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Factors that Delay Definitive Management of Chronic Rhinosinusitis in India: A survey based study
... 15 Despite appropriate medical therapy, a subset of patients with CRS continues to be symptomatic and eventually undergoes endoscopic sinus surgery. 16 Due to this disease, there is significant patient morbidity in terms of negatively affected QOL and substantial impairment of daily functioning, resulting in decreased overall productivity. Many continue to suffer and seek other treatments because the relapse rate can be as high as 47.5%. ...
... 1. Primary outcome: The SNOT-20 total score obtained from the Bengali version of the SNOT-20 questionnaire, where, alongside total SNOT-20 score (items [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], items are also assigned into six subgroups-psychological domain including fatigue (items [15][16][17][18][19][20], rhinological (items 1-3, 5, 6), sleep (items 11-13), ear/facial (items 7-10), cough (item 4), and wake up tired (item 14). The scores of each question range from 0 to 5, according to the severity of the symptom, with 5 being the worst. ...
... 1. Primary outcome: The SNOT-20 total score obtained from the Bengali version of the SNOT-20 questionnaire, where, alongside total SNOT-20 score (items [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], items are also assigned into six subgroups-psychological domain including fatigue (items [15][16][17][18][19][20], rhinological (items 1-3, 5, 6), sleep (items 11-13), ear/facial (items 7-10), cough (item 4), and wake up tired (item 14). The scores of each question range from 0 to 5, according to the severity of the symptom, with 5 being the worst. ...
Background Chronic rhinosinusitis (CRS) is a common disorder, with up to an estimated 134 million Indian sufferers, and having significant impact on quality of life (QOL) and health costs. Despite the evidence favoring homeopathy in CRS being inadequate, it is highly popular. This trial attempts to study the efficacy of individualized homeopathy (IH) medicines in comparison with placebo in patients with CRS.
Methods A double-blind, randomized (1:1), placebo-controlled, preliminary trial (n = 62) was conducted at the National Institute of Homoeopathy, West Bengal, India. Primary outcome measure was the sino-nasal outcome test-20 (SNOT-20) questionnaire; secondary outcomes were the EQ-5D-5L questionnaire and EQ-5D-5L visual analog scale scores, and five numeric rating scales (0–10) assessing intensity of sneezing, rhinorrhea, post-nasal drip, facial pain/pressure, and disturbance in sense of smell, all measured at baseline and after the 2nd and 4th months of intervention. Group differences and effect sizes (Cohen's d) were calculated on the intention-to-treat sample.
Results Groups were comparable at baseline. Attrition rate was 6.5% (IH: 1, Placebo: 3). Although improvements in both primary and secondary outcome measures were higher in the IH group than placebo, with small to medium effect sizes, the group differences were statistically non-significant (all p > 0.05, unpaired t-tests). Calcarea carbonica, Lycopodium clavatum, Sulphur, Natrum muriaticum and Pulsatilla nigricans were the most frequently prescribed medicines. No harmful or unintended effects, homeopathic aggravations or any serious adverse events were reported from either group.
Conclusion There was a small but non-significant direction of effect favoring homeopathy, which ultimately renders the trial as inconclusive. Rigorous trials and independent replications are recommended to arrive at a confirmatory conclusion. [Trial registration: CTRI/2018/03/012557; UTN: U1111–1210–7201].
... There is no clear guideline regarding the timing of surgical intervention. 4 The advent of endoscopes has revolutionized the sinus operations. Prior to introduction of endoscopes there were very few sinus operations being done. ...
... Jagdish et al carried out an interview based study among ENT specialists. 4 The author tried to find out the reasons for denial of surgery among patients who were advised to undergo surgery by these ENT specialists. The authors thus found that cost of operation, fear about surgery and anesthesia were the major factors which were responsible for delaying the surgery among the patients who need surgery. ...
p class="abstract"> Background: Early surgical intervention has been found to be better in terms of patient satisfaction compared even with the medical management. The objective of the study was to study effectiveness of minimally invasive endoscopic sinus surgery in alleviating the symptom complex in chronic rhino-sinusitis.
Methods: Retrospective review of the chronic rhino-sinusitis data of 164 patients done, who undergone functional endoscopic sinus surgery with or without septoplasty between 2005 and 2013. Any recurrence of symptoms and radiological evidence recorded in the patient notes. The number of patients who undergone revision surgery also recorded.
