis (CRS), and evaluate the difference in quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) between these clusters for better surgical case selection. A prospective cohort study included 131 patients with medical refractory CRS who elected ESS. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate QOL before and 12months after surgery. Unsupervised two-step clustering method was performed. One hundred and thirteen subjects were retained in this study: 46 patients with CRS without nasal polyps and 67 patients with nasal polyps. Nasal polyps, gender, mucosal eosinophilia profile, and prior sinus surgery were the most discriminating factors in the generated clusters. Three clusters were identified. A significant clinical improvement was observed in all clusters 12months after surgery with a reduction of SNOT-22 scores. There was a significant difference in QOL outcomes between clusters; cluster 1 had the worst QOL improvement after FESS in comparison with the other clusters 2 and 3. All patients in cluster 1 presented CRSwNP with the highest mucosal eosinophilia endotype. Clustering method is able to classify CRS phenotypes and endotypes with different associated surgical outcomes.

Background: Chronic sinusitis (CRS) includes all inflammatory diseases of the nose and paranasal sinuses with a minimum duration of 12 weeks. Physical examination (anterior rhinoscopy, endoscopy) and/or radiography, ideally from sinus computed tomography, can provide objective proof of the same. After failure of conservative treatment, functional endoscopic sinus surgery (FESS) is the preferred modality for chronic rhinosinusitis that has been frequently used over the past years. Methods: The present prospective study aimed to assess the quality of life (QOL), the nasal endoscopy scores- before and after FESS in 60 patients aged more than 18 years suffering from chronic rhinosinusitis. QOL was assessed using SNOT-20 questionnaire and endoscopy was quantified using Lund-Kennedy sinonasal endoscopy scoring system. Results: QOL scores were significantly higher (p&lt;0.001) before surgery (41.28±15.30) than after FESS (6.83±5.96) indicating improvement in QOL. Lund-Kennedy endoscopy scores of patients suffering from chronic rhinosinusitis before and after surgery was also significantly reduced (p&lt;0.001). Conclusions: This study concludes that there is significant improvement in the QOL and reduction in the severity of symptoms in patients suffering from chronic rhinosinusitis after FESS.

Determinants of outcomes of sinus surgery: A multi-institutional prospective cohort study

Previous outcomes studies of patients with chronic rhinosinusitis (CRS) have mostly excluded subjects with immunodeficiency or autoimmune disease. Although expert opinion suggests these patients are often refractory to therapy, outcomes after endoscopic sinus surgery (ESS) are not well delineated. We evaluated improvement in objective and quality of life (QoL) measures after ESS in adult patients treated in the ambulatory setting with immune dysfunction including immunodeficiency and autoimmune diseases. Patients with CRS associated with immune dysfunction (n = 22) were evaluated and matched 1:1 with control subjects from a prospective cohort in a nested case-control design. Preoperative computed tomography (CT) and pre-/postoperative endoscopic findings were recorded. Disease-specific QoL instruments (the Rhinosinusitis Disability Index [RSDI] and Chronic Sinusitis Survey [CSS]) were administered pre- and postoperatively. Mean postoperative follow-up was similar for both cases (18.6 +/- 6.6 months) and controls (18.4 +/- 8.7 months). Preoperative CT and endoscopy scores (i.e., disease severity) were similar in both cases and controls. Postoperative endoscopy scores were significantly improved for both cases (p < 0.001) and controls (p = 0.012). Both groups had similar preoperative and postoperative scores on the CSS; however, control subjects reported significantly worse RSDI baseline scores. Immunodeficiency and autoimmune cases and CRS controls experienced significant improvement in QoL after surgery (p < or = 0.041). Immunodeficiency and autoimmune cases, in the ambulatory setting, present with similar severity of disease when compared with controls with CRS. We found similar improvements in both objective and QoL outcomes for case subjects and control subjects, suggesting that patients with immune dysfunction may experience similar benefit from ESS.

