BOSTON - Researchers from Brigham and Women’s Hospital (BWH) have found that patients who suffer from chronic rhinosinusitis (CRS), a long term viral or bacterial sinus infection, can find relief from symptoms which include nasal obstruction, discolored nasal drainage, loss of smell, facial pressure or pain, fatigue and headache, through endoscopic sinus surgery (ESS), a noninvasive outpatient procedure. In addition, study results suggested that ESS helps reduce dependence on antibiotics and antihistamines to mange these symptoms. These findings will be published in the March 2004 issue of The Archives of Otolaryngology–Head & Neck Surgery.
CRS is a debilitating form of sinusitis whose symptoms can lead to substantial physical and emotional impairment. According to the Sinus and Allergy Health Partnership (SAHP), approximately 31 million Americans are believed to have a sinus infection each year with approximately 20 million Americans experiencing CRS at some point during their lifetime. Sinusitis is more prevalent than arthritis and hypertension and, when chronic, sinusitis can be as equally debilitating as diabetes and chronic heart disease. In addition, according to the National Center for Health, Americans make 545,000 emergency department visits annually for CRS at significant costs to themselves. CRS sufferers have several treatment options but few that reduce symptoms to the same degree as ESS, a minimally invasive procedure that lasts approximately one to three hours with patients typically returning home that day. ESS allows a surgeon to delicately remove diseased tissue without having to make more radical facial incisions.
According to study’s lead researcher Neil Bhattacharyya, MD, division of Otolaryngology at BWH and assistant professor of Otology and Laryngology at Harvard Medical School (HMS), “Patients suffering from CRS symptoms experience a significant negative impact on their quality of life including missed days at work and medical costs associated with frequent treatments. This research demonstrates the clinical effectiveness of ESS to specifically address these symptoms allowing patients to take advantage of a straightforward, noninvasive medical procedure to reduce their symptoms to a point where medication dependence is lessened and quality of life is improved.”
In a nonrandomized clinical trial with 100 adult patients, researchers first conducted a rhinosinusitis symptom inventory, or a listing of the major and minor symptoms associated with CRS, within the study population. After following patients for an average of 19 months, researchers found that following ESS, patients experienced a statistically significant decrease in both major and minor symptoms associated with CRS as compared to the initial inventory. Specifically, researchers noted large size effects for reductions in facial pressure and nasal obstruction in addition to headache and fatigue. And, patients also demonstrated a 50 percent decrease in the number of workdays missed due to physician appointments. Findings also suggested that while use of topical nasal steroids did not appear to lessen after ESS, usage of antibiotics and antihistamines were reduced by 33 percent and 20 percent respectively.
“Prior to this study, the success of ESS to address individual symptoms such as facial pain, smell loss and fatigue, has been questioned, with many medical professionals believing that it provided only an incomplete relief of symptoms and, patients still experienced a high recurrence rate post-surgery,” Bhattacharyya said. “Clearly, this study provides compelling evidence that this may not be the case. Although ESS is not appropriate for every patient with CRS, if significant symptoms persist after appropriate medical treatment, CRS sufferers should talk to their physicians about surgical options that could help improve their quality of life as well as lessen their dependence on antibiotics.”
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