Subjective Outcomes Assessment in Chronic Rhinosinusitis

Abstract

The treatment of chronic rhinosinusitis (CRS) requires an increasing use of medical and economic resources. Therefore, the assessment of objective and subjective outcome of different treatment strategies is of considerable interest. Validated quality of life (QOL) instruments are one important means to assess subjective outcome of the patients. Frequently used generic instruments are the Short Form 36 Health Survey (SF-36) for prospective evaluations and the Glasgow Benefit Inventory (GBI) for retrospective evaluations. Normative data and numerous comparative data sets collected from various diseases are available for the SF-36. Disease-specific QOL instruments for CRS have been developed over the last 15 years. In this review 11 disease-specific instruments are discussed. Only four of these instruments cover all four main symptoms of CRS and are completely validated as well. Most frequently used instruments (Sino-Nasal Outcome Test, SNOT-20; Chronic Sinusitis Survey, CSS) do not query all the main symptoms of CRS. Until the nineteen-nineties the evaluation of success was straitened to the reporting of complications, revision surgery rates etc. It was postulated that normal and non- inflammatory endoscopic clinical findings were always a successful result even for the patient. However, frequently strong divergences between clinical findings and subjective patient reports had to be noted (10). Furthermore, computed tomography (CT) which is the most important imaging method in these patients could not establish significant correlations between imaging and symptom severity. Since the nineteen-eighties quality of life (QOL) instruments were systematically developed and validated for use in clinical medicine to achieve the goal of measuring the subjective outcome of the patients. The first instruments for use in patients with CRS were developed in the nineteen- nineties. In the following general and disease-specific QOL instruments which are in use in patients with CRS are presented.