Abstract
Purpose of Review
Chronic rhinosinusitis (CRS) has a significant negative impact on quality of life (QoL). Surgical treatment of CRS is indicated when medical therapy fails to achieve adequate symptom control. This review summarizes the latest information on the outcomes after endoscopic sinus surgery (ESS) with relation to QoL, revision rates, olfaction, absenteeism, asthma control, use of systemic medications, quality of sleep and complications. We also provide an update regarding the factors that can impact outcomes.
Recent Findings
CRS has classically been divided into two phenotypes depending on the presence or absence of nasal polyps. However, this is an oversimplification as many factors impact disease burden and outcome after treatment. It has been demonstrated that in many cases, ESS fails to meet the expectations of the patients. Evidence based patient counselling is key to help surgeons guide their patients in the best possible way to make well-informed decisions.
Summary
Repeatedly it has been demonstrated that ESS improves QoL, improves olfaction, leads to better asthma control and less use of systemic antibiotics. However, various patient characteristics including phenotype, disease burden, comorbidities, age, gender and surgical technique can influence the outcome after ESSIt is of paramount importance to include a follow-up period when discussing revision rates. Based on available data, the genuine revision rate is probably 15–20% after five to ten years of follow-up. The revision rate is also affected by various factors and comorbidities.
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References
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Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J, Bockelbrink A, et al. Chronic rhinosinusitis in Europe--an underestimated disease. A GA2LEN study. Allergy. 2011;66(9):1216–23.
Johansson L, Akerlund A, Holmberg K, Melén I, Bende M. Prevalence of nasal polyps in adults: the Skövde population-based study. Ann Otol Rhinol Laryngol. 2003;112(7):625–9.
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1–464 Excellent and very comprehensive review of evidence based treatment of chronic rhinosinusitis.
Bhattacharyya N. Ambulatory sinus and nasal surgery in the United States: demographics and perioperative outcomes. Laryngoscope. 2010;120(3):635–8.
Smith TL, Schlosser RJ, Mace JC, Alt JA, Beswick DM, DeConde AS, et al. Long-term outcomes of endoscopic sinus surgery in the management of adult chronic rhinosinusitis. Int Forum Allergy Rhinol. 2019;9(8):831–41.
Loftus CA, Soler ZM, Koochakzadeh S, Desiato VM, Yoo F, Nguyen SA, et al. Revision surgery rates in chronic rhinosinusitis with nasal polyps: meta-analysis of risk factors. Int Forum Allergy Rhinol. 2020;10(2):199–207. Comprehensive metaanalysis of revision rates after endoscopic sinus surgery.
Soler ZM, Smith TL. Quality of life outcomes after functional endoscopic sinus surgery. Otolaryngol Clin N Am. 2010;43(3):605–12 x.
Gliklich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg. 1995;113(1):104–9.
Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item Sinonasal outcome test. Clin Otolaryngol. 2009;34(5):447–54.
Hopkins C, Slack R, Lund V, Brown P, Copley L, Browne J. Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope. 2009 [cited 2019 Nov 18];119(12):2459–65. Available from: https://doi.org/10.1002/lary.20653. Show that sinus surgery is safe and can improve quality of life on the long term.
Katotomichelakis M, Simopoulos E, Tripsianis G, Balatsouras D, Danielides G, Kourousis C, et al. Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery. Eur Arch Otorhinolaryngol. 2014;271(4):733–41.
Newton E, Janjua A, Lai E, Liu G, Crump T, Sutherland JM. The impact of surgical wait time on patient reported outcomes in sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2017;7(12):1156–61.
Hopkins C, Rudmik L, Lund VJ. The predictive value of the preoperative Sinonasal Outcome Test-22 score in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. 2015;125(8):1779–84.
Soler ZM, Jones R, Le P, Rudmik L, Mattos JL, Nguyen SA, et al. Sino-nasal outcome test-22 outcomes after sinus surgery: a systematic review and meta-analysis. Laryngoscope. 2018;128(3):581–92.
Ayoub N, Walgama E, Thamboo A, Chitsuthipakorn W, Patel ZM, Nayak JV, et al. Correlation between extent of sinus surgery, radiographic disease, and postoperative outcomes. Rhinology. 2020;58(1):36–44.
Schlosser RJ, Hyer JM, Smith TL, Mace JC, Cortese BM, Uhde TW, et al. Depression-specific outcomes after treatment of chronic rhinosinusitis. JAMA Otolaryngol Head Neck Surg. 2016;142(4):370–6.