Results: The recurrence rate of symptoms and sinus disease was 20% (33 patients). There was no relation between the severity of the symptoms and the amount of disease seen in the CT scans. The two patients, who had purulent sinusitis, WERE completely relieved of their headaches and resumed their routine work soon after the operation. About 90% patients improved regarding nasal obstruction, 75% patients improved of nasal discharge, 60% patients showed improvement for sneezing. There were adhesions in about 6% patients and polyps recurred in 30% of patients. The recurrence of symptoms improved with medication in majority of patients.
Conclusions: The meticulously performed functional endoscopic surgery effectively improved symptom complex. If properly performed it is effective in alleviating all the symptoms and decrease recurrence rate and complications can be kept at negligible levels. Hence it offers a clear advantage in reducing complications and recurrence rates in sinus disease. </p
... CRS is one of the most prevalent chronic diseases worldwide with various studies reporting an affliction of 5-15% in some studies and 16% of the adult population in others and this disease has similar prevalence rates in India as well. Currently there are two key options in management, long term medical management and functional endoscopic sinus surgery (FESS) [4][5][6][7][8]. The failure rate of medical treatment ranges from 50-88% in various studies, following which patients undergo endoscopic sinus surgery. ...
Chronic Rhinosinusitis (CRS) is a disease said to affect 1 in 7 people across the globe. It is associated with debilitating symptoms that have a significant impact economically as well as on the patient’s quality of life. It results when the nasal passages and paranasal sinuses are afflicted by concurrent inflammation and infection. Currently the two key options in management include long term medical management and functional endoscopic sinus surgery (FESS). The failure rate of medical treatment ranges from 50-88% in literature, following which patients undergo endoscopic sinus surgery. FESS involves the removal of mucosal and osteoid tissue to achieve adequate disease clearance. In keeping with the principle of regaining physiological nasal clearance and ventilation, balloon sinuplasty was approved in 2005, which dilates the ostia of the diseased sinuses, allows for mucous clearance and improves ventilation. In a survey based study looking at the factors leading to delay in definitive management in patients with Chronic Rhinosinusitis in India it was concluded that there is a need for an affordable, minimally invasive solution for CRS soon after medical management fails. Balloon sinuplasty or balloon catheter dilation (BCD) is a relatively novel procedure would be a suitable option to bridge this gap. This article is a review of literature on the efficacy and safety of balloon dilation as a standalone procedure, in comparison with FESS or as a hybrid procedure with balloon sinuplasty being conducted along with FESS.
Balloon Sinuplasty is a new technique which has revolutionized sinus surgery in recent times. Since its introduction in USA in 2004, it has become popular world-wide, due to its sophisticated technology, which uses balloon dilatational systems for dilating the sinus ostia through a minimally invasive approach and has provided satisfactory results in patients with chronic rhinosinusitis. Recent world literature supports the efficacy and outcomes of Balloon Sinuplasty system, with large multi-centric studies proving it to be a very effective tool in the management of various sinus pathologies. We performed this prospective clinical study to assess the efficacy & outcomes of Balloon Sinuplasty among 20 patients at our institution, who were followed up for 12 months after surgery. Patients were included as per inclusion criteria formulated for this study & were analyzed with respect to their pre-operative & post-operative symptomatology scores in comparison with their objective Diagnostic Nasal Endoscopy (DNE) & Computerized Tomography Scan of Paranasal Sinuses (CT-PNS) scoring systems. Significant improvements were recorded in patient’s symptoms, from the first post-operative week until the end of the study period, and were objectively confirmed by the DNE & CT-PNS scores. The observations & results of our study highlight the efficacy of Balloon Sinuplasty technology in comparison to similar studies reported in recent world literature.
The surgical management of sinusitis was revolutionized worldwide with the advent of the rigid Hopkins rod nasal endoscopes three decades ago. The traditional Messerklinger technique, was thus propagated worldwide by Prof. Stammberger, from the University of Graz in Austria and has come into vogue as functional endoscopic sinus surgery (FESS). The principal aim behind this procedure was the maximal preservation of the nasal mucosal integrity, while providing optimal disease clearance. Today, the introduction of a new technological innovation called 'balloon sinuplasty', has taken the field of sinus surgery a step further. This new technology is very similar to the principles of balloon angioplasty and today, this system has added an efficient, non-invasive tool in the armamentarium of the innovative endoscopic rhinologist. This FDA approved technique, in recent times has provided excellent results in various centers across the western world. We share our first surgical experience with the introduction of this cutting-edge technology in India.
