European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 2, pp 795–802 | Cite as

Quality of life before and after sinonasal surgery: a population-based matched cohort study

  • Antti I. AlakärppäEmail author
  • Timo J. Koskenkorva
  • Petri T. Koivunen
  • Olli-Pekka Alho


A population-based matched cohort study was conducted to explore how the quality of life (QoL) changes in patients with septal deviation or recurrent/chronic rhinosinusitis after septoplasty (SP) and endoscopic sinus surgery (ESS). We also compared the QoL of the surgical cohort with that of a concurrently collected healthy cohort. We collected data on QoL in a population-based surgical cohort of 160 patients residing in one health care district (population 405,000) in Northern Finland, and in a control cohort comprised of 206 age- and sex-matched randomly selected subjects residing in Finland (population 5,470,000). QoL was assessed at entry and 12 months later with the Sino-Nasal Outcome Test-22 (SNOT-22) and the RAND-36 generic instruments. Seventy-six SP and 84 ESS patients and 206 controls were enrolled. At entry, the mean SNOT-22 scores of the SP and ESS groups were similar (34.9 and 35.1, respectively) and both were significantly worse than the control group (17.7). At 12 months, the mean SNOT-22 score had improved after SP [change 15.7, 95 % confidence interval (CI) 11.4–19.9] and ESS (change 18.0, 95 % CI 12.4–20.9) and almost reached that of the control group, which remained unchanged. The benefit was similar regardless of the surgical indication. At 12 months, mean RAND-36 scores had improved in most domains in both patient groups and remained unchanged in the controls. After appropriate surgical criteria, both SP and ESS are effective in enhancing QoL on the population level, and postoperative QoL almost reaches the level of the control population.


Cohort studies Paranasal sinuses Quality of life Sinusitis Nasal surgical procedures Nasal septum 


Compliance with ethical standards

Conflict of interest

All of the authors declare no conflict of interest.

No external funding. All the procedures in this study were in accordance with regional ethics committee: The Northern Ostrobothnia Hospital District’s ethical committee approved the study protocol; register code 10/2010. Informed consent was obtained from all participants of the study.

Supplementary material

405_2016_4272_MOESM1_ESM.pdf (103 kb)
Supplementary material 1 (PDF 103 kb)


