Sinonasal Symptoms and Self-Reported Health before and after Endoscopic Pituitary Surgery—A Prospective Study

Abstract

Objectives Despite the limited invasiveness of endoscopic transsphenoidal surgery (ETSS), some degree of nasal structure destruction is unavoidable. Our objective was to evaluate sinonasal morbidity and self-reported health before and 6 months after ETSS for pituitary tumors, and to identify possible predictive factors for deterioration in sinonasal health. Design Prospective observational cohort study. Setting University tertiary referral hospital. Participants Totally 109 consecutive adult patients undergoing ETSS for pituitary tumors between 2015 and 2019. Main Outcome Measures Sinonasal symptoms and self-reported health before and 6 months after ETSS, assessed by the Sinonasal Outcome Test (SNOT-22) and the EQ-5D questionnaire. Predictive factors for postoperative deterioration in sinonasal symptoms. Results The overall SNOT-22 score did not change, but the score of the rhinologic domain of SNOT-22 worsened from 6.0 ± 5.9 before to 8.0 ± 7.4 6 months after surgery (p = 0.011). The EQ-5D visual analog scale improved from 64.0 ± 22.9 before to 71.1 ± 18.7 6 months after surgery (p = 0.00088). Univariate and multivariable regression analyses showed that prior sinonasal surgery was associated with a significant worsening in rhinologic symptoms 6 months after surgery (p = 0.046 and p = 0.020, respectively). Conclusions Although self-reported overall health improved, significant deterioration of rhinologic symptoms was seen 6 months after ETSS. This information is important for preoperative patient counselling. Further refinement of the surgical technique and follow-up strategies to reduce postoperative sinonasal morbidity could be of value, especially in patients who have undergone prior sinonasal surgery.

The influence of radiological tumor growth pattern on sino‑nasal health in pituitary adenomas

“…Moreover, negative effects of extended surgical intervention on SNH have already been reported for the Hadad septal flap ( 19 ). In addition, Hallén et al and Chmielewski et al reported that previous nasal surgery might be a risk factor for decreased SNH after endoscopic pituitary adenomectomy ( 20 , 21 ) underlining the role of unaffected mucosa for SNH.…”

Exploring the influence of nasal morbidity on quality of life following endoscopic endonasal skull base surgery: a retrospective cohort study of 95 patients

“…Embase and MEDLINE databases were interrogated with the search phrase [(“endoscopic endonasal” OR “endoscopic transsphenoidal”) AND (“nasal morbidity” OR “sino-nasal outcome” OR “sino-nasal outcome test 22”)]. 12 contemporary papers were identified [ 3 , 5 , 8 , 9 , 14 – 21 ]. Scagnelli et al demonstrated that overall SNOT-22 scores followed the expected rise and fall pattern after endoscopic transsphenoidal surgery.…”

Headache in patients with non-functioning pituitary adenoma before and after transsphenoidal surgery – a prospective study

“…Each patient graded their perceived health status before and at 12-months after TSS on a 101-point scale (0 = "the worst health you can imagine"; 100 = "the best health you can imagine"). The EQ-5D is commonly used by clinical researchers to evaluate QoL [24] and treatment effects, including those in patients with pituitary tumors [25,26] and headache [27,28].…”