Endoscopic sinus surgery (ESS) is considered a therapeutic option after failure of maximal medical therapy (MMT) for chronic rhinosinusitis (CRS). There is currently no consensus on the definition of MMT. The objective of this systematic review is to describe the various MMT criteria employed prior to considering ESS.
A systematic review was performed using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were adults with CRS based on guideline diagnostic criteria, enrolled to undergo ESS, and study publication within the last 5 years (January 1, 2009, to December 30, 2014). Studies were excluded if the study population included non-CRS indications for ESS. Primary outcome was the MMT criteria employed prior to considering a patient a candidate for ESS. A subgroup analysis was performed based on polyp status.
Of 387 reviewed studies, 21% reported MMT criteria. When reported, criteria included topical nasal corticosteroids (91% of studies) for a mean of 8 ± 8 weeks, oral antibiotics (89%) for 23 ± 8 days, systemic corticosteroids (61%) for 18 ± 12 days, saline irrigations (39%), oral antihistamines (11%), oral mucolytics (10%), and topical/oral decongestants (10%).
A minority of studies report MMT criteria used as the indication for ESS. When reported, the majority included an 8-week course of topical intranasal corticosteroids and 3-week course of oral antibiotics. Use of systemic corticosteroids did not differ based on polyp status. Because of variation in current MMT criteria, there is a need to develop standardized indications for ESS that will work to improve the appropriateness of care for patients with.
© 2015 ARS-AAOA, LLC.
Objectives/HypothesisThe objective of this study was to examine the rates and geographic variation of endoscopic sinus surgery (ESS) in a representative sample of the US working population.Study DesignObservational cohort study using the MarketScan Commercial Claim and Encounters database.Methods
All patients who received ESS between 2009 and 2013 were included. The annual adjusted rates of ESS per 1,000 people were calculated for each US state. Geographic variations were evaluated using the extremal quotient (EQ), weighted coefficient of variation (CV), systematic component of variance (SCV), and empirical Bayes statistic. The χ2 statistic tests was used to quantify variation of the adjusted ESS rates across states within the US.ResultsThe annual adjusted rate of ESS was 0.94 per 1,000 people in the US. South Dakota and Alabama were observed to have the highest rates of ESS, 1.80 and 1.69, respectively. Vermont and Arkansas were observed to have the lowest rates of ESS, 0.51 and 0.57, respectively. The mean EQ was 4.54, indicating a four- to fivefold difference between the highest (South Dakota) and lowest (Vermont) states. The mean CV was 31.4 and mean SCV was 10.1, which demonstrates very high variation.Conclusions
This study observed very high geographic variation in the rates of ESS across the United States. Given that practice variation indicates the presence of potentially harmful and inefficient unwarranted care, outcomes from this study indicate a need to further evaluate the delivery of ESS to improve overall health system performance.Level of Evidence2b. Laryngoscope, 2015
Objective/study design:
The objective of this systematic review was to summarize the literature evaluating the costs associated with the management of adult chronic rhinosinusitis (CRS) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Methods:
Two separate authors systematically searched eight commonly used medical databases. Included articles were categorized into seven domains: 1) overall healthcare cost (direct and indirect), 2) resource utilization, 3) medical management strategies, 4) overall procedure cost of endoscopic sinus surgery (ESS), 5) intraoperative technologies, 6) ESS litigation, and 7) CRS diagnostics. To maintain a common currency for comparison, all costs were converted to 2014 United States dollars (USD) using an inflation calculator in September 2014.
Results:
Forty-four studies were identified for inclusion. The range for overall CRS-related healthcare costs was $6.9 to $9.9 billion 2014 USD per year. Indirect costs were estimated as $13 billion 2014 USD per year. Annual medication costs prior to ESS ranged between $1,547 and $2,700 2014 USD per patient, with a uniform reduction in costs after ESS. The overall US cost of outpatient ESS ranged from $8,200 to $10,500 2014 USD per case. The overall annual economic burden of CRS in the United States was estimated to be $22 billion 2014 USD (direct and indirect costs).
