Impact of continued medical therapy in patients with refractory chronic rhinosinusitis

Authors

  • Kristine A. Smith MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
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  • Luke Rudmik MD, MSc

    Corresponding author
    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
    • Correspondence to: Luke Rudmik, MD, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Foothills Medical Centre, South Tower suite 602, 1403 – 29th St. NW T2N 2T9, Calgary, AB, Canada; e-mail: Lukerudmik@gmail.com

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Abstract

Background

Patients with refractory chronic rhinosinusitis (RCRS) have persistent symptoms despite best medical therapy. Some evidence suggests continued medical therapy (CMT) is appropriate for patients with RCRS. The primary objective of this study was to evaluate the clinical impact of CMT in patients with RCRS who have significant reductions in baseline disease-specific quality of life (QoL) and would be considered candidates for endoscopic sinus surgery (ESS).

Methods

A prospective longitudinal observational study was undertaken between August 2011 and June 2013. Inclusion criteria: age >18 years, CRS defined by American Academy of Otolaryngology (AAO) adult sinusitis guidelines, failed medical therapy (defined by a 3-month minimum of topical intranasal steroid, minimum 7-day course of systemic corticosteroid, ± 2-week course of broad spectrum systemic antibiotic), and elected ESS. Primary outcomes were change in disease-specific QoL and endoscopic scores between enrolment and immediately prior to ESS. Secondary outcomes included medication consumption and work days missed.

Results

A total of 31 patients were enrolled. Following CMT for a mean of 7.1 months, there was an absolute worsening in mean 22-item Sino-Nasal Outcomes Test (SNOT-22) score between baseline and preoperative follow-up, 57.6 to 66.1, respectively (p = 0.006). There was a significant worsening of mean endoscopic score between baseline and preoperative follow-up, 6.9 to 7.7, respectively (p = 0.002). There was an increase in budesonide irrigations along with a reduction in use of topical nasal steroid sprays prior to ESS. Patients experienced a mean increase of 3.6 work days lost while receiving CMT (p = 0.023).

Conclusion

Results from this study suggest that patients with RCRS who have significant reductions in baseline disease-specific QoL do not experience clinical improvement while receiving CMT.

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