Sinus Surgery For Chronic Rhinosinusitis Research Articles

Endoscopic Treatment of Huge Sinus Mucoceles Causing Orbital Symptoms.

Paranasal sinus mucoceles are accumulation of mucoid secretions and desquamated epithelium within the sinus causing distension of its wall. They occur mostly in the frontal and ethmoid sinuses. Patients with giant frontal or ethmoidal sinus mucoceles suffer from orbital symptoms such as proptosis, visual disturbance, periorbital swelling, pain, or visual disturbance mostly, but they can also have rhinologic or neurologic symptoms. The purpose of this study is to evaluate the efficacy of endoscopic marsupialization for treating giant frontal and ethmoidal sinus mucoceles causing orbital symptoms. This study was a retrospective, consecutive clinical review of patients with giant frontal and ethmoidal sinus mucoceles with orbital symptoms, who were treated by endoscopic marsupialization between January 2012 and August 2019. Medical records including age, gender, nasal and orbital symptoms, imaging findings, and surgical methods were reviewed. There were 15 patients with giant frontal and/or ethmoidal sinus mucoceles accompanied with orbital symptoms. The mean age of the patients was 50.5 years. One patient had previously undergone endoscopic sinus surgery for chronic rhinosinusitis. Within 15 patients, the main orbital symptoms were visual disturbance (6 patients), proptosis (8 patients), eyelid swelling (6 patients), and periorbital pain (1 patient). Other symptoms included nasal congestion, rhinorrhea, and headache. All patients underwent endoscopic marsupialization of the mucocele and had improvement in nasal and orbital signs and symptoms. Endoscopic marsupialization is an effective treatment for giant frontal and ethmoidal mucoceles with orbital symptoms.

Prolonged Implantation of Sinus Devices and Implications for Chronic Rhinosinusitis: A Case Report and Review of the Literature.

Implantation of sinus stents and spacers can be used as adjuvant management to maintain patency of sinuses after endoscopic sinus surgery for chronic rhinosinusitis. These implants are typically removed several weeks after surgery. We present two cases of different patients who were initially treated by different physicians and were found to have retained sinus spacers in their paranasal sinuses 6-10 years after implantation. Case 1: a 40-year old male with chronic rhinosinusitis and history of balloon sinuplasty six years prior presented with worsening symptoms of chronic rhinosinusitis refractory to medical management. He underwent revision functional endoscopic sinus surgery and was found to have retained sinus implants in the left and right frontal sinus recesses. Case 2: a 48-year-old female with long-standing chronic rhinosinusitis refractory to medical management presented after two prior sinus surgeries most recently 10 years ago. She underwent revision functional endoscopic surgery and was found to have a retained sinus implant from prior surgery in the right frontal recess outflow tract embedded within scar tissue and reactive hyperostosis. Foreign bodies from both patients were removed without complication and patients were healing appropriately in the post-operative period. While sinus stents and spacers can help with post-operative scarring, leaving then unmonitored and in place will eventually result in them becoming a nidus for scarring and infection. It is critical that patients are aware of any foreign bodies we place, if they need scheduled removal or routine observation, and what symptoms may indicate that they are causing a problem.

Dynamic Change of T-Helper Cell Cytokines in Nasal Secretions and Serum after Endoscopic Sinus Surgery in Chronic Rhinosinusitis with Nasal Polyps

