The Impact of Type II Diabetes Mellitus on Sinonasal Symptoms after Resection of Inverted Papilloma

Objectives: Inverted papilloma (IP) is a benign but locally destructive tumor in the sinonasal cavity. Treatment of IP consists of surgical resection with endoscopic sinus surgery (ESS). Patients with type II diabetes mellitus (DMII) are known to have systemic manifestations of their disease, including poor wound healing after surgery. The Sinonasal Outcomes Test (SNOT-22) is a validated tool to assess patient quality of life and the burden of symptoms from sinonasal disease. The goal of this study was to compare postoperative quality of life, based on SNOT-22, after resection of inverted papilloma in patients with and without DMII.

Methods: Patients who underwent ESS for IP at a tertiary care center between 2012 and 2019 were identified for this retrospective cohort study. Demographic information for these patients was collected, including diagnosis of DMII. SNOT-22 scores were recorded preoperatively and postoperatively at 1-, 3-, 6-, and 12- months. Student's t-tests were used to compare SNOT-22 scores between individuals with and without DMII at each time point.

Results: Of the 131 patients who underwent resection of IP, 20 patients had a diagnosis of DMII (15.2%). The average preoperative hemoglobin A1C for patients with diabetes was 6.33 with a standard deviation of 0.93. There were no statistically significant differences in SNOT-22 scores preoperatively (p = 0.42), at 1 month (p = 0.55), or at 3 months (p = 0.79) between patients with and without diabetes. SNOT-22 scores were lower in patients with DMII with an average score of 4.00 + 2.71 at 6 months (p < 0.01) and 6.78 + 7.80 at 12 months post-operatively (p < 0.05). Both cohorts demonstrated significant improvement in SNOT-22 scores 12 months after surgery, with an average decrease of 13.0 + 15.8 points (p < 0.01) at 12 months in individuals with diabetes and 12.6 + 17.0 points (p < 0.01) in individuals without diabetes.

Conclusion: Although systemic inflammation associated with hyperglycemia in DMII has been associated with poor wound healing, we discovered that patients with DMII experience similar reduction in the burden of sinonasal symptoms after undergoing surgical resection of IP. These findings suggest that in moderate to well-controlled diabetics, quality of life outcomes will not be compromised after surgery ([Fig. 1]).[1]-[3]

Fig. 1 Sinonasal Outcome Test (SNOT-22) scores after resection of inverted papilloma for patients with and without type II diabetes mellitus (DMII). Patients with and without diabetes were identified and SNOT-22 scores were recorded preoperatively and at 1, 3, 6, and 12 months postoperatively after endoscopic resection of inverted papilloma (* p < 0.05, ** p < 0.01).

Publication History

Article published online:
15 February 2022

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