Physician, Patient Perspectives on Successful Chronic Rhinosinusitis Management

Metrics of success in the treatment of chronic rhinosinusitis (CRS) should include minimizing patient impairment and risk, according to research presented at the 2021 AAO-HNSF Annual Meeting.

In their presentation, Ahmad R. Sedaghat, MD, PhD, and Stacey T. Gray, MD, FACS, discuss both patient and physician perspectives for successful control of CRS, a condition that affects approximately 5% of the population and has a significant effect on quality of life.

Treatment of CRS can include saline irrigations, intranasal steroids, leukotriene-modifying agents, low dose macrolides, antibiotics, oral steroids, biologics, and endoscopic sinus surgery. Generally, patients are started at one end of the spectrum with saline irrigations and steroid sprays and progress to treatments such as biologics and sinus surgery when first-line therapies have failed.

Findings from studies reporting on patient outcomes using the 22-item Sinonasal Outcome Test (SNOT-22) show that CRS patients are mainly affected by 4 types of symptoms. These include nasal symptoms, poor sleep quality, craniofacial discomfort, and emotional disturbance. Of these, sleep and craniofacial discomfort were most associated with a decrease in quality of life and success was associated with improvement in these symptoms.

Nasal symptoms, however, are what patients notice most with respect to their disease, said Dr Sedaghat. Findings from patient-reported studies show nasal obstruction and nasal drainage drive how patients report disease control. Olfactory dysfunction, while burdensome, was found to be a secondary outcome for CRS improvement.

Successful CRS management also includes minimizing risks for patients, including acute exacerbations. With regard to pharmacotherapy, frequent CRS/polyp-related prednisone tapers can put a patient at significant risk of drug-related adverse effects when looking at the cumulative amounts of steroid used. Dr Sedaghat noted that in his research, systemic medication usage (CRS-related antibiotics and corticosteroids) in the last 3 months was found to be an “independent and valid metric of disease burden.”

From the physician perspective, CRS disease control was found to be significantly associated with SNOT-22 score (symptom burden) as well as systemic medication usage in the prior 3 months, while endoscopic and radiographic findings were not associated with overall control for CRS patients. Studies have shown a poor correlation between objective measures of disease (endoscopic exam, CT scan) and patient symptoms, though Dr Gray noted that more information is needed to ascertain whether objective measurements can be used to understand control.

Dr Gray concluded that success in the treatment of CRS comes in many forms and physicians “must avoid being myopic with respect to focusing on just diagnostic sinonasal symptoms.”

Reference

Sedaghat AR, Gray ST. Measuring success in chronic rhinosinusitis. Presented at: AAO-HNSF 2021 Annual Meeting; October 2-6, 2021; Los Angeles, CA.