Hessler Jill L, Piccirillo Jay F, Fang David, Vlahiotis Anna, Banerji Aleena, Levitt Robert G, Kramper Maggie A, Thawley Stanley E, Hamilos Daniel L
Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Am J Rhinol. 2007 Jan-Feb;21(1):10-8. doi: 10.2500/ajr.2007.21.2960.
Little information exists regarding the outcome of medical management of chronic rhinosinusitis (CRS) in adults. The aim of this study was to examine whether baseline patient demographics, symptoms, objective findings, or treatment strategies were associated with improved CRS outcomes over time.
Eighty-four new patients with CRS were evaluated and medically treated for up to 12 months. Patients completed monthly health status questionnaires. The average change of symptom scores using the Sino-Nasal Outcome Test plus one additional symptom--sense of smell (SNOT-20+1)-was the primary outcome measure.
Overall, patients experienced a modest improvement in SNOT-20+1 scores (delta = -0.61; p< 0.0001), but this did not reach the predetermined level of a clinically meaningful effect (delta = -0.80). Baseline facial pain or facial pressure was negatively associated with outcome (p = 0.048 and 0.029, respectively) and did not correlate with extent of disease by sinus CT scoring. Other factors, including nasal discharge, hyposmia, cough, nasal polyps, and sinus CT severity, did not predict outcomes. The use of either oral antibiotics or oral steroids was associated with trends toward improved outcomes only when sinus-specific symptoms alone were considered.
The majority of CRS patients receiving medical treatment show modest improvement over time in SNOT-20+1 scores. Facial pain or facial pressure at entry are negatively associated with outcomes and may reflect causes other than CRS. These findings highlight the limitations of current medical treatment for CRS and the need for novel treatment strategies.
关于成人慢性鼻-鼻窦炎（CRS）药物治疗效果的信息较少。本研究的目的是探讨基线患者人口统计学特征、症状、客观检查结果或治疗策略是否与CRS随时间推移的改善结果相关。
对84例新诊断的CRS患者进行评估并给予长达12个月的药物治疗。患者每月完成健康状况问卷。使用鼻窦结局测试加一项额外症状——嗅觉（SNOT-20+1）的症状评分平均变化是主要结局指标。
总体而言，患者的SNOT-20+1评分有适度改善（差值=-0.61；p<0.0001），但未达到临床有意义效果的预定水平（差值=-0.80）。基线面部疼痛或面部压迫感与结局呈负相关（分别为p=0.048和0.029），且与鼻窦CT评分的疾病程度无关。其他因素，包括鼻分泌物、嗅觉减退、咳嗽、鼻息肉和鼻窦CT严重程度，均不能预测结局。仅在考虑鼻窦特异性症状时，使用口服抗生素或口服类固醇与结局改善趋势相关。
大多数接受药物治疗的CRS患者的SNOT-20+1评分随时间有适度改善。初始时的面部疼痛或面部压迫感与结局呈负相关，可能反映了CRS以外的原因。这些发现凸显了当前CRS药物治疗的局限性以及对新治疗策略的需求。
