Impact of synechiae after endoscopic sinus surgery on long-term outcomes in chronic rhinosinusitis

Authors

  • Oswaldo A. Henriquez MD,

    1. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
    Search for more papers by this author
  • Rodney J. Schlosser MD,

    1. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
    2. Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, U.S.A
    Search for more papers by this author
  • Jess C. Mace MPH,

    1. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
    Search for more papers by this author
  • Timothy L. Smith MD, MPH,

    1. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
    Search for more papers by this author
  • Zachary M. Soler MD, MSc

    Corresponding author
    1. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
    • Send correspondence to Zachary Soler, MD, MSc, Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425. E-mail: solerz@musc.edu

    Search for more papers by this author

  • Zachary M. Soler, MD, MSc Jess C. Mace, MPH, and Timothy L. Smith, MD, MPH are supported by a grant from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, Bethesda, MD. (2R01 DC005805; PI: T.L. Smith). Public clinical trial registration ID#NCT01332136: (http://www.clinicaltrials.gov). Timothy L. Smith, MD is also a consultant for Intersect ENT (Palo Alto, CA.), which is not affiliated in any way with this investigation. Rodney J. Schlosser, MD is a consultant for BrainLAB, Olympus, and Sunovion and receives grant support from a VA Merit, NeilMed, Medtronic, and Arthrocare. None of these are affiliated with this study. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Synechiae are one of the most common unwanted outcomes after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). However, there has been scant investigation into the true significance of synechiae formation after ESS. The aim of this study was to evaluate the impact of synechiae formation on health-related quality of life (HRQoL) outcomes after ESS in patients with CRS.

Study Design

Prospective, multi-institutional cohort.

Methods

Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS) scores were measured in adult patients before and after undergoing ESS for CRS. Differences in HRQoL were evaluated between those who developed sinonasal synechiae and those who did not, controlling for demographic factors, medical comorbidities, and measures of disease severity at baseline.

Results

A total of 286 patients underwent ESS, with 55 (19.2%) developing synechiae in the follow-up period. Patients developing synechiae reported significantly less improvement on the RSDI total scores (13.5 vs. 21.4, P = 0.008), RSDI physical subscores (5.3 vs. 8.3, P = 0.007), RSDI emotional subscores (2.9 vs. 5.8, P = 0.008), CSS total scores (14.5 vs. 21.2, P = 0.093), and CSS symptom subscores (19.9 vs 30.3, P = 0.069) compared to those who did not develop synechiae postoperatively. These differences persisted even after controlling for baseline differences in disease severity.

Conclusions

Synechiae of the sinonasal cavity commonly occurs following ESS, particularly in those undergoing revision surgeries. Although both groups improve, the degree of HRQoL improvement appears to be less in those who form postoperative synechiae after surgery compared to those who do not.

Level of Evidence

2c. Laryngoscope, 123:2615–2619, 2013

Ancillary