Abstract
Chronic rhinosinusitis has a significant impact on health-related and generic quality-of-life, has a high cost burden to both society and patients, and may be associated with absenteeism, loss of productivity and poor respiratory function. Though there is a paucity of level 1 evidence, endoscopic sinus surgery may be considered in medically refractory patients and a variety of objective and subjective outcome measures exist to assess the effectiveness of intervention. We outline the outcome measurements available and review in-depth the published outcomes to date. Furthermore we discuss the literature that indicates that endoscopic sinus surgery can have a positive effect on respiratory function in asthma. How patient selection, timing and extent of surgery, and post-operative care interventions may optimise surgical outcomes is explored.
Highlights
Chronic rhinosinusitis (CRS) affects approximately 11 % of people in the UK [1], and may exist with or without nasal polyps
This review aims to discuss which outcome measures might be considered in the evaluation of endoscopic sinus surgery for CRS and what the published outcomes of surgery are to date
To be included in this review, studies were preferentially chosen for their higher level of evidence, size of study, clearly defined outcome measures, and those with the outcome measures we describe as their primary outcome
Summary
Chronic rhinosinusitis (CRS) affects approximately 11 % of people in the UK [1], and may exist with or without nasal polyps. There was a statistically significant increase in complication rates with increasing SNOT-22 and Lund-Mackay CT scores, and extent of polyposis [28], demonstrating that important subjective and objective outcome measures may be used as a predictor of postoperative outcome when measuring complication rates This rate of major complications from the UK (0.4 %) compares with a rate of 1.1 % reported in a meta-analysis from 10 years previously of 4691 patients who underwent ESS in the US [29]. In a single-centre prospective cohort study of revision versus primary ESS, 167 patients with similar preoperative Lund-Mackay, RSDI and CSS scores, following surgery both groups experienced significant and comparable symptomatic improvement and there was no significant difference between the two groups measured by the CSS. No significant differences were found in postoperative improvement between the revision subgroups
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