2016 Section 5 Green Book

Treatment of sinus disease

Outcomes (medical vs. surgery)

Baguley C, Brownlow A, Yeung K, et al. The fate of chronic rhinosinusitis sufferers

after maximal medical therapy.

Int Forum Allergy Rhinol

. 2014; 4(7):525-532. EBM

level 3..........................................................................................................................84-91

Summary

: The authors evaluated the course of progress in patients after maximal medical therapy

for chronic rhinosinusitis. They found that 50% were symptomatic with persistent radiographic

disease, 14% were asymptomatic with no radiographic disease, 24% were asymptomatic with

persistent radiographic disease, and 12% were symptomatic but with no radiographic disease.

Patients with objective evidence of persistent disease had a high rate of relapse of symptoms,

despite initial improvement in symptoms following maximal medical therapy.

DeConde AS, Mace JC, Alt JA, et al. Investigation of change in cardinal symptoms of

chronic rhinosinusitis after surgical or ongoing medical management.

Int Forum Allergy

Rhinol

. 2015; 5(1):36-45. EBM level 2...................................................................92-101

Summary

: In this prospective cohort study, patients who met criteria for endoscopic sinus surgery

were allowed to choose either surgery or continued medical management, and cardinal symptoms

(nasal obstruction, thick nasal discharge, facial pain/pressure, and olfactory dysfunction) were

followed for at least 6 months. Surgical management proved more effective in managing the

cardinal symptoms in question, with the exception of olfactory dysfunction.

Hopkins C, Rimmer J, Lund VJ. Does time to endoscopic sinus surgery impact

outcomes in chronic rhinosinusitis? Prospective findings from the National Comparative

Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis.

Rhinology

. 2015;

53(1):10-17. EBM level 2c.....................................................................................102-109

Summary

: Hopkins et al evaluated the duration of sinus symptoms to determine the impact on

outcomes following sinus surgery. They hypothesized that patients with longer histories of sinus

symptoms would be less responsive to surgery than those undergoing surgery earlier in the

disease process. Their data demonstrated greater durability of benefits in patients with symptoms

for less than 12 months as compared to those with symptoms for 12 to 60 months and those with

symptoms for longer than 60 months.

Luk LJ, Steele TO, Mace JC, et al. Health utility outcomes in patients undergoing

medical management for chronic rhinosinusitis: a prospective multiinstitutional study.

Int Forum Allergy Rhinol

. 2015; 5(11):1018-1027. EBM level 2..........................110-119

Summary

: In this study, chronic rhinosinusitis patients were prospectively enrolled and followed

for 12 months. After initial medical therapy, patients were allowed to choose either continued

medical therapy or endoscopic sinus surgery followed by medical therapy. The Medical

Outcomes Study Short Form-6D was used to generate health utility values at baseline, 6 months,

and 12 months. Patients who elected continued medical management were found to have better

baseline health utility as compared to patients who elected surgery. Patients electing surgery

showed significant improvement in health utility, while those electing continue medical

management did not.