Costa Milena L, Psaltis Alkis J, Nayak Jayakar V, Hwang Peter H
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
Department of Otolaryngology, Clinics Hospital, School of Medicine, University of São Paulo, São, Paulo, Brazil.
Int Forum Allergy Rhinol. 2015 Aug;5(8):667-73. doi: 10.1002/alr.21533. Epub 2015 May 7.
Treatment indications for recurrent acute rhinosinusitis (RARS) remain poorly defined. We studied outcomes of medical vs surgical treatment of RARS, anatomic variants associated with RARS, and factors predicting crossover from medical to surgical treatment.
A total of 220 RARS patients treated between 2006 and 2014 were retrospectively divided into 3 cohorts: medical only (MED); surgical only (SURG); or medical crossing over into surgical (CROSS). Twenty-two item Sino-Nasal Outcome Test (SNOT-22) scores, modified Lund-Kennedy endoscopy scores, and prevalence of anatomic variants by computed tomography (CT) were compared. A total of 220 CT scans obtained for non-sinus indications served as controls. A logistic regression model was used for analysis.
The mean baseline SNOT-22 scores for all cohorts were similar (MED = 48, SURG = 49, CROSS = 45, p < 0.0001). The SURG cohort showed greater reduction of SNOT-22 scores compared to the MED cohort at 3, 6, and 12 months follow-up (p < 0.0001). The crossover cohort converted to surgery after escalation of SNOT-22 score by a mean of 15 points (p < 0.03), and showed significant reduction postoperatively (p < 0.0001). Haller cell (odds ratio [OR] 3.9; p < 0.0001), concha bullosa (OR 3.7; p < 0.003), and accessory ostium (OR 2.2; p < 0.01) were more common in the entire RARS group vs controls; however, there were no inter-cohort differences in prevalence.
RARS patients can benefit from both medical and surgical treatment strategies, but surgical treatment results in greater symptomatic improvement compared to medical treatment. Patients cross over from medical to surgical treatment when SNOT-22 scores escalate by a mean of 15 points. Haller cell, concha bullosa, and accessory ostium are associated with RARS but are equally common in medical, surgical, and crossover cohorts.
复发性急性鼻-鼻窦炎（RARS）的治疗指征仍不明确。我们研究了RARS的药物治疗与手术治疗的效果、与RARS相关的解剖变异以及预测从药物治疗转为手术治疗的因素。
对2006年至2014年间接受治疗的220例RARS患者进行回顾性分组，分为3组：单纯药物治疗组（MED）；单纯手术治疗组（SURG）；药物治疗后转为手术治疗组（CROSS）。比较22项鼻-鼻窦结局测试（SNOT-22）评分、改良的Lund-Kennedy内镜评分以及计算机断层扫描（CT）显示的解剖变异患病率。以220例因非鼻窦指征进行的CT扫描作为对照。采用逻辑回归模型进行分析。
所有组的平均基线SNOT-22评分相似（MED = 48，SURG = 49，CROSS = 45，p < 0.0001）。在3个月、6个月和12个月的随访中，SURG组的SNOT-22评分较MED组下降更明显（p < 0.0001）。CROSS组在SNOT-22评分平均升高15分后转为手术治疗（p < 0.03），术后评分显著降低（p < 0.0001）。与对照组相比，整个RARS组中Haller气房（优势比[OR] 3.9；p < 0.0001）、泡状鼻甲（OR 3.7；p < 0.003）和副鼻窦口（OR 2.2；p < 0.01）更为常见；然而，各组之间的患病率无差异。
RARS患者可从药物和手术治疗策略中获益，但与药物治疗相比，手术治疗能带来更显著的症状改善。当SNOT-22评分平均升高15分时，患者会从药物治疗转为手术治疗。Haller气房、泡状鼻甲和副鼻窦口与RARS相关，但在药物治疗组、手术治疗组和转换治疗组中同样常见。
