Impact of endoscopic sinus surgery on otologic symptoms associated with chronic rhinosinusitis

Abstract

ObjectiveTo evaluate improvements in otologic symptoms after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS), and identify differences in symptoms, if any, between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyposis.Material and methodsThis is a prospective multi-center observational cohort study. Adults with medically recalcitrant CRS who elected ESS were enrolled in a prospective, multi-center, observational cohort study between March, 2011 and October, 2014. Preoperative evaluation of subjects included assessment of clinical characteristics, measures of disease severity, and quality of life evaluation using the 22-item SinoNasal Outcome Test (SNOT-22). Postoperative improvement in otologic symptoms (ear fullness, dizziness, ear pain) scores were evaluated and compared between CRSwNP and CRSsNP subgroups.ResultsThree hundred and ninety-five study patients completed both preoperative and postoperative evaluations, with an average follow-up of 13.9 months after ESS. The prevalence of patients reporting at least one otologic symptom preoperatively (87%) significantly decreased after ESS (63%, P < 0.001). Significant postoperative improvement across all otologic scores was also reported (P < 0.001). Relative mean improvement in otologic symptom severity was similar for both CRSwNP and CRSsNP, except patients with CRSwNP reported significantly greater postoperative improvement in ear fullness compared to CRSsNP (54% vs. 41%, P = 0.039). A total of 61%, 44%, and 43% of patients reported experiencing improvement in “ear fullness”, “dizziness” and “ear pain”, respectively.ConclusionSinus surgery significantly improves otologic symptoms associated with CRS. CRSwNP patients reported slightly greater relief of ear fullness than CRSsNP patients following ESS.

Systematic literature review of humanistic and economic burdens of chronic rhinosinusitis with nasal polyposis

“…Five RCTs [14][15][16][17][18] and 25 RWE studies 65 reported mean baseline SNOT-22 scores in the moderate range. Five RCTs [19][20][21][22][23] and 17 RWE studies [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] reported severe mean baseline SNOT-22 scores. These findings were consistent with the treatment plan for CRSwNP provided by Fokkens et al 92 , which recommended surgery as treatment for patients with more severe symptoms or with polyps that are recalcitrant to medical management.…”

Clinical outcomes of Eustachian tube dysfunction in chronic rhinosinusitis following endoscopic sinus surgery

“…Previous studies reported deterioration of otologic symptoms in 2.9%-12% of patients. 6,8,9 In this cohort, we found that 5.4% (5/92) of patients reported worse ETD symptoms compared with their preoperative status, perhaps due to chronic sinonasal inflammation. In this study, at 1 Patients who received revision surgery had higher ETDQ-7 scores during the follow-up period.…”

“…Previous studies using the otologic subdomain of the 22-item Sino-Nasal Outcome Test (SNOT-22) to evaluate ETD symptoms after ESS found significant improvement in symptom scores. 8,9 However, these surveys used questionnaires that were not validated specifically for ETD-associated symptoms.…”

Eustachian tube dysfunction (ETD) in chronic rhinosinusitis with comparison to primary ETD: A systematic review and meta‐analysis

“…Following PRISMA guidelines (Figure 1), 16 studies met criteria for inclusion. There were nine prospective studies (three case‐control, six cohort studies) encompassing 1336 patients with CRS and patients with CRS and ETD (CRS+ETD) 1,8–15 . There were seven studies (one RCT, four prospective case series, and two retrospective case series) including 161 patients with primary ETD 3,16–19 2122.…”

“…Two studies in this analysis included patients that has previously undergone ESS. A comparison of ETD outcomes after primary ESS or revision ESS found that ESS led to improvements in ETD symptoms in both cohorts 12,13 . Higgins et al 1 .…”