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OR I G I NAL ART I CLE

Investigation of change in cardinal symptoms of chronic rhinosinusitis a er

surgical or ongoing medical management

Adam S. DeConde, MD

, Jess C. Mace, MPH, CCRP

, Jeremiah A. Alt, MD, PhD

Zachary M. Soler, MD, MSc

, Richard R. Orlandi, MD

and Timothy L. Smith, MD, MPH

Background:

Chronic rhinosinusitis (CRS) has been de-

fined as inflammation of the paranasal sinuses lasting at

least 12 weeks with corresponding 2 or more “cardinal symp-

toms” that include: (1) nasal obstruction; (2) thick nasal dis-

charge; (3) facial pain/pressure; and (4) reduction or loss

of sense of smell. Although prior studies have investigated

symptoms of CRS a er sinus surgery, none have compared

the outcomes of these specific symptoms to ongoing med-

ical therapy.

Methods:

Patients with CRS were prospectively enrolled

into a multi-institutional, comparative effectiveness, cohort

study. Subjects elected either continued medical manage-

ment or endoscopic sinus surgery (ESS). Baseline char-

acteristics and objective clinical findings were collected.

Cardinal symptoms of CRS were operationalized by 4 ques-

tions on the 22-item Sino-Nasal Outcome Test (SNOT-22).

Symptom improvement was evaluated in subjects with at

least 6-month follow-up.

Results:

A total of 342 subjects were enrolled, with 69

(20.2%) electing continued medical management, whereas

273 (79.8%) elected ESS. Subjects electing surgical ther-

apy were more likely to have a higher baseline aggregate

SNOT-22 score (44.3 (18.9) vs 53.6 (18.8);

0.001). All

subjects improved across all cardinal symptoms; however,

subjects undergoing ESS were significantly more likely (

0.013) to experience improvement in thick nasal discharge

(odds ratio [OR]

4.36), facial pain/pressure (OR

3.56),

and blockage/congestion of nose (OR

2.76). Subjects with

nasal polyposis were significantly more likely to report com-

plete resolution of smell/taste following ESS compare to

medical management (23.8% vs 4.0%;

0.026).

Conclusion:

Across a large population, surgical manage-

ment is more effective at resolving the cardinal symptoms

of CRS than ongoing medical management with the excep-

tion of sense of smell/taste.

2014 ARS-AAOA, LLC.

Key Words:

Sinusitis; diagnosis; quality of life; endoscopy; therapy

How to Cite this Article

DeConde AS, Mace JC, Alt JA, Soler ZM, Orlandi RR,

Smith TL. Investigation of change in cardinal symptoms

of chronic rhinosinusitis a er surgical or ongoing medical

management.

Int Forum Allergy Rhinol.

2015;5:36–45.

Department of Surgery, Division of Otolaryngology–Head and Neck

Surgery, University of California San Diego, San Diego, CA;

Department of Otolaryngology–Head and Neck Surgery, Division of

Rhinology, Oregon Health and Science University, Portland, OR;

Division of Head and Neck Surgery, Rhinology–Sinus and Skull Base

Surgery Program, Department of Surgery, University of Utah, Salt Lake

City, UT;

Department of Otolaryngology–Head and Neck Surgery,

Division of Rhinology and Sinus Surgery, Medical University of South

Carolina, Charleston, SC

Correspondence to: Timothy L. Smith, MD, MPH, Oregon Health and

Science University, Department of Otolaryngology–Head and Neck Surgery,

Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center,

3181 SW Sam Jackson Park Road, PV-01, Portland, OR 97239; e-mail:

smithtim@ohsu.edu

Funding sources for the study: National Institutes of Health (National

Institute on Deafness and Other Communication Disorders [NIDCD] R01

DC005805 to T.L.S.)

Potential conflict of interest: T.L.S., J.C.M., and Z.M.S. are supported by a

grant from the National Institutes of Health (National Institute on Deafness

hronic rhinosinusitis (CRS) is defined in the 2007

Adult Sinusitis Clinical Practice Guidelines

and the

2012 European Position Paper on Rhinosinusitis

as in-

flammation of the nose and paranasal sinuses manifesting

with 2 or more “cardinal” symptoms for 12 weeks with

and Other Communication Disorders [NIDCD] R01 DC005805 to T.L.S.).

T.L.S. is also a consultant for IntersectENT, Inc (Menlo Park, CA), which is not

affiliated with this investigation. R.R.O. is a consultant for Medtronic ENT

(Jacksonville, FL), which is not affiliated with this research.

Submitted for oral presentation to the American Rhinologic Society (ARS) at

the Annual American Academy of Otolaryngology–Head and Neck Surgery

(AAO-HNS) meeting on September 20, 2014, Orlando, FL (Abstract

submission #718).

Public clinical trial registration:

http://clinicaltrials.gov/show/NCT01332136.

Determinants of Medical and Surgical Treatment Outcomes in Chronic

Sinusitis.

Received: 22 May 2014; Revised: 24 July 2014; Accepted: 5 August 2014

DOI: 10.1002/alr.21410

View this article online at

wileyonlinelibrary.com.

International Forum of Allergy & Rhinology, Vol. 5, No. 1, January 2015

Reprinted by permission of Int Forum Allergy Rhinol. 2015; 5(1):36-45.