Evolution of sinonasal symptoms following endoscopic anterior skull base surgery

Abstract

To assess the severity and evolution of sinonasal symptoms in patients following endoscopic anterior skull base surgery to define the typical postoperative course.

Design: Cross sectional study. Participants include 69 patients who underwent endoscopic skull base surgery by a dual surgeon team (otolaryngologist and neurosurgeon) from January 2008 to August 2009.

Main outcome measures: Sinonasal Outcomes Test (SNOT)-20 survey scores at preoperative and at three postoperative time points. An ordinal logistic regression model was used to analyze the data, summarizing the relationship between the outcome (SNOT score) and the predictor (time point) using an odds ratio. Scores for the symptoms of need to blow nose, sneezing, runny nose, postnasal discharge, thick nasal discharge, ear fullness, and facial pain showed significant worsening at the early postoperative time point. These symptoms showed significant improvement over time; however, scores for post nasal discharge remained high at the late time period compared with baseline. All patients will experience considerable sinonasal symptoms following transnasal endoscopic skull base surgery. Postnasal discharge and thick nasal discharge improve significantly over time. Symptoms approach baseline by 6 to 9 months following surgery.

Keywords: Skull base; endoscopic; sinonasal; sinus surgery.

Figure 1

Graph showing mean SNOT-20 scores across time points: baseline ♦; early (36–101 days) ▪; middle (106–190 days) ▴; late (202–300 days) X. Scores for items 1 (need to blow nose), 5 (postnasal discharge), 6 (thick nasal discharge), 12 (wake up at night), 13 (lack of a good night's sleep), 14 (wake up tired), 15 (fatigue), and 16 (reduced productivity) all had the highest mean scores at the early time point. These scores gradually returned to baseline, except for item 5 (postnasal discharge), which remained relatively high even at the late time period. Scores for items 11–20, the global systemic and psychological symptoms, remained at similar levels through all time periods.

Figure 2

Graph showing comparison of odds ratios over time. The odds ratios were relatively high for items 1 (need to blow nose), 2 (sneezing), 5 (postnasal discharge), 6 (thick nasal discharge), 7 (ear fullness), and 10 (facial pain/pressure) during the early postoperative period. However, the scores tended to improve over time, as evidenced by the odds ratios becoming closer to 1 for many of the items by the late time period. Items 5 (postnasal discharge) and 6 (thick nasal discharge) had the highest odds ratios for early versus baseline scores, but these ratios improved in the middle and late time periods. The odds ratios for items 11–20, the global systemic and psychological symptoms, remained close to 1 for all time periods.