Medical therapy vs surgery for chronic rhinosinusitis

A prospective, multi-institutional study

Timothy L. Smith, Robert C. Kern, James N. Palmer, Rodney J. Schlosser, Rakesh K. Chandra, Alexander G Chiu, David Conley, Jess C. Mace, Rongwei F. Fu, James A. Stankiewicz

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background: Evidence evaluating the comparative effectiveness of various treatments for chronic rhinosinusitis (CRS) is insufficient. This study evaluates outcomes in patients who failed initial medical management and elect a subsequent treatment option, either continued medical management or endoscopic sinus surgery (ESS) coupled with continued medical management. Methods: Adult subjects were prospectively enrolled into a nonrandomized, multi-institutional cohort. Baseline characteristics and objective clinical findings were collected. Primary outcome measures included 2 disease-specific quality-of-life (QOL) instruments: the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS). Bivariate and multivariate analyses compared QOL improvement by treatment type, as well as differences in antibiotic and oral steroid utilization and work/school productivity. Results: Subjects (n = 180) were enrolled between March 2009 and April 2010. Patients electing medical management (n = 55) reported significantly better baseline QOL on 1 instrument relative to surgery patients (CSS symptom [p = 0.019] and total scores [p = 0.010]). Surgical patients (n = 75) reported significantly more improvement than medically managed patients (RSDI, p = 0.015; CSS, p < 0.001). Surgical patients reported significantly fewer oral antibiotics (p = 0.002), oral steroids (p = 0.042), and missed days of work/school (p < 0.001) following ESS. After adjustment, more frequent improvement was found within the surgical cohort as measured by the RSDI physical (78.7% vs 56.4%; odds ratio [OR], 3.36; 95% confidence interval [CI], 1.15-9.87; p = 0.027), CSS symptom (80.6% vs 57.4%; OR, 2.65; 95% CI, 1.06-6.66; p = 0.038), medication (49.3% vs 29.6%; OR, 2.33; 95% CI, 0.96-5.64; p = 0.060), and total scores (76.4% vs 53.7%; OR, 2.20; 95% CI, 0.86-5.59; p = 0.099). Conclusion: Patients electing ESS experienced significantly higher levels of improvement in several outcomes. Further investigation with a larger cohort is warranted as treatment selection bias may confound the magnitude of improvement experienced with each treatment.

Original languageEnglish (US)
Pages (from-to)235-241
Number of pages7
JournalInternational Forum of Allergy and Rhinology
Volume1
Issue number4
DOIs
StatePublished - Jul 2011

Fingerprint

Sinusitis
Odds Ratio
Confidence Intervals
Quality of Life
Therapeutics
Steroids
Outcome Assessment (Health Care)
Anti-Bacterial Agents
Selection Bias
Quality Improvement
Multivariate Analysis
Surveys and Questionnaires

Keywords

  • Assessment
  • Endoscopy
  • Outcomes
  • Sinusitis
  • Surgery
  • Therapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology
  • Medicine(all)

Cite this

Smith, T. L., Kern, R. C., Palmer, J. N., Schlosser, R. J., Chandra, R. K., Chiu, A. G., ... Stankiewicz, J. A. (2011). Medical therapy vs surgery for chronic rhinosinusitis: A prospective, multi-institutional study. International Forum of Allergy and Rhinology, 1(4), 235-241. https://doi.org/10.1002/alr.20063

Medical therapy vs surgery for chronic rhinosinusitis : A prospective, multi-institutional study. / Smith, Timothy L.; Kern, Robert C.; Palmer, James N.; Schlosser, Rodney J.; Chandra, Rakesh K.; Chiu, Alexander G; Conley, David; Mace, Jess C.; Fu, Rongwei F.; Stankiewicz, James A.

In: International Forum of Allergy and Rhinology, Vol. 1, No. 4, 07.2011, p. 235-241.

Research output: Contribution to journalArticle

Smith, TL, Kern, RC, Palmer, JN, Schlosser, RJ, Chandra, RK, Chiu, AG, Conley, D, Mace, JC, Fu, RF & Stankiewicz, JA 2011, 'Medical therapy vs surgery for chronic rhinosinusitis: A prospective, multi-institutional study', International Forum of Allergy and Rhinology, vol. 1, no. 4, pp. 235-241. https://doi.org/10.1002/alr.20063
Smith, Timothy L. ; Kern, Robert C. ; Palmer, James N. ; Schlosser, Rodney J. ; Chandra, Rakesh K. ; Chiu, Alexander G ; Conley, David ; Mace, Jess C. ; Fu, Rongwei F. ; Stankiewicz, James A. / Medical therapy vs surgery for chronic rhinosinusitis : A prospective, multi-institutional study. In: International Forum of Allergy and Rhinology. 2011 ; Vol. 1, No. 4. pp. 235-241.
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