Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre

Abstract

RationaleThe European Position Paper on Sinusitis (EPOS) guidelines provide composite criteria to evaluate chronic rhinosinusitis (CRS) control, taking into consideration the severity of patients’ symptoms, aspect of nasal mucosa and medical intake as parameters of CRS control.ObjectivesTo study the degree of CRS control using novel EPOS control criteria at 3–5 years after a functional endoscopic sinus surgery (FESS) and correlate these data to symptoms scores.MethodsAdult CRS patients (n = 560) who had undergone bilateral FESS for chronic inflammatory sinonasal disease 3–5 years prior to the study were included. Patients received a postal questionnaire asking for control items according to EPOS control criteria, visual analogue scale (VAS) scores for total and individual sinonasal symptoms, sinonasal outcome test (SNOT)‐22 and Short Form (SF)‐36 questionnaires.Measurements and main resultsAbout 19.5% of CRS patients were well controlled, with 36.8% of patients being partly controlled and 43.7% uncontrolled. The levels of control corresponded to mean total VAS, SNOT‐22 and SF‐36 scores. Subgroup analysis revealed that female gender, aspirin intolerance and revision FESS were associated with higher prevalence of uncontrolled CRS, whereas allergy, asthma and smoking status did not alter the percentage of patients in each category of control. In 81 patients attending the outpatient clinic, nasal endoscopy changed classification in only four patients (4.9%).ConclusionsBased on the novel EPOS control criteria, at least 40% of CRS patients are uncontrolled at 3–5 years after FESS. Therefore, better treatment strategies leading to higher disease control are warranted in CRS care.

Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis – A EUFOREA‐ARIA‐EPOS‐AIRWAYS ICP statement

“…17 Surgery is considered if prolonged medical treatment fails, but up to 40% of patients remain symptomatic despite sinus surgery. 21 Medical treatment for any condition aims at controlling the disease including clinically significant symptom reduction with improvement of quality of life and reduction of socio-economic impact of the disorder. In contrast to other diseases like asthma 22 and despite the high prevalence of AR and CRS, 23,24 the concept of control of disease has only recently been introduced in AR 10,25 and CRS.…”

Visual analogue scale for sino-nasal symptoms severity correlates with sino-nasal outcome test 22: paving the way for a simple outcome tool of CRS burden

“…As this was a postal questionnaire survey, applying the current EPOS criteria for defining the level of control was not feasible [1]. Utilization of specific VAS–TNSS cut-offs for level of control assessment was based on a previous real-life study, where VAS scores of CRS symptoms were compared for different levels of control according to EPOS criteria in 389 patients [15]. Recently, the same cut-off points were used in mySinusitisCoach, an app for patients with CRS developed by medical experts in the field, to assess the level of disease control [23].…”

“…In research, VAS for TNSS and individual symptoms are frequently incorporated into studies as an instrument for estimating symptoms severity and burden of disease [15]. In contrast to allergy, correlations between VAS scores with more complex instruments assessing disease-specific burden like SNOT-22 in CRS are scarce [16, 17].…”

Endotype-driven treatment in chronic upper airway diseases

“…The reasons for an uncontrolled disease are related to disorder-, diagnosis-, treatment- or patient-associated factors. The relative importance of these factors is unclear, specialists agree that optimal disease management approaches are needed [5–7]. …”