Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA.
Int Forum Allergy Rhinol. 2011 Jul-Aug;1(4):235-41. doi: 10.1002/alr.20063. Epub 2011 Jun 6.
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.
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.
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).
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.
目前评估慢性鼻-鼻窦炎（CRS）各种治疗方法的比较效果的证据不足。本研究评估了初始药物治疗失败后选择后续治疗方案（继续药物治疗或内镜鼻窦手术（ESS）联合继续药物治疗）的患者的结局。
成年患者前瞻性入组至一项非随机、多机构队列研究。收集基线特征和客观临床发现。主要结局指标包括 2 种疾病特异性生活质量（QOL）量表：鼻-鼻窦炎患者生存质量量表（RSDI）和慢性鼻窦炎调查量表（CSS）。采用双变量和多变量分析比较了不同治疗类型的 QOL 改善情况，以及抗生素和口服类固醇的使用差异和工作/学业生产力。
2009 年 3 月至 2010 年 4 月期间共纳入 180 名患者。选择药物治疗的患者（n=55）在一项量表上的基线 QOL 评分明显优于手术患者（CSS 症状评分[P=0.019]和总分评分[P=0.010]）。手术患者（n=75）报告的改善程度明显高于接受药物治疗的患者（RSDI，P=0.015；CSS，P<0.001）。手术患者报告使用的口服抗生素（P=0.002）、口服类固醇（P=0.042）和缺勤天数（P<0.001）明显减少。调整后，手术组的 RSDI 躯体功能（78.7% vs 56.4%；优势比[OR]，3.36；95%置信区间[CI]，1.15-9.87；P=0.027）、CSS 症状（80.6% vs 57.4%；OR，2.65；95% CI，1.06-6.66；P=0.038）、药物治疗（49.3% vs 29.6%；OR，2.33；95% CI，0.96-5.64；P=0.060）和总分（76.4% vs 53.7%；OR，2.20；95% CI，0.86-5.59；P=0.099）的改善程度显著更高。
选择 ESS 的患者在多项结局上经历了显著更高水平的改善。需要更大的队列进一步研究，因为治疗选择偏倚可能会影响每种治疗方法的改善程度。
