119 / 236
Cardinal symptom improvement in CRS treatment
TABLE 4.
Improvement in mean cardinal symptom scores over time
*
Cardinal symptoms
Baseline
Follow-up
Improvement
p
Total cohort (n
=
342)
“Thick nasal discharge”
3.0 (1.5)
1.6 (1.5)
−
1.4 (1.7)
<
0.001
“Facial pain/pressure”
2.6 (1.5)
1.3 (1.4)
−
1.3 (1.5)
<
0.001
“Sense of smell/taste”
2.8 (1.8)
1.9 (1.7)
−
1.0 (1.8)
<
0.001
“Blockage/congestion of nose”
3.5 (1.4)
1.8 (1.5)
−
1.7 (1.9)
<
0.001
Medical management (n
=
69)
“Thick nasal discharge”
2.9 (1.5)
2.2 (1.6)
−
0.6 (1.4)
0.001
“Facial pain/pressure”
2.3 (1.7)
1.8 (1.7)
−
0.5 (1.2)
0.002
“Sense of smell/taste”
2.8 (1.8)
2.3 (1.9)
−
0.5 (1.9)
0.044
“Blockage/congestion of nose”
3.2 (1.5)
2.6 (1.6)
−
0.6 (1.8)
0.009
Endoscopic sinus surgery (n
=
273)
“Thick nasal discharge”
3.0 (1.4)
1.5 (1.5)
−
1.6 (1.7)
<
0.001
“Facial pain/pressure”
2.7 (1.5)
1.2 (1.4)
−
1.5 (1.5)
<
0.001
“Sense of smell/taste”
2.9 (1.8)
1.8 (1.7)
−
1.1 (1.8)
<
0.001
“Blockage/congestion of nose”
3.6 (1.3)
1.6 (1.4)
−
2.0 (1.7)
<
0.001
*Values are mean (SD).
SD
=
standard deviation.
TABLE 5.
Comparison of average and relative score improvement between treatment modalities
Medical management (n
=
69)
Endoscopic sinus surgery (n
=
273)
Cardinal symptoms
Improvement mean (SD)
Relative improvement (%)
Improvement mean (SD)
Relative improvement (%)
p
“Thick nasal discharge”
−
0.6 (1.4)
24.1
−
1.6 (1.7)
50.0
<
0.001
“Facial pain/pressure”
−
0.5 (1.2)
21.7
−
1.5 (1.5)
55.6
<
0.001
“Sense of smell/taste”
−
0.5 (1.9)
17.9
−
1.1 (1.8)
37.9
0.007
“Blockage/congestion of nose”
−
0.6 (1.8)
18.8
−
2.0 (1.7)
55.6
<
0.001
SD
=
standard deviation.
standard of complete resolution of symptoms, although an
extremely high standard, carries no ambiguity, and allows
for determination of OR between treatment modalities
(Table 7). These ORs are easily articulated to patients
and help translate CRS outcomes research to clinical care
when counseling patients with CRS. An important caveat
to these ORs is that they were derived from a sampling of
patients spanning several academic referral centers and care
should be taken when applying these findings to individual
patients. Furthermore, our regression models were built to
isolate the impact of treatment modality on outcomes, not
to identify other clinical factors which could potentially
skew the probability of success for an individual.
The present study represents the largest prospective co-
hort study to investigate the impact of different therapies
on the cardinal symptoms of CRS. The current available
literature investigating individual symptom scores is dom-
inated by smaller cohort studies at single institutions. A
meta-analysis of these prior studies demonstrated that ESS
successfully improves all cardinal symptoms.
8
Interestingly,
patient-reported olfactory dysfunction improved less than
the other cardinal symptoms. The shortcomings of available
interventions for olfaction may result from an irreversible
olfactory neuron end-organ damage that has been described
in the presence of long-standing inflammation.
18
Recover-
ing durable olfactory function may require more than just
control of inflammation in patients with impaired olfac-
tion using available treatment modalities. The focus of this
study was to investigate patient-based clinical responses to
different treatment modalities because quantifiable, objec-
tive measures of olfaction are cost prohibitive and rarely
employed in standard clinical practice for this patient pop-
ulation. Additionally, subjectively measured olfaction cor-
relates only weakly with objective measures of olfaction
International Forum of Allergy & Rhinology, Vol. 5, No. 1, January 2015
97