Conclusion:
The results of this systematic review have demonstrated substantial direct and indirect costs associated with the management of adult CRS. Future research should continue to improve the costing data, which can be used to improve the value of care provided for this chronic inflammatory disease.
To evaluate the impact of early versus delayed endoscopic sinus surgery (ESS) in terms of postoperative health care utilization, using a patient cohort with chronic rhinosinusitis (CRS).
Retrospective administrative database analysis.
US-based primary and secondary sites of care.
CRS patients with ESS in 2010-with no other ESS before 2010 and with complete medical history from 2004 to 2012-were identified within the MarketScan database. Patients were characterized by time interval of first sinusitis or nasal polyposis diagnosis to ESS and grouped as following: group 1, < 1 year (n = 818); group 2, 1 to <2 years (n = 247); group 3, 2 to <3 years (n = 274); group 4, 3 to <4 years (n = 364); group 5, 4 to <5 years (n = 595); and group 6, ≥5 years (n = 535). Outpatient visits/procedures and prescriptions associated with sinusitis and/or nasal polyps were analyzed for 1 year preoperatively and 2 years postoperatively. Subanalyses were conducted on separate cohorts with or without asthma or polyps, within each group.
Patients in group 1 had significantly fewer visits and prescriptions than patients in group 6 (postoperative visits: group 1, 4.45 [95% CI, 4.06-4.84]; group 6, 6.70 [95% CI, 6.10-7.30; prescriptions: group 1, 4.54 [95% CI, 4.12-4.96]; group 6, 7.61 [95% CI, 6.92-8.31]). Gradual increases in utilization were observed from groups 1 to 6. Subanalysis of patients with and without asthma or polyps showed similar findings.
Early intervention after diagnoses of CRS, with or without asthma or polyps, is associated with lower health care utilization than intervention after many years of medical management.
© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Background
The decision to continue medical therapy or recommend endoscopic sinus surgery (ESS) can be challenging in patients with refractory chronic rhinosinusitis (CRS). The objective of this study was to evaluate continued medical therapy vs ESS for patients with refractory CRS who have severe reductions in baseline disease-specific quality of life (QoL).Methods
This was a prospective longitudinal crossover study between August 2011 and June 2013. All patients were >18 years old, diagnosed with CRS based on guideline recommendations, failed initial medical therapy and elected ESS. While waiting for ESS, all patients received continued medical therapy. The preoperative waiting period outcomes (continued medical therapy) were compared to the postoperative outcomes. The primary outcome was change in disease-specific QoL (22-item Sinonasal Outcome Test [SNOT-22]). Secondary outcomes were change in endoscopic grading (Lund-Kennedy score), medication consumption, and work days missed in the preceding 90 days.ResultsThirty-one patients were enrolled. Mean baseline SNOT-22 score was 57.6. After a mean of 7.1 months of continued medical therapy, there was a worsening in SNOT-22 score (57.6 to 66.1; p = 0.006). After ESS, with a mean postoperative follow-up of 14.6 months, there was a significant improvement in SNOT-22 score (66.1 to 16.0; p < 0.001). There was also a significant improvement in endoscopic grading (p < 0.001) coupled with a reduction in both work days lost (p < 0.001) and medication consumption (p < 0.01).Conclusion
Results from the study suggest that ESS is a more effective intervention compared to continued medical therapy for patients with refractory CRS who have severe reductions in their baseline disease-specific QoL.