Background/Aims: This study aimed to determine the dynamic change of postoperative T-helper cell cytokines in nasal secretions and serum in chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: Nasal secretions and serum samples of 30 CRSwNP patients and 10 healthy subjects were collected. Among CRSwNP patients, samples of 30 patients were collected 1 day before endoscopic sinus surgery (ESS) and that of 18 patients (12 asthmatic and 6 non-asthmatic) were collected 4, 8, and 12 weeks after ESS. Concentrations of interleukin (IL)-2, IL-4, IL-5, IL-17, and interferon gamma (IFN-γ) were determined by Cytometric Beads Array. The Sino-Nasal Outcomes Test 22 and Lund-Kennedy endoscopic scoring (LKES) system were collected for all patients. Results: The levels of IL-2 and IL-5 in secretions of CRSwNP were significantly higher than that of healthy control at the baseline. At the 4th and 8th week after ESS, the IL-4 levels in nasal secretions of the asthmatic group were significantly higher than their baseline controls (preoperatively). From the 4th to 12th week after ESS, the IL-2, IFN-γ, IL-4, and IL-17 levels in nasal secretions of the non-asthmatic group were significantly increased as compared to their baseline controls. Postoperative IL-5 levels in serum of the asthmatic group decreased significantly as compared to their baseline controls. There was no significant association between LKES and levels of cytokines in postoperative secretions and serum. Conclusions: Our results indicate that postoperative endoscopic findings may not directly reflect the underlying mucosal inflammation, and surgery could not change the systemic immunity status. Despite endoscopic resolution of mucosal abnormalities, it may not avert the need for subsequent postoperative medical intervention to treat the underlying mucosal inflammation.

Risk factors for complications of endoscopic sinus surgery for Chronic rhinosinusitis

Risk factors for complications of endoscopic sinus surgery for Chronic rhinosinusitis

A comparative study and correlation between preoperative computed tomogram and endoscopic sinus surgery in chronic rhinosinusitis

<p class="abstract"><strong>Background:</strong> Chronic rhinosinusitis (CRS) with its classical symptoms of nasal obstruction, nasal discharge, and headache is relatively a common disease in otorhinolaryngology practice. The objectives of the present study was to correlate the operative findings in such patients with the CT findings, using the Perioperative sinus endoscopy (POSE) scoring system and to correlate the maximum scores obtained in the POSE scoring system and Lund-Mackay scoring system.</p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted from January 2014 to March 2015 in 50 patients suffering from chronic rhinosinusitis who underwent endoscopic sinus surgery in the age group of 36-60 years of age. </p><p class="abstract"><strong>Results:</strong> Agger nasi cells were the most common wandering ethmoid cell detected (90%) followed by various types of frontal cells (54%), Haller cells (26%) and least commonly Onodi cells (12%). Almost perfect agreement was obtained for rest of the criteria which included middle turbinate status, ethmoid cavity mucosal edema and ethmoid cavity polypoid change. Lund-Mackay scoring system was used to score findings in the CT scan and POSE scoring system used to score peroperative findings in the study and this study reveals excellent correlation (Pearson correlation value of 0.879).</p><p><strong>Conclusions:</strong> Novel POSE scoring is a new entity which has the potential to be a valid system to score preoperative and perioperative findings. In the current study POSE scoring shows excellent correlation with Lund Mackay scoring which is an established scoring system used in the evaluation CT scan.</p>

Endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps under the guidance of precision medicine：present state and prospective

Endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps under the guidance of precision medicine：present state and prospective

Impact of age on outcomes following endoscopic sinus surgery for chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a common condition that affects people of all ages and negatively impacts quality of life. The goal of this study was to identify differences in outcomes by age following endoscopic sinus surgery (ESS) for CRS utilizing 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Data from 1252 adult CRS patients electing to undergo ESS (2007-2018) were collected retrospectively. The median age of 50 years was used to divide the data into 2 groups for comparison of the impact of age on SNOT-22 scores at 0, 3, and 6 months after surgery. Changes in SNOT-22 scores were analyzed using a mixed models analysis. After adjusting for gender, race, polyp status, and number of prior ESSs, patients younger than 50 years had a higher mean pre-ESS SNOT-22 score (44.0) compared to those of at least 50 years of age (38.9). Among patients younger than 50 years, SNOT-22 scores declined by 20.7 points at 3 months post-ESS and 16.1 points at 6 months post-ESS. The rate of change between the dichotomized age groups was not significantly different at 3 and 6 months post-ESS (p = 0.7952 and p = 0.1057, respectively). Both age groups showed significant and durable improvement in SNOT-22 scores after ESS. Patients younger than 50 years of age have higher pre-ESS SNOT-22 scores, but converge to the same SNOT-22 scores by 3 months post-ESS. The rate of change of SNOT-22 scores is not different between those younger than 50 years and those of at least 50 years.

