Effect of Functional Endoscopic Sinus Surgery on Quality of Life in Patients With Chronic Rhinosinusitis: A Nonrandomized Trial

Abstract

Background: Chronic rhinosinusitis (CRS) is a persistent inflammatory disorder of the nose and paranasal sinuses characterized by substantial symptom burden and disease-specific impairment of quality of life. Functional endoscopic sinus surgery (FESS) is offered to patients who remain symptomatic despite adequate medical therapy, and outcome assessment should encompass both patient-reported and objective endoscopic measures. Objective: The aim of this study was to evaluate the effect of FESS on disease-specific quality of life and objective endoscopic status in patients with CRS and to compare preoperative disease burden between CRS phenotypes. Methods: This nonrandomized trial enrolled 96 patients diagnosed with CRS who underwent FESS at a tertiary care center. Baseline demographic data, CRS phenotype (with or without nasal polyps), presenting symptoms, comorbidities, and anterior rhinoscopy findings were recorded. Quality of life was assessed using the validated 22-item Sino-Nasal Outcome Test (SNOT-22) preoperatively and at three and six months postoperatively. Objective endoscopic status was evaluated using the Lund-Kennedy endoscopic score at identical time points. Preoperative scores were compared between CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) using Welch's independent-samples t-test. Longitudinal changes in scores were assessed using the Friedman repeated-measures test, and categorical severity distributions were compared with the chi-square test. Results: The mean age was 39.96 ± 10.39 years, and 63 (65.6%) patients were male. Nasal blockage was present in 93 (96.9%) patients, nasal discharge in 85 (88.5%), and smell disturbance in 67 (69.8%). CRSwNP was identified in 59 patients (61.5%). Patients with CRSwNP had a significantly higher mean preoperative SNOT-22 score than those with CRSsNP (45.20 ± 12.87 vs. 39.22 ± 11.71; p = 0.021) and a significantly higher mean preoperative Lund-Kennedy score (9.92 ± 2.44 vs. 7.41 ± 2.49; p < 0.001). Following FESS, the overall mean SNOT-22 score decreased from 42.90 ± 12.72 preoperatively to 12.50 ± 7.98 at three months and 9.65 ± 6.33 at six months (p < 0.001). The proportion of patients in the severe SNOT-22 category (score >50) decreased from 30 (31.2%) preoperatively to 0 (0%) at both postoperative assessments, while the proportion in the mild category increased from 4 (4.2%) to 90 (93.8%) by six months. The mean Lund-Kennedy score decreased from 8.95 ± 2.74 at baseline to 3.61 ± 2.23 at three months (59.6% reduction) and 1.16 ± 1.42 at six months (87.1% reduction; p < 0.001). Conclusion: FESS significantly and consistently improved both disease-specific quality of life and objective endoscopic findings in patients with medically refractory CRS. Patients with nasal polyps had a higher disease burden before surgery, yet both polyp and non-polyp groups experienced meaningful postoperative improvements. Using both the SNOT-22 questionnaire and the Lund-Kennedy endoscopic score offers a thorough and clinically relevant method to assess surgical outcomes in CRS.