| Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study. | |
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MedLine Citation:
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PMID: 22287426 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Evidence evaluating the comparative effectiveness of various treatments for chronic rhinosinusitis (CRS) is insufficient. This study evaluates outcomes in patients who failed initial medical management and elect a subsequent treatment option, either continued medical management or endoscopic sinus surgery (ESS) coupled with continued medical management. METHODS: Adult subjects were prospectively enrolled into a nonrandomized, multi-institutional cohort. Baseline characteristics and objective clinical findings were collected. Primary outcome measures included 2 disease-specific quality-of-life (QOL) instruments: the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS). Bivariate and multivariate analyses compared QOL improvement by treatment type, as well as differences in antibiotic and oral steroid utilization and work/school productivity. RESULTS: Subjects (n = 180) were enrolled between March 2009 and April 2010. Patients electing medical management (n = 55) reported significantly better baseline QOL on 1 instrument relative to surgery patients (CSS symptom [p = 0.019] and total scores [p = 0.010]). Surgical patients (n = 75) reported significantly more improvement than medically managed patients (RSDI, p = 0.015; CSS, p < 0.001). Surgical patients reported significantly fewer oral antibiotics (p = 0.002), oral steroids (p = 0.042), and missed days of work/school (p < 0.001) following ESS. After adjustment, more frequent improvement was found within the surgical cohort as measured by the RSDI physical (78.7% vs 56.4%; odds ratio [OR], 3.36; 95% confidence interval [CI], 1.15-9.87; p = 0.027), CSS symptom (80.6% vs 57.4%; OR, 2.65; 95% CI, 1.06-6.66; p = 0.038), medication (49.3% vs 29.6%; OR, 2.33; 95% CI, 0.96-5.64; p = 0.060), and total scores (76.4% vs 53.7%; OR, 2.20; 95% CI, 0.86-5.59; p = 0.099). CONCLUSION: Patients electing ESS experienced significantly higher levels of improvement in several outcomes. Further investigation with a larger cohort is warranted as treatment selection bias may confound the magnitude of improvement experienced with each treatment. © 2011 ARS-AAOA, LLC. |
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Authors:
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Timothy L Smith; Robert C Kern; James N Palmer; Rodney J Schlosser; Rakesh K Chandra; Alexander G Chiu; David Conley; Jess C Mace; Rongwei F Fu; James A Stankiewicz |
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Publication Detail:
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Type: Journal Article Date: 2011-06-06 |
Journal Detail:
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Title: International forum of allergy & rhinology Volume: 1 ISSN: 2042-6984 ISO Abbreviation: Int Forum Allergy Rhinol Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2012-01-30 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101550261 Medline TA: Int Forum Allergy Rhinol Country: United States |
Other Details:
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Languages: eng Pagination: 235-41 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC. |
Affiliation:
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Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR. smithtim@ohsu.edu. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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