Steele TO, Mace JC, Smith TL. Does comorbid anxiety predict quality of life outcomes in patients with chronic rhinosinusitis following endoscopic sinus surgery? Int Forum Allergy Rhinol. 2015;5(9):829–38.
Zhang Z, Adappa ND, Doghramji LJ, Chiu AG, Lautenbach E, Cohen NA, et al. Quality of life improvement from sinus surgery in chronic rhinosinusitis patients with asthma and nasal polyps. Int Forum Allergy Rhinol. 2014;4(11):885–92.
Khan A, Huynh TMT, Vandeplas G, Joish VN, Mannent LP, Tomassen P, et al. The GALEN rhinosinusitis cohort: chronic rhinosinusitis with nasal polyps affects health-related quality of life. Rhinology. 2019;57(5):343–51.
van der Veen J, Seys SF, Timmermans M, Levie P, Jorissen M, Fokkens WJ, et al. Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre. Allergy. 2017;72(2):282–90.
Alanin MC, Laidlaw T, Society TS, Hopkins C. The burden of non-steroidal anti-inflammatory exacerbated respiratory disease from the patient’s perspective - a qualitative analysis of posts from the Samter’s Society. Rhinology. 2020. https://doi.org/10.4193/Rhin19.430.
Gan EC, Thamboo A, Rudmik L, Hwang PH, Ferguson BJ, Javer AR. Medical management of allergic fungal rhinosinusitis following endoscopic sinus surgery: an evidence-based review and recommendations. Int Forum Allergy Rhinol. 2014;4(9):702–15.
Loftus CA, Soler ZM, Desiato VM, Koochakzadeh S, Yoo F, Storck KA, et al. Factors impacting revision surgery in patients with chronic rhinosinusitis with nasal polyposis. Int Forum Allergy Rhinol. 2020.
Smith TL, Litvack JR, Hwang PH, Loehrl TA, Mace JC, Fong KJ, et al. Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg. 2010;142(1):55–63.
White LC, Kazi AA, Jang DW, Gurrola J, Kountakis SE. The effect of smoking on quality of life following sinus surgery: 10-year follow-up. ORL J Otorhinolaryngol Relat Spec. 2015;77(1):39–43.
Hopkins C, Andrews P, Holy CE. Does time to endoscopic sinus surgery impact outcomes in chronic rhinosinusitis? Retrospective analysis using the UK clinical practice research data. Rhinology. 2015;53(1):18–24.
Benninger MS, Sindwani R, Holy CE, Hopkins C. Early versus delayed endoscopic sinus surgery in patients with chronic rhinosinusitis: impact on health care utilization. Otolaryngol Head Neck Surg. 2015;152(3):546–52.
Alt JA, Orlandi RR, Mace JC, Soler ZM, Smith TL. Does delaying endoscopic sinus surgery adversely impact quality-of-life outcomes? Laryngoscope. 2019;129(2):303–11.
Lal D, Golisch KB, Elwell ZA, Divekar RD, Rank MA, Chang Y-H. Gender-specific analysis of outcomes from endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(9):896–905.
Kohli P, Naik AN, Farhood Z, Ong AA, Nguyen SA, Soler ZM, et al. Olfactory outcomes after endoscopic sinus surgery for chronic rhinosinusitis: a meta-analysis. Otolaryngol Head Neck Surg. 2016;155(6):936–48.
Soler ZM, Smith TL, Alt JA, Ramakrishnan VR, Mace JC, Schlosser RJ. Olfactory-specific quality of life outcomes after endoscopic sinus surgery. Int Forum Allergy Rhinol. 2016;6(4):407–13.
Akiyama K, Samukawa Y, Hoshikawa H. Short-term outcomes of olfaction in patients with eosinophilic chronic rhinosinusitis after endoscopic sinus surgery and an assessment of prognostic factors. Int Forum Allergy Rhinol. 2020;10(2):208–216.
Bogdanov V, Walliczek-Dworschak U, Whitcroft KL, Landis BN, Hummel T. Response to glucocorticosteroids predicts olfactory outcome after ESS in chronic rhinosinusitis. Laryngoscope. 2019. https://doi.org/10.1002/lary.28233.
Smith KA, Orlandi RR, Oakley G, Meeks H, Curtin K, Alt JA. Long-term revision rates for endoscopic sinus surgery. Int Forum Allergy Rhinol. 2019;9(4):402–8.
