Symptom outcomes following endoscopic sinus surgery

Abstract

Purpose of review: To summarize recent studies exploring the response of chronic rhinosinusitis (CRS) symptoms to endoscopic sinus surgery (ESS).

Recent findings: ESS symptom outcomes were reported using various symptom scoring systems and more than 18 survey instruments. When individual symptom scores were pooled by meta-analysis, most major CRS symptoms improved to a similar degree following surgery, with an overall effect size of 1.19 (95% confidence interval, 0.96-1.41; I(2) = 82%). Headache (effect size, 0.98) and hyposmia (effect size, 0.97) improved less than nasal obstruction (effect size, 1.73). Fatigue and bodily pain were more severe than general population normative values and improved following ESS by an effect size of approximately 0.5 SD, a change usually regarded as a minimally important clinical difference. Similarly, quality-of-life score in fibromyalgia improved after surgery. Neither anxiety nor depression confounded CRS symptom reporting, and neither correlated with computed tomography score; however, depression was associated with lower quality-of-life scores before and after ESS.

Summary: Following ESS, most major CRS symptoms usually improve to a similar degree. Bodily pain and fatigue are associated with CRS and improve after ESS. Anxiety and depression do not confound symptom reporting, although depression is associated with poorer preoperative and postoperative quality-of-life scores.