Anatomical variation of the pneumatized superior turbinate and its impact on endoscopic sinus surgery in chronic rhinosinusitis.

The posterior ethmoid sinus is adjacent to important structures, such as the orbit, optic nerve, skull base, and ostium of the sphenoid sinus. The purpose of this study was to examine the effect of pneumatization of the superior turbinate (ST) and its basal lamella, and of the position of the anterior wall of the sphenoid sinus, on opening of the posterior ethmoid and sphenoid sinuses. On axial, coronal, and sagittal computed tomography images, 394 sinuses of 197 patients who underwent endoscopic sinus surgeryatToho University Omori Medical Center in Tokyo, Japan, were classified according to the presence or absence of pneumatization of the ST and its basal lamella. The basal lamella of the ST was classified separately into the vertical and horizontal portions. We examined whether the classification of the anterior wall of the sphenoid sinus was associated with the structure of the ST. Pneumatization was observed in the ST in 28 sinuses (7.1%), in the vertical portion of the basal lamella in 127 (32.2%), and in the horizontal portion of the basal lamella in 90 (22.8%). Pneumatization in the horizontal portion of the basal lamella was significantly more common in the anterior sphenoidal wall classified as optic-canal type. Consideration should be given to the pneumatization of the ST and its basal lamella and optic-canal-type anterior sphenoidal wall, because these reduce the volume of the posterior-most ethmoid cell and may increase the risk of damaging the skull base and optic nerve.

General health, vitality, and social function after sinus surgery in chronic rhinosinusitis.

ObjectivesChronic rhinosinusitis (CRS) has an impact on health‐related quality of life (HRQOL). The objective of this study was to examine generic and disease‐specific HRQOL and symptoms in CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps before and 6 months after sinus surgery, and to identify preoperative patient factors associated with HRQOL outcome in the two groups separately.MethodsThis prospective, observational study consisted of 220 CRSwNP and 196 CRSsNP patients. Generic and disease‐specific HRQOL were measured using the Short‐Form‐Health‐Survey (SF‐36) and Sino‐Nasal‐Outcome‐Test (SNOT‐20). Symptoms were assessed on a visual analog scale.ResultsPreoperatively, CRSwNP patients reported worse score in general health (SF‐36), rhinologic subset (SNOT‐20): nasal obstruction, nasal discharge, and altered sense of smell compared to CRSsNP patients, who reported worse score in physical role, bodily pain, ear/face subset, and facial pain. After surgery, generic and disease‐specific HRQOL and symptoms improved in both groups. CRSwNP patients had greater improvement in general health, vitality and social function, nasal obstruction, and altered sense of smell, compared to CRSsNP‐patients. In both groups, higher age, daily smoking, and having had sinus surgery previously were associated with less generic HRQOL improvement, in addition to female sex and allergy in CRSsNP patients.ConclusionThe greater improvement in general health, vitality, and social function after surgery may indicate a greater potential for generic HRQOL improvement in CRSwNP patients compared to CRSsNP patients. Female sex and allergy was associated with less improvement of generic HRQOL in the CRSsNP group, but not in the CRSwNP group.Level of evidence2c outcome research.

Evaluation of pre-operative sino-nasal outcome test- 22 scores as a predictor of outcome in patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis

<p class="abstract"><strong>Background:</strong> Numerous factors are to be considered when offering FESS as a treatment for patients with chronic rhinosinusitis (CRS) who have failed conservative medical treatment. The objective is to evaluate the sino-nasal outcome test (SNOT-22) and other patient demographic characteristics as predictors of postsurgical improvement in patients with CRS.</p><p class="abstract"><strong>Methods:</strong> Consecutive adult subjects presenting to the Otolaryngology clinics in a tertiary hospital, with refractory CRS that required surgery were included. Subjects were excluded if they did not complete both pre and post-operative SNOT-22 Questionnaire. Demographic and baseline measures, including allergic rhinitis, asthma and addiction status, Lund Kennedy endoscopic scores and Lund-Mackay computed tomography (CT) scoring were also obtained for each subject. Regression analyses were performed. </p><p class="abstract"><strong>Results:</strong> Fifty-one subjects met criteria and were included. These subjects showed a 55.4% overall improvement in postsurgical SNOT-22 evaluations. Multivariate regression analysis revealed that SNOT-22 items related to “runny nose,” “waking up at night”, “need to blow nose”, and “sneezing” were independent predictors of postsurgical SNOT-22 improvement (p<0.05, for all).</p><p class="abstract"><strong>Conclusions:</strong> ENT surgeons can utilize the SNOT-22 tool to predict the possibility of symptom improvement post FESS in patients with CRS.</p>

