Long-term clinical control in chronic rhinosinusitis: Outcomes more than five years after surgery.

Abstract

Purpose: Chronic rhinosinusitis (CRS) is a common chronic and disabling disease with a high socioeconomic burden. The primary goal of treatment is improving health-related quality of life (HRQoL) and maintaining clinical control. The aim of this study was to assess clinical control in CRS patients more than 5 years after endoscopic endonasal surgery (EES).

Methods: In this observational cohort study, 123 patients with CRS were included and they completed the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire and updated European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria. Three clinical control groups were obtained according to the EPOS criteria and corresponding EES-Q and domain scores were analyzed. Univariate analyses were performed to identify variables significantly associated with outcome.

Results: Symptoms of 25.2% of CRS patients were 'controlled', 26.8% were 'partly controlled' and 48.0% were 'uncontrolled' according to the EPOS criteria. Nonsteroidal anti-inflammatory drug - exacerbated respiratory disease, allergic rhinitis, revision surgery, smoking, asthma, and nasal polyps were all significantly associated with partly controlled or uncontrolled CRS. The physical domain played the most significant role in disease control, followed by the social and psychological domain.

Conclusion: According to the updated EPOS criteria, only 25% of patients had controlled CRS more than five years following EES. This emphasizes the importance of unravelling the factors that contribute to disease control to improve treatment. The multidimensional aspect should be taken into account as well as the patients' perspective.

Level of evidence: IIB.