  1. 1.
    Cullen KA, Hall MJ, Golosinskiy A (2009) Ambulatory surgery in the United States, 2006. Natl Health Stat Rep 11:1–25Google Scholar
  2. 2.
    Alakarppa A, Alho OP (2012) Patient-recorded outcomes and quality of life in evidence-based medicine databases on most common ear, throat and nose procedures: a systematic review. Clin Otolaryngol 37(6):436–445. doi: 10.1111/coa.12048 CrossRefPubMedGoogle Scholar
  3. 3.
    Fitzpatrick R, Davey C, Buxton MJ et al (1998) Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 2(14):i–iv, 1–74Google Scholar
  4. 4.
    Gliklich RE, Metson R (1997) Effect of sinus surgery on quality of life. Otolaryngol Head Neck Surg 117(1):12–17 (pii: S0194599897001630) CrossRefPubMedGoogle Scholar
  5. 5.
    Hopkins C, Slack R, Lund V et al (2009) Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope 119(12):2459–2465. doi: 10.1002/lary.20653 CrossRefPubMedGoogle Scholar
  6. 6.
    Smith TL, Litvack JR, Hwang PH et al (2010) Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg 142(1):55–63. doi: 10.1016/j.otohns.2009.10.009 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Arunachalam PS, Kitcher E, Gray J et al (2001) Nasal septal surgery: evaluation of symptomatic and general health outcomes. Clin Otolaryngol Allied Sci 26(5):367–370 (pii: 481) CrossRefPubMedGoogle Scholar
  8. 8.
    Hytonen ML, Lilja M, Makitie AA et al (2012) Does septoplasty enhance the quality of life in patients? Eur Arch Otorhinolaryngol 269(12):2497–2503. doi: 10.1007/s00405-012-1931-9 CrossRefPubMedGoogle Scholar
  9. 9.
    Soler ZM, Smith TL (2010) Quality of life outcomes after functional endoscopic sinus surgery. Otolaryngol Clin North Am 43(3):605–612. doi: 10.1016/j.otc.2010.03.001 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Rudmik L, Mace J, Soler ZM et al (2014) Long-term utility outcomes in patients undergoing endoscopic sinus surgery. Laryngoscope 124(1):19–23. doi: 10.1002/lary.24135 CrossRefPubMedGoogle Scholar
  11. 11.
    Djukic V, Dudvarski Z, Arsovic N et al (2015) Clinical outcomes and quality of life in patients with nasal polyposis after functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol 272(1):83–89. doi: 10.1007/s00405-014-3054-y CrossRefPubMedGoogle Scholar
  12. 12.
    Sahlstrand-Johnson P, Ohlsson B, Von Buchwald C et al (2011) A multi-centre study on quality of life and absenteeism in patients with CRS referred for endoscopic surgery. Rhinology 49(4):420–428. doi: 10.4193/Rhino11.101 PubMedGoogle Scholar
  13. 13.
    Remenschneider AK, D’Amico L, Litvack JR et al (2014) Long-term outcomes in sinus surgery: a new tool for measuring health-related quality of life. Otolaryngol Head Neck Surg 151(1):164–170 (pii: 0194599814529536) CrossRefPubMedGoogle Scholar
  14. 14.
    Katotomichelakis M, Simopoulos E, Tripsianis G et al (2014) Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery. Eur Arch Otorhinolaryngol 271(4):733–741. doi: 10.1007/s00405-013-2626-6 CrossRefPubMedGoogle Scholar
  15. 15.
    Naraghi M, Amirzargar B, Meysamie A (2012) Quality of life comparison in common rhinologic surgeries. Allergy Rhinol (Providence) 3(1):e1–e7. doi: 10.2500/ar.2012.3.0020 CrossRefGoogle Scholar
  16. 16.
    Official Statistics of Finland (OSF) (2014) Population structure [e-publication]. ISSN = 1797-5395. Statistics Finland, Helsinki. Accessed 28 Jan 2016Google Scholar
  17. 17.
    Fokkens WJ, Lund VJ, Mullol J et al (2012) European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl 23:3 (preceding table of contents, 1–298) Google Scholar
  18. 18.
    Blomgren K, Alho OP, Ertama L et al (2005) Acute sinusitis: Finnish clinical practice guidelines. Scand J Infect Dis 37(4):245–250PubMedGoogle Scholar
  19. 19.
    Stammberger H, Posawetz W (1990) Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 247(2):63–76CrossRefPubMedGoogle Scholar
  20. 20.
    Piccirillo JF, Edwards D, Haiduk A, Yonan C, Thawley SE (1995) Psychometric and clinimetric validity of the 31-item rhinosinusitis outcome measure (RSOM-31). Am J Rhinol 6:297–306CrossRefGoogle Scholar
  21. 21.
    Piccirillo JF, Merritt MG Jr, Richards ML (2002) Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg 126(1):41–47CrossRefPubMedGoogle Scholar
  22. 22.
    Morley AD, Sharp HR (2006) A review of sinonasal outcome scoring systems—which is best? Clin Otolaryngol 31(2):103–109. doi: 10.1111/j.1749-4486.2006.01155.x CrossRefPubMedGoogle Scholar
  23. 23.
    Dietz de Loos DA, Segboer CL, Gevorgyan A et al (2013) Disease-specific quality-of-life questionnaires in rhinitis and rhinosinusitis: review and evaluation. Curr Allergy Asthma Rep 13(2):162–170. doi: 10.1007/s11882-012-0334-8 CrossRefPubMedGoogle Scholar
  24. 24.
    Hopkins C, Gillett S, Slack R et al (2009) Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 34(5):447–454. doi: 10.1111/j.1749-4486.2009.01995.x CrossRefPubMedGoogle Scholar
  25. 25.
    Buckland JR, Thomas S, Harries PG (2003) Can the Sino-nasal Outcome Test (SNOT-22) be used as a reliable outcome measure for successful septal surgery? Clin Otolaryngol Allied Sci 28(1):43–47 (pii: 663) CrossRefPubMedGoogle Scholar
  26. 26.
    Poirrier AL, Ahluwalia S, Goodson A et al (2013) Is the Sino-Nasal Outcome Test-22 a suitable evaluation for septorhinoplasty? Laryngoscope 123(1):76–81. doi: 10.1002/lary.23615 CrossRefPubMedGoogle Scholar
  27. 27.
    Hays RD, Sherbourne CD, Mazel RM (1993) The RAND 36-item health survey 1.0. Health Econ 2(3):217–227CrossRefPubMedGoogle Scholar
  28. 28.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483CrossRefPubMedGoogle Scholar
  29. 29.
    Aalto A, Aro S, Ohimaa AR et al (1999) RAND-36 as a measure of health-related quality of life. Reliability, construct validity and reference values in the Finnish general population (in Finnish). Helsinki, Stakes, Research reports 101Google Scholar
  30. 30.
    Rudmik L, Soler ZM, Mace JC et al (2014) Using preoperative SNOT-22 score to inform patient decision for Endoscopic sinus surgery. Laryngoscope. doi: 10.1002/lary.25108 Google Scholar
  31. 31.
    Konstantinidis I, Triaridis S, Triaridis A et al (2005) Long term results following nasal septal surgery. Focus on patients’ satisfaction. Auris Nasus Larynx 32(4):369–374 (pii: S0385-8146(05)00087-8) CrossRefPubMedGoogle Scholar
  32. 32.
    Bliven BD, Kaufman SE, Spertus JA (2001) Electronic collection of health-related quality of life data: validity, time benefits, and patient preference. Qual Life Res 10(1):15–22CrossRefPubMedGoogle Scholar
  33. 33.
    Gwaltney CJ, Shields AL, Shiffman S (2008) Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: a meta-analytic review. Value Health 11(2):322–333CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology and Head and Neck SurgeryOulu University HospitalOuluFinland
  2. 2.PEDEGO Research UnitUniversity of OuluOuluFinland
  3. 3.Medical Research Center OuluOuluFinland

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