Predictive Factors for a Good Outcome Following Endoscopic Sinus Surgery

Abstract

The aim of this study was to establish if there are any symptoms which can predict increased patient satisfaction following Endoscopic Sinus Surgery (ESS) and whether these symptoms correlate with Lund-Mackay score on Computerised Tomography (CT). A prospective observational study was performed. Ninety-three consecutive patients who were offered ESS were recruited from an otolaryngology department in a UK Teaching Hospital. All patients had failed medical therapies for chronic rhinosinusitis (CRS), recurrent acute sinusitis and/or nasal polyposis. Patients were asked to complete a questionnaire pre-operatively and 12 months after surgery. Symptoms were assessed using a visual analogue scale. Endoscopic examination of the nose was performed pre and post-operatively. Lund-Mackay score was recorded for the pre-operative CT scan. Results were analysed using linear regression analysis and Pearson correlation coefficient. All symptoms improved after ESS (P < 0.001). However, a high pre-operative score for nasal discharge and olfactory disturbance were predictive of lesser improvement in symptom scoring (P < 0.001). Patients undergoing polypectomy with ESS demonstrated greater improvement in symptom score than those undergoing ESS with septoplasty or turbinate reduction surgery. There was no correlation between symptom score improvement and pre-operative Lund-Mackay score (r = 0.09). Patients who have high pre-operative symptom scores for nasal discharge and olfactory disturbance may gain less benefit from ESS, whilst those with nasal polyposis appear to perceive the greatest benefit. Increasing pre-operative Lund-Mackay score is not a predictor of a favourable operative outcome.

Preoperative Lund‐Mackay computed tomography score is associated with preoperative symptom severity and predicts quality‐of‐life outcome trajectories after sinus surgery

“…CRS is a debilitating disease and its diagnosis is based on subjective and objective criteria. To date, studies are mixed regarding the correlation between inflammation, as seen on CT, and CRS symptoms . In this study we found evidence for an association between LMCTS and pre‐ and postoperative sinonasal quality of life, as measured by the SNOT‐22.…”

“…Several studies have concluded that there is little concordance between CT and total symptom–based scores, which implies that increased mucosal inflammation does not correlate with increased symptom severity. However, some of these same studies, as well as others, have shown significant correlation between CT scores and specific symptoms .…”

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“…The two constructs (rhinologic, ear & facial domains) address symptoms and two others (sleep and psychological domains) address aspects of health related quality of life. The above 2 studies show effectiveness of FESS in CRS patients and the efficacy of FESS has been established by many other studies with large no of patients [10]. Other studies by Net kovski et al (2006) [13], Chopra H. et al (2006) [14], Venkatraman V et al (2013) [15] revealed significant symptomatic improvement after FESS and its efficacy in CRS patients.…”

Subjective and Objective Outcome Evaluation of FESS with and without Mitomycin C: A Randomized Control Trial

“…A study by Murthy P.et al (2013) [10] showed the symptoms of facial pain, headache, nasal obstruction, nasal discharge, smell disturbance and overall discomfort improved with statistical significance (p<0.001) but most improved were nasal obstruction and facial pain. National audit of sinus surgery's report was published by the Royal College of Surgeons of England, which reported rates of improvement in nasal obstruction of 84% and pain in 75%.…”