Objectives/HypothesisTo evaluate the long-term cost-effectiveness of endoscopic sinus surgery (ESS) compared to continued medical therapy for patients with refractory chronic rhinosinusitis (CRS). Study DesignCohort-style Markov decision-tree economic evaluation. Methods
The economic perspective was the U.S. third-party payer with a 30-year time horizon. The two comparative treatment strategies were: 1) ESS, followed by appropriate postoperative medical therapy; and 2) continued medical therapy alone. Primary outcome was the incremental cost per quality-adjusted life year (QALY). Costs were discounted at a rate of 3.5% in the reference case. Multiple sensitivity analyses were performed, including differing time-horizons, discounting scenarios, and a probabilistic sensitivity analysis (PSA). ResultsThe reference case demonstrated that the ESS strategy cost a total of $48,838.38 and produced a total of 20.50 QALYs. The medical therapy alone strategy cost a total of $28,948.98 and produced a total of 17.13 QALYs. The incremental cost effectiveness ratio for ESS versus medical therapy alone is $5,901.90 per QALY. The cost-effectiveness acceptability curve from the PSA demonstrated that there is a 74% certainty that the ESS strategy is the most cost-effective decision for any willingness to pay a threshold greater than $25,000. The time-horizon analysis suggests that ESS becomes the cost-effective intervention within the third year after surgery. Conclusion
Results from this study suggest that employing an ESS treatment strategy is the most cost-effective intervention compared to continued medical therapy alone for the long-term management of patients with refractory CRS. Level of EvidenceN/A. Laryngoscope, 125:25-32, 2015
Disease-specific reductions in patient productivity can lead to substantial economic losses to society. The purpose of this study was to: 1) define the annual productivity cost for a patient with refractory chronic rhinosinusitis (CRS) and 2) evaluate the relationship between degree of productivity cost and CRS-specific characteristics.
Prospective, multi-institutional, observational cohort study.
The human capital approach was used to define productivity costs. Annual absenteeism, presenteeism, and lost leisure time was quantified to define annual lost productive time (LPT). LPT was monetized using the annual daily wage rates obtained from the 2012 U.S. National Census and the 2013 U.S. Department of Labor statistics.
A total of 55 patients with refractory CRS were enrolled. The mean work days lost related to absenteeism and presenteeism were 24.6 and 38.8 days per year, respectively. A total of 21.2 household days were lost per year related to daily sinus care requirements. The overall annual productivity cost was $10,077.07 per patient with refractory CRS. Productivity costs increased with worsening disease-specific QoL (r = 0.440; p = 0.001).
Results from this study have demonstrated that the annual productivity cost associated with refractory CRS is $10,077.07 per patient. This substantial cost to society provides a strong incentive to optimize current treatment protocols and continue evaluating novel clinical interventions to reduce this cost.
N/A. Laryngoscope, 2014.
A 50-year-old woman with nonallergic rhinitis, asthma, and aspirin intolerance presented with worsening symptoms of nasal congestion, purulent drainage, and anosmia. Nasal polyps were visualized on anterior rhinoscopy, and there was evidence of chronic rhinosinusitis (CRS) on imaging studies during work-up for another medical condition. Over a 2-year period she had numerous bouts of acute exacerbations of CRS which required multiple courses of antibiotics; however, she was unwilling to undergo surgery to reduce polyp burden. She successfully underwent aspirin desensitization and experienced partial relief of symptoms with daily aspirin ingestion.
Nasal obstruction is a common symptom that can result from multiple causes, including mucosal disorders (eg, allergic and nonallergic rhinitis, rhinosinusitis, sarcoid) and structural disorders (eg, nasal septal deviation, tumors, mucoceles). The various causes and work-up for nasal obstruction are discussed with emphasis placed on CRS, which is a prevalent disease characterized by inflammation of the nose and paranasal sinuses for a duration of >12 weeks. The different subtypes of CRS, including CRS with and without nasal polyps, allergic fungal rhinosinusitis, and aspirin-exacerbated respiratory disease, are discussed along with pathogenesis, diagnosis, and treatment options.
The use of common surgical procedures varies widely across regions. Differences in illness burden, diagnostic practices, and patient attitudes about medical intervention explain only a small degree of regional variation in surgery rates. Evidence suggests that surgical variation results mainly from differences in physician beliefs about the indications for surgery, and the extent to which patient preferences are incorporated into treatment decisions. These two components of clinical decision making help to explain the so-called surgical signatures of specific procedures, and why some consistently vary more than others. Variation in clinical decision making is, in turn, affected by broad environmental factors, including technology diffusion, supply of specialists, local training frameworks, financial incentives, and regulatory factors, which vary across countries. Better scientific evidence about the comparative effectiveness of surgical and non-surgical interventions could help to mitigate regional variation, but broader dissemination of shared decision aids will be essential to reduce variation in preference-sensitive disorders.
Chronic rhinosinusitis (CRS) is one of the most common chronic diseases and is associated with a high socioeconomic burden from direct and indirect costs. Its estimated prevalence ranges widely, from 2 to 16%. It is more common in female subjects, aged 18-64 years, and in southern and midwestern regions of the United States. CRS is more prevalent in patients with comorbid diseases such as asthma, chronic obstructive pulmonary disease, and environmental allergies. Few studies examine patient ethnicity, socioeconomic status, geographic location, and cultural factors in CRS populations. This article provides an overview of the epidemiology, racial variations, and economic burden of CRS.
