122 / 236
DeConde et al.
TABLE 6.
Comparison of complete symptom resolution frequency between treatment modalities
*
Medical management
Endoscopic sinus surgery
p
Total cohort
“Thick nasal discharge” (n
=
324)
8 (12.1)
89 (34.5)
<
0.001
“Facial pain/pressure” (n
=
292)
8 (15.7)
92 (38.2)
0.002
“Sense of smell/taste” (n
=
305)
12 (20.0)
66 (26.9)
0.270
“Blockage/congestion of nose” (n
=
333)
8 (11.8)
71 (26.8)
0.009
CRSwNP
“Thick nasal discharge”
3 (11.5)
35 (34.3)
0.029
“Facial pain/pressure”
2 (6.9)
41 (47.1)
0.004
“Sense of smell/taste”
1 (4.0)
24 (23.8)
0.026
“Blockage/congestion of nose”
3 (11.1)
33 (32.0)
0.032
CRSsNP
“Thick nasal discharge”
5 (12.5)
54 (34.6)
0.006
“Facial pain/pressure”
6 (18.8)
51 (33.1)
0.109
“Sense of smell/taste”
11 (31.4)
42 (29.2)
0.793
“Blockage/congestion of nose”
5 (12.2)
38 (23.5)
0.137
*Values are n (%).
CRSsNP
=
chronic rhinosinusitis without nasal polyposis; CRSwNP
=
chronic rhinosinusitis with nasal polyposis.
TABLE 7.
Logistic regression findings for endoscopic sinus surgery to result in resolution of cardinal symptoms compared
to continued medical management
Cardinal symptom resolution
Unadjusted OR
Adjusted OR
95% CI
p
H-L
χ
2
“Thick nasal discharge”
3.82
4.36
a
1.90–10.04
0.001
3.03
*
“Facial pain/pressure”
3.32
3.56
b
1.48–8.55
0.005
8.00
*
“Sense of smell/taste”
1.48
1.50
c
0.69–3.24
0.306
10.70
*
“Blockage/congestion of nose”
2.75
2.76
d
1.24–6.13
0.013
12.24
*
a
Adjusted for significant independent predictors (
p
<
0.050) including: age, enrollment site, previous sinus surgery, and baseline SNOT-22 item score.
b
Adjusted for significant independent predictors (
p
<
0.050) including: enrollment site, previous sinus surgery, nasal polyposis, COPD, and baseline SNOT-22 item score.
c
Adjusted for significant independent predictors (
p
<
0.050) including: enrollment site, previous sinus surgery, and baseline CT score.
d
Adjusted for significant independent predictors (
p
<
0.050) including: age, previous sinus surgery, and nasal polyposis.
*
H-L
χ
2
tests indicate adequate goodness-of-fit for all models (
p
>
0.050).
CI
=
confidence interval; COPD
=
chronic obstructive pulmonary disease; CT
=
computed tomography; H-L
=
Hosmer-Lemeshow test statistic; OR
=
odds ratio; SNOT-22
=
22-item Sino-Nasal Outcome Test.
of the study precludes tight control over medical therapies
and surgical philosophies between sites and patients. By al-
lowing for this heterogeneity this data reflects a more “real
world” milieu providing greater external validity of these
findings to other tertiary referral centers.
Conclusion
Surgical intervention was found to be more effective at re-
solving thick nasal discharge, nasal obstruction, and facial
pain/pressure than continued medical therapy in patients
with CRS. Patient-reported sense of smell/taste showed no
differential improvement between medical and surgical co-
horts with the exception of the CRSwNP subjects on sub-
group analysis. Subjects electing surgical intervention were
more likely to have worse aggregate baseline QOL scores
than subjects electing continued medical management. Fur-
ther investigation into which symptoms motivate patients
to elect surgical therapy would help elucidate which symp-
toms patients are trying to resolve by electing surgical inter-
ventions. Coupled with further study of the other symptoms
classically associated with CRS, a profile of what symptoms
are best treated surgically could help guide both physicians
and patients in selecting the ideal treatment modality.
International Forum of Allergy & Rhinology, Vol. 5, No. 1, January 2015
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