Role of inferior turbinate reduction in the quality of life of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis.

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.

The comfort of patients with different nasal packings after endoscopic sinus surgery for chronic rhinosinusitis: A protocol for network meta-analysis.

Background:Chronic sinusitis (CRS) is a high incidence disease and seriously affects the patients’ quality of life, causes tremendous economic burden as well. Endoscopic sinus surgery (ESS) is one of the most common therapies for chronic sinusitis. While whether there is a need for nasal packing and which is the best one is still unclear.Method and analysis:A systematic search will be performed using PubMed, EMBASE.com, the Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Wanfang database to include randomized controlled trials (RCTs), comparing the efficacy and comfort in patients with nasal packings after ESS who is diagnosed as CRS. The risk of bias of the included RCTs will be assessed by the Cochrane Handbook version 5.1.0. A Bayesian network meta-analysis will be conducted using R-3.3.2 software.Results:This study is ongoing and the results will be published in a peer-reviewed journal.Conclusion:The results of this study will be sent to clinicians and healthcare providers in the National Health Service, which is expected to help clinicians make more informed choices on nasal packings.Ethics and dissemination:Ethical approval is not applicable since this study is a network meta-analysis based on published trials.Protocol registration number:CRD42019119233.

Comparison of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

Abstract OBJECTIVE. To study and compare the benefits of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery in terms of subjective and objective improvement in symptoms of nasal polyposis. MATERIAL AND METHODS. This study involved 60 patients with bilateral sinonasal polyposis scheduled to undergo Endoscopic Sinus Surgery. The patients were randomized into two groups: Group A -Conventional endoscopic sinus surgery and Group B -Microdebrider-assisted endoscopic sinus surgery. RESULTS. There was a significant difference in the mean VAS at 3 months postoperatively in Group B, but no significant difference at 6 months postoperatively following either of the two methods. The mean time for surgery (p<0.01) and the mean intraoperative blood loss (p<0.01) were significantly lower in Group B. CONCLUSION. A well-trained surgeon with proper anatomical knowledge, good instruments, hypotensive anaesthesia, minimal mucosal injury and regular proper follow-up will have similar postoperative results with both methods.

Health Care Disparities in Patients Undergoing Endoscopic Sinus Surgery for Chronic Rhinosinusitis: Differences in Disease Presentation and Access to Care.

Data on health care disparities by socioeconomic status for chronic rhinosinusitis (CRS) are lacking, and the available literature shows mixed results. The aim of this study was to evaluate several indicators of disease complexity in patients with CRS undergoing endoscopic sinus surgery between a private and a public hospital to determine if there are any disparities in the severity of disease presentation or in access to care. Two hundred patients with CRS who underwent endoscopic sinus surgery from 2015 to 2017 were retrospectively reviewed. Demographics, disease-specific data, and pre- and postoperative management were collected. Public hospital patients (n = 100) were significantly more likely to be non-Caucasian (73.0% vs 25.0%, P < .0001) and to have Medicaid or no insurance (86.0% vs 4.0%, P < .0001). Patients from the public hospital were more likely to have CRS with nasal polyposis (85.0% vs 60.0%, P < .0001) and to have longer wait times for surgery (68 vs 45 days, P < .0001) and were more likely to be lost to follow-up (26.0% vs 16.0%, P = .031). Patients at the public hospital had CRS symptoms 21% longer ( P = .0206), and if a patient carried a diagnosis of asthma, he or she had on average more severe asthma ( P = .0021). This study suggests that patients of lower socioeconomic status had a longer duration of disease prior to surgery, more often had nasal polyposis, and had decreased access to care, as indicated by increased surgical wait times and being lost to follow-up. Acting as a foundation for further investigation, the ultimate intent of this study is to improve care for all patients.