Background:
This study evaluated 1-year outcomes in patients with chronic rhinosinusitis (CRS) who were considered surgical candidates by study criteria and elected either medical management or endoscopic sinus surgery (ESS). In addition, some patients initially enrolled in the medical treatment arm crossed over to the surgery arm during the study period and their respective outcomes are evaluated.
Methods:
Adult subjects with CRS who failed initial medical therapy were prospectively enrolled into a nonrandomized, multi-institutional cohort. Subjects were included in 1 of 3 cohorts: medically managed, surgically managed, or crossover (from medical to surgical). The primary outcome measure was disease-specific quality-of-life (QOL). Bivariate and multivariate analyses compared QOL improvement between cohort groups.
Results:
Baseline comorbidity, QOL, and other disease severity measures were not different between the 3 cohorts. With 1-year follow up, surgical patients (n = 65) reported significantly more improvement than medically managed patients (n = 33; Rhinosinusitis Disability Index (RSDI), p = 0.039; Chronic Sinusitis Survey (CSS), p = 0.018). Seventeen subjects who had initially elected medical management crossed over to surgery during the follow-up period. QOL in the crossover cohort was initially stagnant or worsening followed by improvement after ESS (RSDI, p = 0.035; CSS, p = 0.070). At 1-year follow-up, higher frequency of improvement was found in the surgical cohort vs medical cohort for several outcomes (total CSS: 70.8% vs 45.5%; odds ratio [OR], 3.37; 95% confidence interval [CI], 1.27-8.90; p = 0.014).
Conclusion:
With 1 year of follow-up, patients electing ESS experienced significantly higher levels of improvement in outcomes compared to patients managed by medication alone. In addition, a crossover cohort who initially elected medical management experienced improvement in several outcomes after crossing over to ESS.
To determine endoscopic sinus surgery (ESS) rates among 306 hospital referral regions (HRRs) and to assess whether variability in ESS rates correlates with population density of beneficiaries, per capita number of otolaryngologists within an HRR, or proportion of patients diagnosed as having chronic rhinosinusitis.
Retrospective cohort analysis.
Academic research.
A 20% sample of Medicare beneficiaries aged 65 to 99 years diagnosed as having chronic rhinosinusitis and undergoing ESS in 2006.
Variation in per capita rates of chronic rhinosinusitis diagnosis and ESS in 2006.
Among 306 HRRs nationally, ESS was performed in sufficient volume to be reported in 148 HRRs. Per capita ESS rates (sinus surgical procedures per 1000 beneficiaries) varied 5-fold, from 0.02 to 0.10, with significant variations within states. Nationally, no geographic or regional patterns were noted, and high-use HRRs were often geographically proximal to low-use HRRs. Higher rates of chronic rhinosinusitis diagnosis and more beneficiaries in particular HRRs did not predict increased ESS within the HRRs.
Local ESS rates in the Medicare population vary considerably across the United States. Variability in high-use vs low-use regions seems to be random and independent of climate or the number of beneficiaries diagnosed as having chronic rhinosinusitis. Given that the appropriate rate of sinus surgery is unknown, this study points to the need for identifying and adopting more rigorous clinical criteria for ESS.
To determine the time interval during which quality-of-life (QOL) outcomes stabilize after endoscopic sinus surgery (ESS).
Multi-institutional, longitudinal cohort.
Tertiary rhinology centers.
Adults with chronic rhinosinusitis from three medical centers were asked to provide responses to the Rhinosinusitis Disability Index (RSDI) and the Chronic Sinusitis Survey (CSS) at baseline and six months, 12 months, and 20 months after endoscopic sinus surgery. Repeated measures and post-hoc analyses were used to compare QOL scores among follow-up time points. Subgroup analyses were performed in a similar fashion for patients with and without nasal polyposis, asthma, allergies, acetylsalicylic acid intolerance, depression, and previous sinus surgery.
