Response to medical or surgical therapy in chronic rhinosinusitis: A one year prospective analysis

Introduction: Chronic rhinosinusitis (CRS) is treated with both surgical and medication options. However, long term data on patient outcomes is rare. In a real world clinical environment, our objective was to identify CRS patients, gather patient characteristics, and follow symptoms over one year. Patients and methods: This observational study enrolled patients with CRS. Primary clinical markers included atopy testing, serum IgE, and complete blood counts. A sinus computerized tomography (CT) scan was performed serially. Patients were enrolled into medical treatment Arm A and into surgical treatment Arm B. Symptom scores were calculated using the chronic sinusitis survey (CSS). Results: Atopy testing was positive in 67%. IgE levels or atopy did not correlate with CSS scores. A 23% decrease in total CSS scores was noted in Arm A at one year (P = .01). Arm B demonstrated a 38% reduction in total CSS scores at 3 months (P = .02) only. CT evidence of CRS was found in 74% of patients. However, CT scores did not change significantly over 12 months. Conclusions: No correlation was found between serum IgE levels or atopy versus CSS scores. CT scan scores did not change significantly over 12 months in either treatment group. A reduction of CSS scores was seen in both treatment groups; however a rebound effect was suggested in the surgical arm. Our study demonstrates the disconnection between clinical markers, radiographic evidence and response to therapy in CRS in a common clinical setting. It exemplifies the need for controlled studies with years of chronic rhinosinusitis outcome analysis. (C) 2009 SEICAP. Published by Elsevier Espaha, S.L. All rights reserved.