BACKGROUND: The significance of osteitis in the management of recalcitrant chronic rhinosinusitis (CRS) has yet to be clearly understood and clinical outcomes data for these patients is lacking. Osteitis has been characterized by inflammatory infiltrate, osteoneogenesis, and bony sclerosis with remodeling. In this study we sought to determine if osteitis negatively impacts quality-of-life (QOL) or clinical outcomes following endoscopic sinus surgery (ESS). METHODS: A total of 190 adult patients with CRS were prospectively enrolled.Osteitis was characterized by quantifiable bony thickening on sinus computed tomography (CT). Baseline measures and postoperative outcomes were evaluated using endoscopy exam, olfactory testing, and 2 validated disease-specific QOL surveys: the Chronic Sinusitis Survey (CSS) and Rhinosinusitis Disability Index (RSDI). Bivariate and multivariate analyses were performed to evaluate differences between patients with and without osteitis. RESULTS: Patients with osteitis (n = 79) had higher prevalence of nasal polyposis and prior ESS (both p < 0.001) and significantly worse baseline CT, endoscopy, and olfactory scores (all p < 0.001) than patients without osteitis. There was no difference in baseline QOL scores between patients with and without osteitis. Following ESS, there were significant improvements in all QOL measures in both groups; however, patients without osteitis were more likely to exhibit clinically meaningful improvement on physical RSDI subscale scores, independent of other clinical factors (79.0% vs 62.3%; odds ratio [OR]: 3.85, p = 0.011). CONCLUSION: Osteitis is associated with worse baseline measures of disease severity and inflammation. Our data suggest that whereas patients with osteitis improve after ESS, the presence of osteitis is associated with a reduced chance of improvement in some outcome measures.
BACKGROUND: The significance of osteitis in the management of recalcitrant chronic rhinosinusitis (CRS) has yet to be clearly understood and clinical outcomes data for these patients is lacking. Osteitis has been characterized by inflammatory infiltrate, osteoneogenesis, and bony sclerosis with remodeling. In this study we sought to determine if osteitis negatively impacts quality-of-life (QOL) or clinical outcomes following endoscopic sinus surgery (ESS). METHODS: A total of 190 adult patients with CRS were prospectively enrolled.Osteitis was characterized by quantifiable bony thickening on sinus computed tomography (CT). Baseline measures and postoperative outcomes were evaluated using endoscopy exam, olfactory testing, and 2 validated disease-specific QOL surveys: the Chronic Sinusitis Survey (CSS) and Rhinosinusitis Disability Index (RSDI). Bivariate and multivariate analyses were performed to evaluate differences between patients with and without osteitis. RESULTS:Patients with osteitis (n = 79) had higher prevalence of nasal polyposis and prior ESS (both p < 0.001) and significantly worse baseline CT, endoscopy, and olfactory scores (all p < 0.001) than patients without osteitis. There was no difference in baseline QOL scores between patients with and without osteitis. Following ESS, there were significant improvements in all QOL measures in both groups; however, patients without osteitis were more likely to exhibit clinically meaningful improvement on physical RSDI subscale scores, independent of other clinical factors (79.0% vs 62.3%; odds ratio [OR]: 3.85, p = 0.011). CONCLUSION:Osteitis is associated with worse baseline measures of disease severity and inflammation. Our data suggest that whereas patients with osteitis improve after ESS, the presence of osteitis is associated with a reduced chance of improvement in some outcome measures.
Authors: Michael S Benninger; Berrylin J Ferguson; James A Hadley; Daniel L Hamilos; Michael Jacobs; David W Kennedy; Donald C Lanza; Bradley F Marple; J David Osguthorpe; James A Stankiewicz; Jack Anon; James Denneny; Ivor Emanuel; Howard Levine Journal: Otolaryngol Head Neck Surg Date: 2003-09 Impact factor: 3.497
Authors: Timothy L Smith; Jamie R Litvack; Peter H Hwang; Todd A Loehrl; Jess C Mace; Karen J Fong; Kenneth E James Journal: Otolaryngol Head Neck Surg Date: 2010-01 Impact factor: 3.497
Authors: Peter Karempelis; Emily Karp; Nathan Rubin; Ryan Hunter; Jordan Dunitz; Holly Boyer Journal: Int Forum Allergy Rhinol Date: 2019-12-19 Impact factor: 3.858
Authors: Kara Y Detwiller; Timothy L Smith; Jess C Mace; Dennis R Trune; Nathan B Sautter Journal: Int Forum Allergy Rhinol Date: 2013-02-08 Impact factor: 3.858
Authors: John F Pallanch; Lifeng Yu; David Delone; Rich Robb; David R Holmes; Jon Camp; Phil Edwards; Cynthia H McCollough; Jens Ponikau; Amy C Dearking; John Lane; Andrew Primak; Aaron Shinkle; John Hagan; Evangelo Frigas; Joseph J Ocel; Nicole Tombers; Rizwan Siwani; Nicholas M Orme; Kurtis B Reed; Nivedita Jerath; Robinder Dhillon; Hirohito Kita Journal: Int Forum Allergy Rhinol Date: 2013-09-17 Impact factor: 3.858