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DeConde et al.

TABLE 6. Comparison of complete symptom resolution frequency between treatment modalities *

Medical management

Endoscopic sinus surgery

p

Total cohort “Thick nasal discharge” (n = 324) “Facial pain/pressure” (n = 292) “Sense of smell/taste” (n = 305)

8 (12.1)

89 (34.5)

< 0.001

8 (15.7)

92 (38.2)

0.002

12 (20.0)

66 (26.9)

0.270

“Blockage/congestion of nose” (n = 333)

8 (11.8)

71 (26.8)

0.009

CRSwNP

“Thick nasal discharge”

3 (11.5)

35 (34.3)

0.029

“Facial pain/pressure”

2 (6.9)

41 (47.1)

0.004

“Sense of smell/taste”

1 (4.0)

24 (23.8)

0.026

“Blockage/congestion of nose”

3 (11.1)

33 (32.0)

0.032

CRSsNP

“Thick nasal discharge”

5 (12.5)

54 (34.6)

0.006

“Facial pain/pressure”

6 (18.8)

51 (33.1)

0.109

“Sense of smell/taste”

11 (31.4)

42 (29.2)

0.793

“Blockage/congestion of nose”

5 (12.2)

38 (23.5)

0.137

*Values are n (%). CRSsNP = chronic rhinosinusitis without nasal polyposis; CRSwNP = chronic rhinosinusitis with nasal polyposis. TABLE 7. Logistic regression findings for endoscopic sinus surgery to result in resolution of cardinal symptoms compared to continued medical management

H-L χ 2

Cardinal symptom resolution

Unadjusted OR

Adjusted OR

95% CI

p

4.36 a

3.03 *

“Thick nasal discharge”

3.82

1.90–10.04

0.001

3.56 b

8.00 *

“Facial pain/pressure”

3.32

1.48–8.55

0.005

1.50 c

10.70 *

“Sense of smell/taste”

1.48

0.69–3.24

0.306

2.76 d

12.24 *

“Blockage/congestion of nose”

2.75

1.24–6.13

0.013

a Adjusted for significant independent predictors ( p < 0.050) including: age, enrollment site, previous sinus surgery, and baseline SNOT-22 item score. b Adjusted for significant independent predictors ( p < 0.050) including: enrollment site, previous sinus surgery, nasal polyposis, COPD, and baseline SNOT-22 item score. c Adjusted for significant independent predictors ( p < 0.050) including: enrollment site, previous sinus surgery, and baseline CT score. d Adjusted for significant independent predictors ( p < 0.050) including: age, previous sinus surgery, and nasal polyposis. * H-L χ 2 tests indicate adequate goodness-of-fit for all models ( p > 0.050). CI = confidence interval; COPD = chronic obstructive pulmonary disease; CT = computed tomography; H-L = Hosmer-Lemeshow test statistic; OR = odds ratio; SNOT-22 = 22-item Sino-Nasal Outcome Test.

of the study precludes tight control over medical therapies and surgical philosophies between sites and patients. By al- lowing for this heterogeneity this data reflects a more “real world” milieu providing greater external validity of these findings to other tertiary referral centers. Conclusion Surgical intervention was found to be more effective at re- solving thick nasal discharge, nasal obstruction, and facial pain/pressure than continued medical therapy in patients with CRS. Patient-reported sense of smell/taste showed no

differential improvement between medical and surgical co- horts with the exception of the CRSwNP subjects on sub- group analysis. Subjects electing surgical intervention were more likely to have worse aggregate baseline QOL scores than subjects electing continued medical management. Fur- ther investigation into which symptoms motivate patients to elect surgical therapy would help elucidate which symp- toms patients are trying to resolve by electing surgical inter- ventions. Coupled with further study of the other symptoms classically associated with CRS, a profile of what symptoms are best treated surgically could help guide both physicians and patients in selecting the ideal treatment modality.

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