Journal
LARYNGOSCOPE
Volume 123, Issue 10, Pages 2341-2346Publisher
WILEY-BLACKWELL
DOI: 10.1002/lary.24027
Keywords
Chronic disease; sinusitis; decision making; general surgery; drug therapy; therapeutics
Funding
- National Institute on Deafness and Other Communication Disorders (NIDCD)
- National Institutes of Health, Bethesda, Maryland [2R01 DC005805]
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Objectives/HypothesisTo explore possible factors that might impact a patient's choice to pursue endoscopic sinus surgery (ESS) or continue with medical management for treatment of refractory chronic rhinosinusitis (CRS). Study DesignCross-sectional evaluation of a multicenter prospective cohort. MethodsTwo hundred forty-two subjects with CRS were prospectively enrolled within four academic tertiary care centers across North America with ongoing symptoms despite prior medical treatment. Subjects either self-selected continued medical management (n=62) or ESS (n=180) for treatment of sinonasal symptoms. Differences in demographics, comorbid conditions, and clinical measures of disease severity between subject groups were compared. Validated metrics of social support, personality, risk aversion, and physician-patient relationships were compared using bivariate analyses, predicted probabilities, and receiver operating characteristic curves at the 0.05 alpha level. ResultsNo significant differences were found between treatment groups for any demographic characteristic, clinical cofactor, or measure of social support, personality, or the physician-patient relationship. Subjects electing to pursue sinus surgery did report significantly worse average quality-of-life (QOL) scores on the 22-item Sinonasal Outcome Test (SNOT-22; P<.001) compared to those electing continued medical therapy (54.618.9 vs. 39.417.7), regardless of surgical history or polyp status. SNOT-22 score significantly predicted treatment selection (odds ratio, 1.046; 95% confidence interval, 1.028-1.065; P<.001) and was found to accurately discriminate between subjects choosing endoscopic sinus surgery and those electing medical management 72% of the time. ConclusionsWorse patient-reported disease severity, as measured by the SNOT-22, was significantly associated with the treatment choice for CRS. Strong consideration should be given for incorporating CRS-specific QOL measures into routine clinical practice. Level of Evidence2b. Laryngoscope, 123:2341-2346, 2013
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