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Reprinted by permission of Int Forum Allergy Rhinol. 2015; 5(1):36-45.

OR I G I NAL ART I CLE

Investigation of change in cardinal symptoms of chronic rhinosinusitis a er surgical or ongoing medical management

Adam S. DeConde, MD 1 , Jess C. Mace, MPH, CCRP 2 , Jeremiah A. Alt, MD, PhD 3 , Zachary M. Soler, MD, MSc 4 , Richard R. Orlandi, MD 3 and Timothy L. Smith, MD, MPH 2

Background: Chronic rhinosinusitis (CRS) has been de- fined as inflammation of the paranasal sinuses lasting at least 12 weeks with corresponding 2 or more “cardinal symp- toms” that include: (1) nasal obstruction; (2) thick nasal dis- charge; (3) facial pain/pressure; and (4) reduction or loss of sense of smell. Although prior studies have investigated symptoms of CRS a er sinus surgery, none have compared the outcomes of these specific symptoms to ongoing med- ical therapy. Methods: Patients with CRS were prospectively enrolled into a multi-institutional, comparative effectiveness, cohort study. Subjects elected either continued medical manage- ment or endoscopic sinus surgery (ESS). Baseline char- acteristics and objective clinical findings were collected. Cardinal symptoms of CRS were operationalized by 4 ques- tions on the 22-item Sino-Nasal Outcome Test (SNOT-22). Symptom improvement was evaluated in subjects with at least 6-month follow-up. Results: A total of 342 subjects were enrolled, with 69 (20.2%) electing continued medical management, whereas 273 (79.8%) elected ESS. Subjects electing surgical ther- apy were more likely to have a higher baseline aggregate 1 Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of California San Diego, San Diego, CA; 2 Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, OR; 3 Division of Head and Neck Surgery, Rhinology–Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City, UT; 4 Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC Correspondence to: Timothy L. Smith, MD, MPH, Oregon Health and Science University, Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, 3181 SW Sam Jackson Park Road, PV-01, Portland, OR 97239; e-mail: smithtim@ohsu.edu Funding sources for the study: National Institutes of Health (National Institute on Deafness and Other Communication Disorders [NIDCD] R01 DC005805 to T.L.S.) Potential conflict of interest: T.L.S., J.C.M., and Z.M.S. are supported by a grant from the National Institutes of Health (National Institute on Deafness

SNOT-22 score (44.3 (18.9) vs 53.6 (18.8); p < 0.001). All subjects improved across all cardinal symptoms; however, subjects undergoing ESS were significantly more likely ( p 0.013) to experience improvement in thick nasal discharge (odds ratio [OR] = 4.36), facial pain/pressure (OR = 3.56), and blockage/congestion of nose (OR = 2.76). Subjects with nasal polyposis were significantly more likely to report com- plete resolution of smell/taste following ESS compare to medical management (23.8% vs 4.0%; p = 0.026). Conclusion: Across a large population, surgical manage- ment is more effective at resolving the cardinal symptoms of CRS than ongoing medical management with the excep- tion of sense of smell/taste. C 2014 ARS-AAOA, LLC. Key Words: Sinusitis; diagnosis; quality of life; endoscopy; therapy How to Cite this Article : DeConde AS, Mace JC, Alt JA, Soler ZM, Orlandi RR, Smith TL. Investigation of change in cardinal symptoms of chronic rhinosinusitis a er surgical or ongoing medical management. Int Forum Allergy Rhinol. 2015;5:36–45. C hronic rhinosinusitis (CRS) is defined in the 2007 Adult Sinusitis Clinical Practice Guidelines 1 and the 2012 European Position Paper on Rhinosinusitis 2 as in- flammation of the nose and paranasal sinuses manifesting with 2 or more “cardinal” symptoms for 12 weeks with and Other Communication Disorders [NIDCD] R01 DC005805 to T.L.S.). T.L.S. is also a consultant for IntersectENT, Inc (Menlo Park, CA), which is not affiliated with this investigation. R.R.O. is a consultant for Medtronic ENT (Jacksonville, FL), which is not affiliated with this research. Submitted for oral presentation to the American Rhinologic Society (ARS) at the Annual American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) meeting on September 20, 2014, Orlando, FL (Abstract submission #718). Public clinical trial registration: http://clinicaltrials.gov/show/NCT01332136. Determinants of Medical and Surgical Treatment Outcomes in Chronic Sinusitis. Received: 22 May 2014; Revised: 24 July 2014; Accepted: 5 August 2014 DOI: 10.1002/alr.21410 View this article online at wileyonlinelibrary.com.

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