DeConde Adam S, Mace Jess C, Ramakrishnan Vijay R, Alt Jeremiah A, Smith Timothy L
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, U.S.A.
Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, Oregon, U.S.A.
Laryngoscope. 2018 Feb;128(2):304-310. doi: 10.1002/lary.26788. Epub 2017 Aug 4.
Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may "cross over" to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality.
Retrospective analysis of a prospective, multi-center cohort of adult patients with CRS enrolled between March 2011 and June 2015 in academic, tertiary referral clinics.
Subjects who initially elected CMT were followed up to 18 months, provided a comprehensive medical history, and completed the 22-item SinoNasal Outcome Test (SNOT-22) at baseline and during 6-month follow-up intervals. Hazard regression modeling was used to identify covariates associated with elective change in treatment modality.
One hundred seventy-nine subjects were followed for an average 15.1 (standard deviation ± 4.6) months. Subjects who elected ESS (55 of 179) had significantly worse average endoscopy scores and reported worse SNOT-22 sleep dysfunction scores at baseline (P ≤ 0.026). For each single increasing (worsening) point of Lund-Kennedy endoscopy score, the hazard ratio (HR) of crossover increased by ∼6%. Similarly, for every point of worsening in baseline SNOT-22 total score, the hazard of treatment crossover increased by ∼2%. After covariate adjustment, only baseline SNOT-22 sleep dysfunction scores were associated with an increased risk of treatment crossover (HR = 1.07; 95% confidence interval: 1.02-1.11; P = 0.003).
Baseline total SNOT-22 and endoscopy scores are associated with treatment crossover, but reported sleep dysfunction is the only significant independent predictor of treatment crossover.
2c. Laryngoscope, 128:304-310, 2018.
药物难治性慢性鼻窦炎（CRS）可通过适当的持续药物治疗（CMT）或手术加CMT来处理。最初选择CMT但症状未得到充分缓解的患者可能会“转而”接受鼻内镜手术（ESS）。我们的目的是确定与选择这种治疗方式改变的这部分患者相关的协变量。
对2011年3月至2015年6月在学术性三级转诊诊所登记的成年CRS患者的前瞻性多中心队列进行回顾性分析。
最初选择CMT的受试者随访18个月，提供全面的病史，并在基线和6个月随访间隔期间完成22项鼻鼻窦结局测试（SNOT-22）。采用风险回归模型确定与治疗方式选择性改变相关的协变量。
179名受试者平均随访15.1（标准差±4.6）个月。选择ESS的受试者（179名中的55名）在基线时平均内镜评分明显更差，且报告的SNOT-22睡眠功能障碍评分更差（P≤0.026）。Lund-Kennedy内镜评分每增加（恶化）1个单位，转而接受手术的风险比（HR）增加约6%。同样，基线SNOT-22总分每恶化1分，治疗方式转变的风险增加约2%。在进行协变量调整后，只有基线SNOT-22睡眠功能障碍评分与治疗方式转变风险增加相关（HR = 1.07；95%置信区间：1.02 - 1.11；P = 0.003）。
基线SNOT-22总分和内镜评分与治疗方式转变相关，但报告的睡眠功能障碍是治疗方式转变的唯一显著独立预测因素。
2c。《喉镜》，2018年，第128卷，第304 - 310页。
