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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2023; 27(02): e274-e277
DOI: 10.1055/s-0043-1768206
Original Research

The Value of Multiple Medication Trials Prior to Balloon Sinuplasty in the Management of Chronic Sinonasal Disease

Anand G. Shah
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, San Antonio Health Science Center, University of Texas, San Antonio, Texas, United States.
,
Macaulay Ojeaga 
2   Rio Grande Valley School of Medicine, University of Texas, Edinburg, Texas, United States.
,
Josephine Novak
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, San Antonio Health Science Center, University of Texas, San Antonio, Texas, United States.
,
Vincent Honrubia
3   South Texas Sinus Institute, McAllen, Texas, United States.
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Abstract

Introduction In patients with chronic rhinosinusitis, conservative interventions with extended medical trials are often attempted prior to procedural treatment. Balloon sinuplasty (BSP) is an established procedure for symptomatic relief from chronic rhinosinusitis. However, data suggesting the suboptimal efficacy of prolonged medication management trials, prior to BSP, is lacking.

Objectives The purpose of this study was to evaluate the efficacy of prolonged medication management trials, prior to BSP, for patients with chronic rhinosinusitis.

Methods A retrospective review was performed for all adults with chronic rhinosinusitis who received extended medical management prior to their BSP at two outpatient clinics, from November 1, 2013, to June 31, 2018. The patients' Sino-Nasal Outcome Test (SNOT) scores were compared between baseline, post-medication trials, and post-BSP.

Results The SNOT scores of a total of 64 patients were collected. Overall, patients showed a significant worsening of symptoms during the medication management trials from baseline (p = 0.002126) but significant improvement of symptoms after undergoing BSP (p < 0.0001).

Conclusion The patient symptom burden worsened and prolonged during medication management trials. The BSP procedure alone showed significant improvement in the quality of life for chronic rhinosinusitis patients, when considering their SNOT scores. The worsening of patients' symptoms during medication management may invalidate the necessity of prolonged medication management trials.

Keywords

rhinology - allergy - chronic rhinosinusitis - upper airway inflammation - otolaryngology - sinus surgery


Publication History

Received: 30 June 2020

Accepted: 01 December 2021

Article published online:
28 April 2023

© 2023. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Chaaban MR, Baillargeon JG, Baillargeon G, Resto V, Kuo YF. Use of balloon sinuplasty in patients with chronic rhinosinusitis in the United States. Int Forum Allergy Rhinol 2017; 7 (06) 600-608
    CrossrefPubMedGoogle Scholar
  • 2 Lee S, Lane AP. Chronic rhinosinusitis as a multifactorial inflammatory disorder. Curr Infect Dis Rep 2011; 13 (02) 159-168
    CrossrefPubMedGoogle Scholar
  • 3 Raghunandhan S, Bansal T, Natarajan K, Kameswaran M. Efficacy & outcomes of balloon sinuplasty in chronic rhinosinusitis: a prospective study. Indian J Otolaryngol Head Neck Surg 2013; 65 (Suppl. 02) 314-319
    CrossrefPubMedGoogle Scholar
  • 4 Taghi AS, Khalil SS, Mace AD, Saleh HA. Balloon Sinuplasty: balloon-catheter dilation of paranasal sinus ostia for chronic rhinosinusitis. Expert Rev Med Devices 2009; 6 (04) 377-382
    CrossrefPubMedGoogle Scholar
  • 5 Slavin RG, Spector SL, Bernstein IL. et al; American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol 2005; 116 (06) S13-S47
    CrossrefPubMedGoogle Scholar
  • 6 Bhattacharyya N. Incremental health care utilization and expenditures for chronic rhinosinusitis in the United States. Ann Otol Rhinol Laryngol 2011; 120 (07) 423-427
    CrossrefPubMedGoogle Scholar
  • 7 Rudmik L, Soler ZM, Mace JC, Schlosser RJ, Smith TL. Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis. Laryngoscope 2015; 125 (01) 25-32
    CrossrefPubMedGoogle Scholar
  • 8 Rudmik L, Smith TL, Schlosser RJ, Hwang PH, Mace JC, Soler ZM. Productivity costs in patients with refractory chronic rhinosinusitis. Laryngoscope 2014; 124 (09) 2007-2012
    CrossrefPubMedGoogle Scholar
  • 9 Rosenfeld RM, Piccirillo JF, Chandrasekhar SS. et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015; 152 (02) S1-S39
    PubMedGoogle Scholar
  • 10 Smith TL, Kern R, Palmer JN. et al. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study with 1-year follow-up. Int Forum Allergy Rhinol 2013; 3 (01) 4-9
    CrossrefPubMedGoogle Scholar
  • 11 Soler ZM, Jones R, Le P. et al. Sino-Nasal outcome test-22 outcomes after sinus surgery: A systematic review and meta-analysis. Laryngoscope 2018; 128 (03) 581-592
    CrossrefPubMedGoogle Scholar
  • 12 Payne SC, Stolovitzky P, Mehendale N. et al. Medical therapy versus sinus surgery by using balloon sinus dilation technology: A prospective multicenter study. Am J Rhinol Allergy 2016; 30 (04) 279-286
    CrossrefPubMedGoogle Scholar