Assessment of quality of life after endoscopic sinus surgery for chronic rhinosinusitis

Chronic rhinosinusitis is a disease of undefined etiology that significantly impacts the quality of life of its patients. Various studies carried out in countries other than Brazil have shown endoscopic sinus surgery as an effective means of treating this condition.ObjectiveThis study aims to analyze, with the aid of SNOT-20, the association between endoscopic sinus surgery and disease-specific quality of life of Brazilian patients treated for chronic rhinosinusitis accompanied or not by nasal polyps.Materials and MethodsThis prospective study enrolled patients submitted to endoscopic sinus surgery after drug therapy failed to improve their symptoms. They were assessed based on questionnaire SNOT-20p before and 12 months after surgery. Improvement on total scores and on the five items deemed more important by each patient were assessed. The study also looked into the correlation between preoperative scores and postoperative improvement and if there were any gender-related improvement differences.ResultsForty-three patients aged 44 (19), md (IQR), 65% of whom (26/43) were males. Statistically significant improvement was seen on SNOT-20 and SNOT-20(5+) and a correlation was established between preoperative scores and postoperative improved scores (p<0.001). No gender-related differences were observed in quality of life.ConclusionEndoscopic sinus surgery in patients with chronic rhinosinusitis is associated with statistically significant improvements in disease-specific quality of life.     

Endoscopic and quality-of-life outcomes after revision endoscopic sinus surgery

OBJECTIVES: First, to examine the impact of endoscopic sinus surgery (ESS) on endoscopic and quality-of-life (QOL) outcomes after revision ESS as compared to primary ESS. Second, to evaluate whether or not other risk factors and/or co-morbidities influence the relationship between revision surgery status and outcomes of ESS. STUDY DESIGN: Prospective observational study with an internal comparison group. METHODS: Preoperative computed tomography scores, pre and postoperative endoscopy scores, and two validated disease-specific QOL instruments, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were collected on a prospective cohort of patients undergoing ESS for chronic rhinosinusitis. Data were analyzed using Pearson's chi and multiple logistic regression models. RESULTS: Mean preoperative Lund-Mackay computed tomography scan scores were similar in primary and revision surgery patients. In patients without polyps, revision ESS patients were 3.88 times more likely to improve on endoscopy scores than primary ESS patients (95% confidence interval 1.70, 8.83; P = .001). In nasal polyp patients, there was no difference by revision status (odds ratio 0.48; 95% confidence interval 0.15, 1.59; P = .23). The odds of improving on the RSDI (odds ratio 0.51, 95% confidence interval 0.25, 1.04, P = .065) and CSS (odds ratio 0.98, 95% confidence interval 0.51, 1.89, P = .950) were not significantly different by revision status. CONCLUSIONS: Both revision and primary ESS patients improved after ESS with regard to endoscopy, RSDI, and CSS scores. In non-polyp patients, revision ESS patients were more likely to improve on endoscopy scores than primary ESS patients; there was no difference in polyp patients by revision status. Revision ESS patients and primary ESS patients were equally as likely to improve on two QOL instruments.     

综合护理干预对鼻内镜鼻窦手术后口干症的改善效果观察

探讨综合护理干预对功能性内镜鼻窦手术（FESS）患者术后口干症的改善效果。     

Effects of depression on quality of life improvement after endoscopic sinus surgery

OBJECTIVES/HYPOTHESIS: To determine whether self- reported depression predicts lesser postoperative improvement in health-related quality of life (HRQoL) after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective open cohort. METHODS: An adult (> or =18 yr) cohort of 23 patients with depression and 79 patients without depression undergoing ESS were followed for 12 +/- 2 months. Patient characteristics and computed tomography scores were examined preoperatively. Endoscopy scores and two HRQoL measures, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey, were analyzed pre- and postoperatively. Univariate and multivariate analyses were used to evaluate outcome differences for patients with depression. RESULTS: There was a significantly higher prevalence of women (P = .002) and longer duration of follow-up (P = .004) for the depressed subgroup. Depressed patients reported significantly lower pre- and postoperative HRQoL scores on all RSDI subscales (P < .05). Without baseline adjustment, depression was not associated with significant differences in postoperative change for disease-specific HRQoL scores (P > .10) in multivariate analysis. CONCLUSIONS: Depressed patients with CRS present similarly but have worse pre- and postoperative HRQoL scores and experience similar disease-specific QoL improvements from sinus surgery compared with other CRS patients. Sinus surgery is not effective in alleviating the effect of depression on disease-specific HRQoL, and it is likely that comorbid depression and CRS are operating on independent disease pathways. Additional research and hypothesis testing using continuous, objective measures is warranted.     