Recovery of olfaction after sinus surgery for chronic rhinosinusitis: A review.

Investigation of the postoperative olfactory function after sinus surgery for chronic rhinosinusitis (CRS) with and without polyps in a review. PubMed. A comprehensive literature search was conducted through June 2018 using relevant keywords. The titles/abstracts were reviewed to identify studies evaluating the sense of smell in CRS-patients pre- and postoperatively by either using the whole or parts of the University of Pennsylvania Smell Identification Test or the Sniffin' Sticks test. Study characteristics and outcome data of the included studies were extracted. In total, 106 studies were retrieved. Twenty-four studies comprising 1,956 patients were included after quality assessment. The number of patients investigated per study was 19 to 206. In the 24 studies, 959 patients with nasal polyps and 516 without nasal polyps were described. The follow-up times varied between 0.5 and 28 months. Twenty-three studies reported an improved sense of smell, at least in certain subgroups. An overall improvement was seen in approximately 50% of the included patients. Nasal polyposis and preoperative anosmia were associated with a higher chance of improvement in olfaction. In those studies that commented on deterioration after sinus surgery, a decrease in olfaction was found in a range from 0% to 10% of cases. Olfaction can be improved by sinus surgery in about every second patient, especially if the patient had chronic rhinosinusitis with polyps, was anosmic, and had no prior surgery. A deterioration of sense of smell after surgery is rare. Laryngoscope, 129:1053-1059, 2019.

Influence of a medialized middle turbinate on olfactory function: a prospective randomized double-blind study.

Medialization of the middle turbinate (MT) is an effective technique to prevent recurrent rhinosinusitis but could, in theory, reduce olfactory function by interfering the odorants to reach the olfactory mucosae. We performed a prospective randomized double-blind trial under the hypothesis that olfactory functions would be affected by the status of olfactory mucosae, not by MT medialization. In randomly selected sides, the unilateral MT was medialized in 80 patients undergoing bilateral endoscopic sinus surgery for chronic rhinosinusitis. The status of the bilateral olfactory cleft (OC) was photodocumented intraoperatively and categorized into patent (normal or mucosal swelling with discharge) and congested (hypertrophied mucosae or nasal polyps) groups. The butanol threshold test (BTT) was conducted in each nostril before and 6 months after the surgery. Correlation between the BTT scores and MT medialization or the OC status was assessed. No smell identification test was conducted side by side, which might limit clinical implications. In total, 46 of 80 patients completed the trial. MT medialization was performed on the left and right side of the nose in 19 and 27 cases, respectively. The intraoperative OC status did not differ between the 2 sides. Perioperative changes in the BTT scores were similar between the medialized and intact MT sides, whereas the preoperative and postoperative BTT scores were higher in the patent OC group than in the congested OC group, regardless of side. MT medialization does not impair olfactory function, and OC status is closely related to olfactory function.

Сравнительная эффективность операций на верхнечелюстной пазухе при хроническом риносинусите у детей с использованием SNOT-20

Сравнительная эффективность операций на верхнечелюстной пазухе при хроническом риносинусите у детей с использованием SNOT-20

Preoperative and postoperative medical therapies for chronic rhinosinusitis: National surveys among Chinese otolaryngologists.

