Adults with chronic rhinosinusitis -- a debilitating inflammation of the nasal passages that lasts for months and keeps coming back -- report significantly improved quality of life following minimally invasive endoscopic sinus surgery, according to a new study led by Oregon Health & Science University (OHSU). The results are published in the January issue of Otolaryngology -- Head and Neck Surgery.
"This study demonstrates the real-world benefits of endoscopic sinus surgery for patients with chronic sinusitis. We now know that most patients who have this surgery experience an important and significant improvement in quality of life," said Timothy L. Smith, M.D., M.P.H., the study's principal investigator, professor of otolaryngology/head and neck surgery in the OHSU School of Medicine and director of the Oregon Sinus Center at OHSU.
"For about eight years I had chronic sinus infections, facial pain and headaches. We're talking really bad. I would be floored. I would lie on the couch and take antibiotics until the infection went away. Two months later, I'd do the same thing again," explained OHSU patient Vlasis Albanis, 56, of Lake Oswego. "My wife and kids would tell you that I was irritable and down and out. The surgery totally made a difference in my quality of life. I have had no repeated infections or sinus pain."
Some 30 million Americans experience the chronic congestion, drainage, fatigue, headache, pain, pressure and sneezing of chronic rhinosinusitis each year, with annual direct costs to society of $4.3 billion annually. They have lower quality of life scores than patients with congestive heart failure, angina, chronic obstructive pulmonary disease or back pain. Standard sinusitis treatments, such as decongestants, pain relievers, heating pads, saline sprays and vaporizers, often do not help. As a result, some 500,000 surgical procedures are performed annually in an attempt to provide some measure of relief.
In this study, Smith and colleagues aimed to evaluate how many patients with chronic rhinosinusitis experienced significant improvement in their quality of life following endoscopic surgery. Using validated, sinusitis-specific diagnostic measurements and tools, they also hoped to be able to better predict which patients would most benefit from surgery.
A total of 302 adults with chronic rhinosinusitis were enrolled in the multi-site study between July 2004 and December 2008 and were followed for 18 months post-surgery. At the conclusion of the study, the researchers found up to 76 percent of participants experienced improved quality of life after endoscopic sinus surgery, including less bodily pain and better social functioning.
Although previous research showed patients undergoing endoscopic sinus surgery experienced improved quality of life following surgery, those studies were limited to patient history rather than present condition and didn't follow patients into the future post-surgery. Past studies also did not employ state-of-the-art, sinusitis-specific quality of life measurements and tools, and were largely single-institution results with limited sample sizes.
Endoscopic sinus surgery involves inserting an endoscope, a thin lighted tube that allows clinicians to view the openings to the sinuses, and surgical instruments into the nose to remove abnormal or obstructive tissues. Because the surgery does not require an incision, it is often performed on an outpatient basis, so most people can go home the same day.
This study was funded by the National Institute on Deafness and Other Communication Disorders, a branch of the National Institutes of Health.
Other researchers who participated in the study include: Jamie R. Litvack, M.D., and Jess C. Mace, M.P.H., Department of Otolaryngology/Head and Neck Surgery, OHSU School of Medicine; Peter H. Hwang, M.D., Department of Otolaryngology/Head and Neck Medicine, Stanford University Medical Center; Todd A. Loehrl, M.D., Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin; Karen J. Fong, M.D., California Sinus Centers; and Kenneth E. James, Ph.D., OHSU Department of Public Health & Preventive Medicine.
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