Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR, USA.
Am J Rhinol Allergy. 2024 Jul;38(4):237-244. doi: 10.1177/19458924241246371. Epub 2024 Apr 16.
Environmental exposures have been postulated to play an important role in the pathophysiology of chronic rhinosinusitis (CRS). Particulate matter (PM) is one of the most widely studied ambient air pollutants, but its peri-operative impact on CRS is unknown.
To determine the effect of acute, peri-operative PM exposure on outcomes after endoscopic sinus surgery (ESS).
Participants with CRS who self-selected ESS were prospectively enrolled. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility values scores were recorded. Using residence zip codes, a secondary analysis of patient exposure to PM <2.5 μm and <10 μm (PM2.5 and PM10, respectively) was performed for the month of surgery utilizing data from Environmental Protection Agency air quality monitors. Spearman's correlation coefficients (ρ), 95% confidence intervals (CIs), and effect estimates (β) were used to determine the magnitudes of association. Simple, multivariate regression analysis was also completed.
One hundred and seven patients from four geographically unique institutions across the US were enrolled with a follow-up of 6 months. Patients with higher peri-operative PM2.5 exposure had less improvement in their SNOT-22 scores after ESS compared to those with less exposure using both univariate analysis (ρ = 0.26, 95% CI: 0.08, 0.43; = .01) and after covariate adjustment with multivariate analysis ( = 1.06, 95% CI: 0.001, 2.14, = .05). Similar associations were not found with SF-6D outcomes or with PM10 as an exposure of interest. No significant correlations were found between peri-operative PM levels and Lund-Kennedy endoscopy scores post-operatively.
Preliminary data from this pilot study reveal that PM exposure at the time of ESS may negatively associate with post-operative improvement in sinonasal quality-of-life. Larger, population-based studies with more standardized PM exposure windows are needed to confirm the clinical significance of the present findings.
环境暴露被认为在慢性鼻-鼻窦炎（CRS）的病理生理学中起着重要作用。颗粒物（PM）是研究最广泛的环境空气污染物之一，但它对 CRS 的围手术期影响尚不清楚。
确定急性围手术期 PM 暴露对内镜鼻窦手术（ESS）后结果的影响。
前瞻性招募选择 ESS 的 CRS 患者。记录 22 项鼻-鼻窦结局测试（SNOT-22）和医疗结局研究短式 6 项健康调查量表（SF-6D）健康效用值评分。使用居住邮政编码，通过美国环境保护署空气质量监测器的数据，对手术当月患者暴露于 PM<2.5μm 和 PM<10μm（分别为 PM2.5 和 PM10）进行二次分析。使用 Spearman 相关系数（ρ）、95%置信区间（CI）和效应估计（β）来确定关联的大小。还完成了简单的多变量回归分析。
来自美国四个地理位置独特的机构的 107 名患者入组，随访 6 个月。与暴露水平较低的患者相比，围手术期 PM2.5 暴露较高的患者在 ESS 后 SNOT-22 评分的改善较小，这一点无论是在单变量分析（ρ=0.26，95%CI：0.08，0.43；P=.01）还是在多变量分析中调整协变量后（β=1.06，95%CI：0.001，2.14，P=.05）均如此。SF-6D 结果或作为研究对象的 PM10 与结果之间未发现类似的关联。术后 Lund-Kennedy 内镜评分与围手术期 PM 水平之间未发现显著相关性。
这项初步的试点研究数据表明，ESS 时的 PM 暴露可能与术后鼻-鼻窦生活质量的改善呈负相关。需要更大规模的、基于人群的研究，并采用更标准化的 PM 暴露窗口来证实本研究结果的临床意义。
