Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre

Abstract

Rationale: The European Position Paper on Sinusitis (EPOS) guidelines provide composite criteria to evaluate chronic rhinosinusitis (CRS) control, taking into consideration the severity of patients' symptoms, aspect of nasal mucosa and medical intake as parameters of CRS control.

Objectives: To study the degree of CRS control using novel EPOS control criteria at 3-5 years after a functional endoscopic sinus surgery (FESS) and correlate these data to symptoms scores.

Methods: Adult CRS patients (n = 560) who had undergone bilateral FESS for chronic inflammatory sinonasal disease 3-5 years prior to the study were included. Patients received a postal questionnaire asking for control items according to EPOS control criteria, visual analogue scale (VAS) scores for total and individual sinonasal symptoms, sinonasal outcome test (SNOT)-22 and Short Form (SF)-36 questionnaires.

Measurements and main results: About 19.5% of CRS patients were well controlled, with 36.8% of patients being partly controlled and 43.7% uncontrolled. The levels of control corresponded to mean total VAS, SNOT-22 and SF-36 scores. Subgroup analysis revealed that female gender, aspirin intolerance and revision FESS were associated with higher prevalence of uncontrolled CRS, whereas allergy, asthma and smoking status did not alter the percentage of patients in each category of control. In 81 patients attending the outpatient clinic, nasal endoscopy changed classification in only four patients (4.9%).

Conclusions: Based on the novel EPOS control criteria, at least 40% of CRS patients are uncontrolled at 3-5 years after FESS. Therefore, better treatment strategies leading to higher disease control are warranted in CRS care.

Keywords: chronic rhinosinusitis; control; functional endoscopic sinus surgery treatment; nasal polyps; uncontrolled rhinitis.

Figure 1

Percentage of patients with CRSsNP compared to CRSwNP stratified by disease control. All CRS patients were divided into two groups; patients without a history of nasal polyps (CRSsNP) and with history of nasal polyps (CRSwNP). They were categorized into three groups using the EPOS control criteria. As seen in this figure, there is a large difference in percentage of controlled and partly controlled patients but a smaller difference between partly controlled and uncontrolled patients.

Figure 2

Mean VAS scores of CRS symptoms for CRS patients stratified by disease control. Mean VAS scores of CRS symptoms for patients without (A) a history of nasal polyps (CRSsNP) or with (B) a history of nasal polyps (CRSwNP) were compared for different levels of control according to the EPOS control criteria. Data were presented as mean with standard deviation.