xRead - Nasal Obstruction (September 2024) Full Articles

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Orlandi et al.

TABLE XII-8 Results of surveys to establish duration of prescribed medical therapy trials prior to surgery Survey Antibiotics INCS

Systemic corticosteroids 0-5 days: 42%, 6-10 days: 29% 11-15 days: 29%

3-6 months: 67%

ENT UK Survey,

< 2 weeks: 29% 2-4 weeks: 26% > 6weeks 26% 0-2 weeks: 12% 2.1-3 weeks: 37% > 6weeks: 3%

2013, n = 159 1924

ARS Survey, 2007, n = 308 1922

Not specified

0-5 days: 7% 6-14 days: 67%

AAOHNS Survey 2006, n = 80 1197 Chinese Oto-HNS Alliance Survey, 2020, n = 134 1923

Mean duration > 5weeks

Mean duration 6 weeks

Mean duration 1 week

< 2 weeks: 53% 1-3 weeks: 12% 1-4 weeks: 19% 1-6 weeks: 8% > 6weeks: 7%

Not specified

< 2 weeks: 81% 1-3 weeks: 7% 1-4 weeks: 5% 1-6 weeks: 4% > 6weeks: 3%

TABLE XII-9 Reported response rates to medical therapy trials prior to surgery Study Intervention Outcome Measured

Response Rate

LOE

Lal 1094

51.03% 17.8%

4

Complete resolution of symptoms Partial response

4 weeks amoxicillin-clavulanate, 12 days oral corticosteroid, 4 weeks INCS, 4 weeks saline rinse 3 weeks oral prednisolone, antibiotics, INCS and saline rinses 4 weeks antibiotics, INCS, saline rinses, 10 days prednisolone 3 weeks prednisolone, 4-6 weeks INCS, saline rinse, optional 20 days antibiotics Not specified

Dilidaer 1925 Young 1092

Complete control

30.4% 37.5%

3 4

Improvement in symptoms sufficient to avoid surgery

Subramanian 1096

Improvement in symptoms sufficient to avoid surgery Control = symptoms resolved or no longer bothersome

90%

4

Baguley 1926

38%

4

intervention for CRS. Three cohorts of patients were defined: early cohort – less than 12 months; mid cohort – 12-60 months; and late cohort – more than 60 months of symptoms. 1493 patients having primary surgery were identified; 11.5% in the early group, 50.2% in the mid group and 38.2% in the late group. Patients in the early group had not only a greater percentage improvement in their symp toms, but the improvement was better maintained over 5 years. At 5 years there was a significantly higher pro portion of patients in the early group maintaining a clini cally significant improvement over baseline (71.5%) than in either the mid (57.3%) or late (53.0%) groups. Using health care utilization as a proxy outcome in the Clinical Prac tice Research Datalink, a UK Primary care dataset, the early, mid and late groups were compared. The authors assumed that higher frequency of healthcare visits and prescription medications reflect a poorer outcome from surgery. Patients having early surgery saw their primary care physician less frequently and received fewer prescrip tion medications each year after surgery compared to those

patients in the mid or late cohorts. These results were further replicated in a US based electronic dataset using MarketScan. 1918 Perhaps of even greater interest to the population as a whole, is the impact of ESS on the subsequent devel opment of asthma. It was found, using both UK and US datasets, that ESS was associated with a reduction in the incidence of new asthma diagnoses following surgery, and that the risk of asthma was lowest in those having early surgery, suggesting they had less exposure. 97 Other groups have subsequently studied the timing of surgery and the impact it has on QoL. A prospec tive investigation in Sweden found that patients with less than 12 months of sinus disease derived greatest bene fit after ESS with respect to improvement in SNOT-22 scores. 241 In contrast, Alt et al. performed a prospective multi-centered cohort study in the US enrolling patients diagnosed with CRS and observed for 14.7 [ ± 4.8] months following primary ESS. Preoperative symptom duration was stratified into short-term ( < 12 months), middle-term