少年儿童鼻内镜手术远期疗效及相关临床因素探讨

目的　探讨接受内镜鼻窦手术少年儿童鼻窦炎患者的疗效及影响疗效的相关因素。方法　接受内镜鼻窦手术的少年儿童鼻窦炎性疾病患者 2 68例 (43 2侧 ) ,年龄 3～ 17岁 ,平均 14 3岁 ,男 186例 ,女 82例。全身麻醉 176例 ,局部麻醉 12例。 188例 (3 0 5侧 )术后随访超过 1年 ,占病例总数 70 1%。随访在鼻内镜下进行 ,以黏膜表面麻醉为主。术后综合治疗包括 :清理术腔、鼻腔冲洗、抗生素、激素、黏液促排剂及免疫调节剂等。结果　慢性鼻窦炎 89例 (14 7侧 ) ,慢性鼻窦炎、鼻息肉86例 (14 2侧 ) ,鼻窦黏液囊肿 13例 (16侧 )。治愈 13 2例 (70 2 % ) ,好转 43例 (2 2 9% ) ,无效 13例(6 9% )。术后头痛缓解率 93 1% (175/ 188) ,其次为鼻堵为 85 1% (160 / 188) ,脓涕 60 1% (113 /188)。 11例手术前后无变化 ,2例症状较术前加重。术前 56例失嗅者 ,术后 3 4例 (60 7% )改善或恢复。术后症状完全缓解 12 3 / 188例 (65 4% ) ,部分缓解 52 / 188例 (2 7 7% ) ,总有效率为 93 1%。 8例 (4 3 % )接受再手术。结论　少儿慢性鼻窦炎、鼻息肉内镜鼻窦手术远期疗效满意 ,应重视术中黏膜合理取舍和积极处理中鼻甲 ;随访质量为影响手术远期疗效重要因素。患者就医和手术前是否进行了规范药物治疗为手术适应证     

大环内酯类药物治疗内镜鼻窦手术后黏膜迁延性炎性反应的临床观察

目的 观察小剂量服用大环内酯类药物对内镜鼻窦手术后鼻窦黏膜长期迁延性炎性反应患者治疗的临床效果。方法 病例来源于2004-2006年中山大学附属第一医院耳鼻咽喉科医院首次经内镜鼻窦手术治疗后2年以上、长期迁延性鼻窦炎性反应、疗效评估未愈的慢性鼻窦炎患者13例。治疗方案采用克拉霉素250 mg/d,连续口服超12 ～ 28周,同时保留原有基本治疗（鼻用糖皮质激素、黏液促排剂、鼻腔盥洗）。在治疗结束时与结束后3、6个月采用症状视觉模拟量表和内镜黏膜形态评估（Lund-Kennedy评分法）对临床疗效进行主客观综合评价。以SPSS 16.0统计软件进行t检验或非参数检验。结果 13例患者中1例经20周治疗无效中断治疗,其他12例均达到预定的停药标准。全部患者停药时间分别为：12周4例,16周2例,20周5例,24周1例,28周1例。综合评价结果：非常好6例,好4例,比较好2例,不好1例。治疗前后症状视觉模拟量表及内镜Lund-Kennedy评分（中位数[25分位数;75分位数]）分别为8.00[7.50;8.50]与1.00[0.25;1.00];7.00[6.50;8.00]与1.00[0.00;1.00],治疗前后差异均有统计学意义(Z分别为-3.201、-3.194,P均＜0.01)。停药后3～6个月未发现鼻窦炎复发。13例患者未发生药物不良反应,肝肾功能均未受到影响。结论 小剂量（250 mg/d）、长期（12 ～28周）使用大环内酯类药物治疗内镜鼻窦手术后顽固的持续性迁延性炎性反应临床疗效显著、稳定。大环内酯类药物临床安全性和患者耐受性较好。