Adam S DeConde1, Jess C Mace2, Vijay R Ramakrishnan3, Jeremiah A Alt4, Timothy L Smith2. 1. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, U.S.A. 2. Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, Oregon, U.S.A. 3. Department of Otolaryngology, University of Colorado, Aurora, Colorado, U.S.A. 4. Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City, Utah, U.S.A.
Abstract
OBJECTIVE: Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may "cross over" to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality. STUDY DESIGN: Retrospective analysis of a prospective, multi-center cohort of adult patients with CRS enrolled between March 2011 and June 2015 in academic, tertiary referral clinics. METHODS: Subjects who initially elected CMT were followed up to 18 months, provided a comprehensive medical history, and completed the 22-item SinoNasal Outcome Test (SNOT-22) at baseline and during 6-month follow-up intervals. Hazard regression modeling was used to identify covariates associated with elective change in treatment modality. RESULTS: One hundred seventy-nine subjects were followed for an average 15.1 (standard deviation ± 4.6) months. Subjects who elected ESS (55 of 179) had significantly worse average endoscopy scores and reported worse SNOT-22 sleep dysfunction scores at baseline (P ≤ 0.026). For each single increasing (worsening) point of Lund-Kennedy endoscopy score, the hazard ratio (HR) of crossover increased by ∼6%. Similarly, for every point of worsening in baseline SNOT-22 total score, the hazard of treatment crossover increased by ∼2%. After covariate adjustment, only baseline SNOT-22 sleep dysfunction scores were associated with an increased risk of treatment crossover (HR = 1.07; 95% confidence interval: 1.02-1.11; P = 0.003). CONCLUSION: Baseline total SNOT-22 and endoscopy scores are associated with treatment crossover, but reported sleep dysfunction is the only significant independent predictor of treatment crossover. LEVEL OF EVIDENCE: 2c. Laryngoscope, 128:304-310, 2018.
OBJECTIVE: Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may "cross over" to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality. STUDY DESIGN: Retrospective analysis of a prospective, multi-center cohort of adult patients with CRS enrolled between March 2011 and June 2015 in academic, tertiary referral clinics. METHODS: Subjects who initially elected CMT were followed up to 18 months, provided a comprehensive medical history, and completed the 22-item SinoNasal Outcome Test (SNOT-22) at baseline and during 6-month follow-up intervals. Hazard regression modeling was used to identify covariates associated with elective change in treatment modality. RESULTS: One hundred seventy-nine subjects were followed for an average 15.1 (standard deviation ± 4.6) months. Subjects who elected ESS (55 of 179) had significantly worse average endoscopy scores and reported worse SNOT-22 sleep dysfunction scores at baseline (P ≤ 0.026). For each single increasing (worsening) point of Lund-Kennedy endoscopy score, the hazard ratio (HR) of crossover increased by ∼6%. Similarly, for every point of worsening in baseline SNOT-22 total score, the hazard of treatment crossover increased by ∼2%. After covariate adjustment, only baseline SNOT-22 sleep dysfunction scores were associated with an increased risk of treatment crossover (HR = 1.07; 95% confidence interval: 1.02-1.11; P = 0.003). CONCLUSION: Baseline total SNOT-22 and endoscopy scores are associated with treatment crossover, but reported sleep dysfunction is the only significant independent predictor of treatment crossover. LEVEL OF EVIDENCE: 2c. Laryngoscope, 128:304-310, 2018.
Authors: Edward El Rassi; Jess C Mace; Toby O Steele; Jeremiah A Alt; Zachary M Soler; Rongwei Fu; Timothy L Smith Journal: Int Forum Allergy Rhinol Date: 2015-12-01 Impact factor: 3.858
Authors: Richard R Orlandi; Todd T Kingdom; Peter H Hwang; Timothy L Smith; Jeremiah A Alt; Fuad M Baroody; Pete S Batra; Manuel Bernal-Sprekelsen; Neil Bhattacharyya; Rakesh K Chandra; Alexander Chiu; Martin J Citardi; Noam A Cohen; John DelGaudio; Martin Desrosiers; Hun-Jong Dhong; Richard Douglas; Berrylin Ferguson; Wytske J Fokkens; Christos Georgalas; Andrew Goldberg; Jan Gosepath; Daniel L Hamilos; Joseph K Han; Richard Harvey; Peter Hellings; Claire Hopkins; Roger Jankowski; Amin R Javer; Robert Kern; Stilianos Kountakis; Marek L Kowalski; Andrew Lane; Donald C Lanza; Richard Lebowitz; Heung-Man Lee; Sandra Y Lin; Valerie Lund; Amber Luong; Wolf Mann; Bradley F Marple; Kevin C McMains; Ralph Metson; Robert Naclerio; Jayakar V Nayak; Nobuyoshi Otori; James N Palmer; Sanjay R Parikh; Desiderio Passali; Anju Peters; Jay Piccirillo; David M Poetker; Alkis J Psaltis; Hassan H Ramadan; Vijay R Ramakrishnan; Herbert Riechelmann; Hwan-Jung Roh; Luke Rudmik; Raymond Sacks; Rodney J Schlosser; Brent A Senior; Raj Sindwani; James A Stankiewicz; Michael Stewart; Bruce K Tan; Elina Toskala; Richard Voegels; De Yun Wang; Erik K Weitzel; Sarah Wise; Bradford A Woodworth; Peter-John Wormald; Erin D Wright; Bing Zhou; David W Kennedy Journal: Int Forum Allergy Rhinol Date: 2016-02 Impact factor: 3.858
Authors: Richard M Rosenfeld; Jay F Piccirillo; Sujana S Chandrasekhar; Itzhak Brook; Kaparaboyna Ashok Kumar; Maggie Kramper; Richard R Orlandi; James N Palmer; Zara M Patel; Anju Peters; Sandra A Walsh; Maureen D Corrigan Journal: Otolaryngol Head Neck Surg Date: 2015-04 Impact factor: 3.497
Authors: Toby O Steele; Luke Rudmik; Jess C Mace; Adam S DeConde; Jeremiah A Alt; Timothy L Smith Journal: Int Forum Allergy Rhinol Date: 2016-02-08 Impact factor: 3.858
Authors: Richard M Rosenfeld; David Andes; Neil Bhattacharyya; Dickson Cheung; Steven Eisenberg; Theodore G Ganiats; Andrea Gelzer; Daniel Hamilos; Richard C Haydon; Patricia A Hudgins; Stacie Jones; Helene J Krouse; Lawrence H Lee; Martin C Mahoney; Bradley F Marple; Col John P Mitchell; Robert Nathan; Richard N Shiffman; Timothy L Smith; David L Witsell Journal: Otolaryngol Head Neck Surg Date: 2007-09 Impact factor: 3.497
Authors: Luke Rudmik; Zachary M Soler; Claire Hopkins; Rodney J Schlosser; Anju Peters; Andrew A White; Richard R Orlandi; Wytske J Fokkens; Richard Douglas; Timothy L Smith Journal: Int Forum Allergy Rhinol Date: 2016-03-11 Impact factor: 3.858
Authors: Joshua M Levy; Jess C Mace; E Ritter Sansoni; Zachary M Soler; Timothy L Smith Journal: Int Forum Allergy Rhinol Date: 2016-05-24 Impact factor: 3.858
Authors: Naweed I Chowdhury; Jess C Mace; Todd E Bodner; Jeremiah A Alt; Adam S Deconde; Joshua M Levy; Timothy L Smith Journal: Laryngoscope Date: 2018-09-12 Impact factor: 3.325