Symptom-specific outcomes of endoscopic sinus surgery: A systematic review
Presented at Annual Meeting of the American Academy of Otolaryngology–Head and Heck Surgery, Chicago, September 2008.
Received 27 August 2008; received in revised form 27 October 2008; accepted 22 December 2008.
Abstract
Background
Although multiple studies have demonstrated that symptoms of chronic rhinosinusitis (CRS) improve after endoscopic sinus surgery (ESS), a systematic large-scale evaluation of specific symptom response has not been performed.
Objective
To analyze the relative effectiveness of surgery in the improvement of individual CRS symptoms.
Study Design
A literature search of MEDLINE, EMBASE, Web of Science, Cochrane databases, and other Web-based sources from January 1, 1980 through June 1, 2008 was performed. Studies of 20 or more adult patients with CRS that used symptom severity scores to analyze at least 3 major CRS criteria (facial pressure, nasal obstruction, postnasal discharge, and hyposmia) or 2 major CRS criteria plus headache were included.
Subjects and Methods
Inclusion criteria were met by 21 of 289 ESS studies reviewed. Meta-analysis was conducted for each symptom separately with the standardized difference between the preoperative and postoperative severity scores as the effect size (ES).
Results
A total of 2070 patients with CRS were studied a mean of 13.9 months after ESS. All symptoms demonstrated improvement compared with their respective preoperative severity scores by an overall ES of 1.19 (95% confidence interval, 0.96 to 1.41; I2 = 81.7%) using the random-effects model. Nasal obstruction (ES, 1.73) improved the most, with facial pain (ES, 1.13) and postnasal discharge (ES, 1.19) demonstrating moderate improvements. Hyposmia (ES, 0.97) and headache (ES, 0.98) improved the least.
Conclusion
The relative improvements in major CRS symptoms and headache after surgery are similar, with the exception of nasal obstruction, which improves most.
aDepartment of Medicine, Georgetown University Hospital, Washington, DC
bDepartment of Otolaryngology–Head and Neck Surgery, St Louis University School of Medicine, St Louis, MO
Corresponding author: Alexander C. Chester, MD, Department of Medicine, Georgetown University Medical Center, 3301 New Mexico Ave, NW, Washington, DC 20016
No sponsorships or competing interests have been disclosed for this article.
ABSTRACT