Stein NR, Jafari A, DeConde AS. Revision rates and time to revision following endoscopic sinus surgery: a large database analysis. Laryngoscope. 2018;128(1):31–6.
Alsharif S, Jonstam K, van Zele T, Gevaert P, Holtappels G, Bachert C. Endoscopic sinus surgery for Type-2 CRS wNP: an endotype-based retrospective study. Laryngoscope. 2019;129(6):1286–92.
Bassiouni A, Wormald P-J. Role of frontal sinus surgery in nasal polyp recurrence. Laryngoscope. 2013;123(1):36–41.
Vashishta R, Soler ZM, Nguyen SA, Schlosser RJ. A systematic review and meta-analysis of asthma outcomes following endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2013;3(10):788–94.
Cao Y, Hong H, Sun Y, Lai Y, Xu R, Shi J, et al. The effects of endoscopic sinus surgery on pulmonary function in chronic rhinosinusitis patients with asthma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2019;276(5):1405–11.
Schlosser RJ, Smith TL, Mace J, Soler ZM. Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis. Allergy. 2017;72(3):483–91.
Benninger MS, Sindwani R, Holy CE, Hopkins C. Impact of medically recalcitrant chronic rhinosinusitis on incidence of asthma. Int Forum Allergy Rhinol. 2016;6(2):124–9.
Sahlstrand-Johnson P, Hopkins C, Ohlsson B, Ahlner-Elmqvist M. The effect of endoscopic sinus surgery on quality of life and absenteeism in patients with chronic rhinosinuitis - a multi-centre study. Rhinology. 2017;55(3):251–61.
Rudmik L, Smith TL, Schlosser RJ, Hwang PH, Mace JC, Soler ZM. Productivity costs in patients with refractory chronic rhinosinusitis. Laryngoscope. 2014;124(9):2007–12.
Smith KA, Smith TL, Mace JC, Rudmik L. Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4(10):823–7.
Rudmik L, Smith TL, Mace JC, Schlosser RJ, Hwang PH, Soler ZM. Productivity costs decrease after endoscopic sinus surgery for refractory chronic rhinosinusitis. Laryngoscope. 2016;126(3):570–4.
Chowdhury NI, Mace JC, Smith TL, Rudmik L. What drives productivity loss in chronic rhinosinusitis? A SNOT-22 subdomain analysis. Laryngoscope. 2018;128(1):23–30.
Alt JA, Ramakrishnan VR, Platt MP, Kohli P, Storck KA, Schlosser RJ, et al. Sleep quality outcomes after medical and surgical management of chronic rhinosinusitis. Int Forum Allergy Rhinol. 2017;7(2):113–8.
Rotenberg BW, Pang KP. The impact of sinus surgery on sleep outcomes. Int Forum Allergy Rhinol. 2015;5(4):329–32.
El Rassi E, Mace JC, Steele TO, Alt JA, Smith TL. Improvements in sleep-related symptoms after endoscopic sinus surgery in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(4):414–22.
Smith SS, Evans CT, Tan BK, Chandra RK, Smith SB, Kern RC. National burden of antibiotic use for adult rhinosinusitis. J Allergy Clin Immunol. 2013;132(5):1230–2.
Ramakrishnan VR, Mace JC, Soler ZM, Smith TL. Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS? Laryngoscope. 2019;129(3):558–66.
Smith TL, Kern RC, Palmer JN, Schlosser RJ, Chandra RK, Chiu AG, et al. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study. Int Forum Allergy Rhinol. 2011;1(4):235–41.
Purcell PL, Beck S, Davis GE. The impact of endoscopic sinus surgery on total direct healthcare costs among patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2015;5(6):498–505.
Krings JG, Kallogjeri D, Wineland A, Nepple KG, Piccirillo JF, Getz AE. Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. 2014;124(4):838–45.
Ramakrishnan VR, Kingdom TT, Nayak JV, Hwang PH, Orlandi RR. Nationwide incidence of major complications in endoscopic sinus surgery. Int Forum Allergy Rhinol. 2012;2(1):34–9.
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Alanin, M.C., Hopkins, C. Effect of Functional Endoscopic Sinus Surgery on Outcomes in Chronic Rhinosinusitis. Curr Allergy Asthma Rep 20, 27 (2020). https://doi.org/10.1007/s11882-020-00932-6
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DOI: https://doi.org/10.1007/s11882-020-00932-6