Predictors of Surgical Intervention in Adults With Recurrent Acute Rhinosinusitis

Abstract

Introduction

The need for surgical intervention in patients with recurrent acute rhinosinusitis (RARS) is not well defined. The goal of this study is to understand the different factors that predict receiving surgical intervention in patients with RARS.

Methods

Retrospective cohort study of adult patients presenting with RARS with at least one objective evidence of rhinosinusitis. Patient characteristics and comorbidities were reviewed. The 22-item sinonasal outcome test (SNOT-22) and endoscopy scores were collected at baseline. Surgical intervention consisted of functional endoscopic sinus surgery (FESS) with or without septoplasty.

Results

One hundred and eighteen patients were included, of which 53 patients underwent surgical intervention during a mean follow-up period of 5.4 (±5.3) months. Patients who underwent surgery were significantly younger (30.0 vs. 48.8, p < 0.01), had higher BMI (43.1 vs. 31.9, p< 0.01), higher CT LM scores (5.3 vs. 2.7, p < 0.01), and were more likely to have nasal septal deviation (NSD) (64.2% vs. 41.5%, p = 0.01). Gender, endoscopy scores, SNOT-22 total and domain scores, and rates of other medical comorbidities did not significantly differ by cohort (p > 0.05 for all). On multivariate analysis, age (OR = 0.89, 95% CI: 0.85, 0.94), BMI (1.05, 95% CI: 1.05, 1.18), CT scores (OR = 1.28, 95% CI: 1.10, 1.48), and NSD (3.52, 95% CI: 1.10, 11.28) remained significant predictors for surgical intervention in patients with RARS.

Conclusion

RARS patients who proceed to surgical intervention are younger, have higher BMI, and have higher objective disease burden, including evidence of NSD and higher CT LM scores.

Level of Evidence

4.