The assessment of quality of life (QOL), identifying functional capacity and frequency of angina and other cardiac symptoms, are key issues in the treatment of chronic patients or in those with disease instability. To identify predictors of quality of life (QOL) improvement in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Patients hospitalized in a cardiology reference hospital were assessed with the Seattle Angina Questionnaire (SAQ) at the time of admission and after 6 months. The analyzed outcome was the variation of the QOL score, resulting from the difference between the score after six months and the score at the time of admission. Differences between patients with or without 6-month QOL improvements regarding the demographic, clinical and therapeutic characteristics were assessed by univariate and multivariate analysis. Hypertensive patients presented lower improvement in QOL scores when compared to non-hypertensive ones [8.3(0-25) vs. 16.6(0-33.3); P=0.05], as well as patients with dyslipidemia, when compared to non-dyslipidemic ones [8.3(0-25) vs. 16.6(0-33.3); P=0.02]. Patients with unstable angina presented greater improvements in QOL in relation to those with NSTE myocardial infarction [16.6(0-33.3) vs. 8.3(-8.3-25); P=0.03]. By multivariate analysis, myocardial revascularization in the first 30-days was associated with the greater improvement in the QOL score (8.47 points; P=0.005). On the other side, the presence of dyslipidemia at the baseline evaluation was an independent predictor of worse QOL scores (-7.2 points; P=0.01). Myocardial revascularization was associated with improvement in the 6-month QOL scores, while dyslipidemia was associated with worse scores.

Both obesity and chronic rhinosinusitis (CRS) are characterized by inflammation. Furthermore, both disease processes are independently associated with decreases in quality-of-life (QOL). We sought to investigate the role of comorbid obesity in QOL outcomes in CRS patients undergoing endoscopic sinus surgery (ESS). Adult patients with medically refractory CRS (n = 241) were prospectively enrolled into a multi-institutional treatment outcomes investigation. Body mass index (BMI) calculations were used to differentiate patient weight groups (normal weight: 18.5 to 24.9, overweight: 25.0 to 29.9; and obese: ≥30.0). Preoperative and postoperative QOL (Rhinosinusitis Disability Index [RSDI] and the 22-item Sino-Nasal Outcome Test [SNOT-22]) were evaluated compared across BMI groups and obesity subclasses. The prevalence of comorbid obesity was 41% (n = 99). Higher prevalence of comorbid disease was found across increasing BMI groups including diabetes mellitus, asthma, and depression. No significant differences were found in mean preoperative QOL measures between any BMI groups. Significant improvement between preoperative and postoperative QOL mean scores (p ≤ 0.050) was found for all BMI groups. Despite no significant difference in mean QOL improvement between BMI groups (p ≥ 0.142), overweight and obese patients reported reduced relative mean percentage (%) improvement compared to normal weight participants on the RSDI total score (33% and 37% vs 55%, respectively) and SNOT-22 total score (29% and 40% vs 48%, respectively). Patients with comorbid obesity experience significant improvement in average QOL gains following ESS though the percentage of relative improvement in QOL may be decreased in patients with comorbid obesity and CRS as compared to those without.

Purpose: A novel method of evaluating response to cardiac resynchronization therapy (CRT) was introduced in the EARTH trials. This substudy sought to assess the relationship between response to CRT using submaximal treadmill exercise testing, and quality of life (QoL) measures. Methods: The GREATER-EARTH trial was a multicentre, randomized, double-blind crossover trial evaluating left ventricular versus biventricular pacing in patients requiring an implantable cardioverter-defibrillator and CRT (LVEF <35% and QRS duration ≥ 120 msec). A total of 121 patients were randomized to CRT by left ventricular pacing (LV) followed by biventricular pacing (BiV) or vice versa for consecutive 6-month periods. The present analyses were restricted to the first 6-month period to avoid carryover effects. Clinical response to CRT was pre-defined as an increase of ≥20% duration of submaximal treadmill exercise testing at 6 months compared to baseline. QoL was assessed at baseline and 6 months using generic (SF-36, Physical [PCS] and Mental [MCS] components) and disease-specific (Minnesota Living with Heart Failure [LWHF]) questionnaires. The relationship between responder status according to submaximal exercise test and change in QoL scores was assessed using multivariate linear regression. Results: Clinical responders showed significant improvements in QoL scores between baseline and 6 months (decrease in LWHF 15 points [p 0.30). Responder status was the only independent predictor of change in QoL scores; resynchronization mode (LV vs BiV), interaction between mode and responder status, age and sex were not independently associated with changes in QoL. Changes in the duration of submaximal exercise testing showed moderate but significant correlations with changes in LWHF (Spearman's ρ= -0.38; p<0.0001) and PCS scores (ρ=0.46; p<0.0001). An exploratory regression tree analysis showed that using a cut-off value of 55% improvement in duration of submaximal exercise testing instead of 20% to define response provided the best discrimination in terms of QoL score change. Conclusions: Submaximal treadmill exercise testing adequately reflects changes in quality of life after resynchronization therapy. Although this test should be compared to other means of assessing response and refined as to its best cut-off value, it has great potential in patient evaluation following resynchronization therapy.