ObjectiveThe aim of this study was to evaluate clinical practice patterns of preoperative and postoperative medical therapies immediately surrounding sinus surgery for chronic rhinosinusitis (CRS) by Chinese otolaryngologists.MethodsTwo anonymous web-based surveys of preoperative and postoperative medical therapies were performed. These surveys assessed the frequency of prescription of oral corticosteroids, intranasal corticosteroid sprays, oral antibiotics, nasal saline irrigation, oral antihistamines, nasal antihistamines, anti-leukotriene agents, topical decongestants and oral mucolytics.ResultsA total of 304 (17.5%) preoperative and 143 (23.5%) postoperative questionnaires were completed and returned. Seventy-eight percent, 63% and 56% of respondents used preoperative intranasal corticosteroid sprays, oral antibiotics and oral mucolytics “always or often”, respectively. Ninety-four percent, 93%, 72% and 69% of respondents used postoperative intranasal corticosteroid sprays, nasal saline irrigation, oral antibiotics and oral mucolytics “always or often”, respectively. Oral antihistamines, nasal antihistamines, anti-leukotrienes and topical decongestants were not commonly used preoperatively or postoperatively.ConclusionsOur study demonstrated that current practice patterns of preoperative medical therapies among otolaryngologists are not uniformly based on evidence-based outcomes research. Postoperative oral antibiotics, intranasal corticosteroid sprays, nasal saline irrigation and oral mucolytics are commonly used by a majority of Chinese otolaryngologist for CRS. Practice patterns of postoperative medical therapy reflect recent guidelines.

Impact of blood eosinophils on clinical effect of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

Objective: To investigate the effect of blood eosinophils on clinical effect of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: From March 2011 to March 2016, 72 cases with CRSwNP were treated by endoscopic sinus surgery in Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital. The clinical records were retrospectively reviewed, and the cases were divided into eosinophilia elevated and non-elevated group according to blood eosinophils, and nasal polyps were evaluated for histopathology eosinophil count. Statistical analysis was performed to compare two groups' pre- and post-operative symptoms of VAS score, sinus computed tomography (CT) scans scores according to the Lund-Mackay system and the outcome of surgery. Both groups' factors that might have affected their outcome were analyzed by t-test, Chi square, Pearson Correlation Coefficient and Willcoxon rank sum test. Results: Seventy two cases were followed up from 24 to 78 months.The average follow-up time was 56 months. The VAS score in the eosinophilia elevated group (n=16) was higher than that in the non-elevated group(n=56), and the difference was statistically significant (11.44±7.13 vs 4.98±5.64, t=3.726, P<0.05). The control of symptoms in the peripheral blood eosinophilia elevated group was less than that in the non-elevated group, and the difference was statistically significant (Z=-1.979, P<0.05). There was a positive correlation between eosinophil counts in peripheral blood and tissues of 72 cases (r=0.429, P<0.05). Conclusion: There is a significant correlation between tissue and blood eosinophil counts, and eosinophilia group has poorer outcomes.

Self-reported anxiety and depression unchanged after endoscopic sinus surgery for chronic rhinosinusitis.

Prior research has established that anxiety and depression, as measured by the Hospital Anxiety Depression Score (HADS), are strongly correlated with disease-specific quality of life (Rhinosinusitis Disability Index - RSDI) in chronic rhinosinusitis (CRS). We hypothesized that anxiety and depression would decrease after functional endoscopic sinus surgery (FESS), and furthermore that HADS would predict improvement in RSDI following surgery. The study cohort from 2014 consisted of 99 CRS patients who underwent nasal endoscopy, RSDI, and HADS evaluation. The cohort was segregated by whether or not they underwent FESS and an updated HADS was administered. For 44 surgical patients, pre- and post-operative RSDI (n=38), Lund-Kennedy (LK) (n=34) and HADS (n=18) scores were compared. Delta RSDI was compared between patients with varying levels of anxiety and depression. Lund-Kennedy scores improved from 5.8 ± 4.1 to 3.2 ± 2.6 following surgery, as did total RSDI (39.3 ± 26.8 to 24.6 ± 29.2). Total HADS (9.8 ± 6.4 to 11.3 ± 7.4) and depression and anxiety subscores were unchanged. Linear regression did not reveal a correlation between HADS and change in RSDI following FESS. Delta RSDI was not significantly different between patients with varying levels of anxiety and depression. Despite improvements in objective evidence of sinonasal inflammation (LK) and disease-specific quality of life (RSDI), neither depression nor anxiety improved after FESS, nor did the magnitude of psychological comorbidity predict post-operative improvement in quality of life. Improvement in RSDI was not different among patients with varying levels of anxiety and depression. Levels of depression and anxiety may be hard-wired, and therefore not influenced by changes in objective or perceived sinonasal disease burden.