A total of 127 patients provided complete follow-up data for all three time points. Improvement in QOL scores was seen at six months after surgery for both the RSDI and CSS instruments. When comparing changes in mean QOL scores among all follow-up time points, there were no significant differences in either RSDI or CSS total scores (all P ≥ 0.853) or subscale scores (all P ≥ 0.251) between six, 12, and 20 months. Each individual subgroup demonstrated stable QOL scores between six and 20 months' follow-up, including patients with polyposis and those with intolerance to acetylsalicylic acid (all P ≥ 0.275).
At a cohort level, improvements in QOL after ESS do not appear to change between six and 20 months. Clinical trial designs incorporating QOL outcomes after ESS should consider the six-month time frame as an appropriate primary end point.
Balloon sinuplasty is a new technology which has only recently been introduced in the UK. We review the current literature, and we present our first year's results for the technique together with a description of indications, outcomes and problems.
Retrospective case note review of 27 consecutive patients undergoing sinuplasty alone in the first year in which this procedure was performed. The main outcome measures used were subjective improvement and Sino-Nasal Outcome Test (SNOT-22) score.
Dilatation was successful in 98 per cent of sinuses in which it was attempted; however, subjective improvement was noted in only 62 per cent of patients thus treated.
We believe that balloon sinuplasty has a place in routine rhinology practice but that its applications are limited, and that its additional costs must be considered. We present advantages and possible limitations of the technique.
Most patients with chronic rhinosinusitis seek medical treatment when the burden of symptoms negatively impacts their quality of life. The degree to which quality of life improves after sinus surgery is a critical indicator of surgical success. This article reviews quality of life outcomes after functional endoscopic sinus surgery, including relevant clinical factors, weaknesses in the current literature, and future research directions.
To understand the reasons that hinder people from uptake of sponsored cataract surgery.
A mixed methods (qualitative and quantitative) approach was used. During routine screening activities at Kwale District, Kenya, local residents with visually impairing cataract were clinically assessed and offered free surgery. Interviews were conducted using a semi-structured guide that covered different aspects related to acceptance of cataract surgery including knowledge of others who underwent surgery and their outcome. Analysis focused on differences between people accepting and people refusing surgery and the reasons for non-acceptance of surgery.
Ninety interviews were conducted, 48 with people accepting and 42 with people refusing free surgery. Those who accepted surgery generally reported good outcome in others, while people who refused surgery often reported to know someone who worsened or even become blind after surgery. Many of these 'failed cases' were prominent figures in the local community, and most of them had already died. Glaucoma was the single most common underlying medical condition. On being re-interviewed, several people admitted that they had actually never met someone who had unsuccessful surgery but only heard rumours.
In Africa, a rumour of blinding eye surgery is not uncommonly being used by patients to justify their refusal to have cataract surgery. Underlying reasons appear to be related to shame, fear of surgery or missing social support. Improved awareness of the general population regarding eye conditions and their management, involvement of the family and local community in decision making, good surgical outcomes and appropriate counselling are possible methods to enhance acceptance.
To study gender-specific preferences regarding timing of elective total joint replacement (TJR) surgery in patients with moderately severe osteoarthritis (OA) of the hip or knee.
Focus group discussions regarding TJR surgery were conducted among 18 women and among 12 men with moderately severe OA of the hip or knee. Discussions were tape recorded, transcribed, coded for themes, and evaluated semiquantitatively and qualitatively for gender differences.
In general, men were more likely to choose surgery earlier in the disease than women and had higher expectations for surgical success. Women were more fearful of surgery. Women preferred to suffer arthritis pain rather than risk surgery, and indicated they would delay surgery to await better technology and to avoid disrupting caregiving roles for dependent spouses and others.
Men and women differ in their willingness to accept continued functional decline, risks of surgery, and disruption of usual role. Gender differences may influence decisions regarding utilization of TJR.
Chronic rhinosinusitis (CRS) is widely recognized as one of the most common, if not the most common, chronic disease entities. This article discusses CRS without nasal polyposis. The discussion of maximal medical therapy concentrates on the best available evidence from published clinical trials.
Chronic rhinosinusitis
- Cj Ocampo
- Lc Grammer
Ocampo CJ, Grammer LC (2013) Chronic rhinosinusitis. J Allergy Clin
Immunol Pract 1(3): 205-211.
1 in 8 Indians hit by Chronic Rhinosinusitis: A study
- Pratibha Masand
Pratibha Masand (2012) 1 in 8 Indians hit by Chronic Rhinosinusitis:
A study.