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Productivity changes following medical and surgical treatment of chronic rhinosinusitis by symptom domain.

ABSTRACT: BACKGROUND:Chronic rhinosinusitis (CRS) is associated with substantial productivity losses. Prior cross-sectional study has identified risk factors and symptom subdomains contributing to baseline productivity loss. This study evaluates correlations between posttreatment changes in symptom subdomain and productivity loss. METHODS:A total of 202 adult patients with refractory CRS were prospectively enrolled into an observational, multi-institutional cohort study between August 2012 and June 2015. Respondents provided pretreatment and posttreatment 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Productivity losses were monetized using measures of absenteeism, presenteeism, lost leisure time, and U.S. government-estimated wage and labor rates. RESULTS:A total of 39 (19%) participants elected continued appropriate medical therapy (CAMT) and 163 (81%) elected endoscopic sinus surgery (ESS). CAMT patients experienced improvement in SNOT-22 total and rhinologic subdomain scores (both p ? 0.039). ESS patients reported improvement in SNOT-22 total scores and all subdomains (all p < 0.001). Mean monetized productivity losses were nearly unchanged following CAMT (-$200, p = 0.887) but significantly reduced following ESS (-$5,015, p < 0.001). Mean productivity losses were reported in CAMT patients reporting worse mean posttreatment extra-rhinologic, psychological, and sleep symptom severity scores; however, no statistically significant linear correlations (r ? 0.249; p ? 0.126) were reported. CONCLUSION:Treatment modalities associate with different posttreatment productivity changes. Patients electing ESS experienced postoperative improvement in productivity distributed across all SNOT-22 symptom domains, suggesting productivity improvement correlates with multiple symptom domains. Patients electing CAMT had better baseline productivity compared to patients electing ESS, and this productivity level was maintained through treatment. Greater productivity loss occurred in patients with worse SNOT-22 scores in the extra-rhinologic, psychological, and sleep subdomains.

SUBMITTER: Beswick DM

PROVIDER: S-EPMC6279579 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Productivity changes following medical and surgical treatment of chronic rhinosinusitis by symptom domain.

Beswick Daniel M DM Mace Jess C JC Rudmik Luke L Soler Zachary M ZM DeConde Adam S AS Smith Timothy L TL

International forum of allergy & rhinology 20180728 12

<h4>Background</h4>Chronic rhinosinusitis (CRS) is associated with substantial productivity losses. Prior cross-sectional study has identified risk factors and symptom subdomains contributing to baseline productivity loss. This study evaluates correlations between posttreatment changes in symptom subdomain and productivity loss.<h4>Methods</h4>A total of 202 adult patients with refractory CRS were prospectively enrolled into an observational, multi-institutional cohort study between August 2012 ...[more]

PMID: 30054977

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Project description:BackgroundThe sinus lift (or sinus augmentation) is a common procedure to improve maxillary bone stock before dental implantation. Chronic rhinosinusitis (CRS) is a potential complication of this procedure and may be refractory to medical treatment. Functional endoscopic sinus surgery has previously been used to address CRS, however, results of previous studies indicated that implant removal is required. There are limited follow-up data available.ObjectiveThe purpose of this study was to characterize the long-term outcomes and efficacy of endoscopic sinus surgery for refractory CRS after sinus lift, including the ability to salvage dental implants.MethodsThis was a retrospective case series that described nine patients who, between June 2011 and September 2016, underwent endoscopic sinus surgery for CRS after a sinus lift procedure. The presenting symptoms of the patients, medical management, imaging results, operative procedures, and outcomes were reviewed.ResultsThe majority of patients developed symptoms (mucopurulent nasal drainage, facial pain and/or pressure, nasal congestion, and foul smell) within 3 months of implant placement and were treated with at least three courses of antibiotics before referral to an otolaryngologist. All the patients underwent wide endoscopic maxillary antrostomy, with no surgical complications or postoperative reports of infection. There was a statistically significant improvement in 22-item Sino-Nasal Outcome Test scores (t(8) = -2.908; p = 0.02) and discharge, inflammation, and polyps/edema endoscopic scores ([z = -2.539; p = 0.011) between pre- and postsurgical treatment. Four patients had their dental implants removed before presentation. Among the five patients who presented with intact dental implants, none required removal before or after functional endoscopic sinus surgery.ConclusionFunctional endoscopic sinus surgery was a reasonable and efficacious treatment option for patients who presented with paranasal sinus disease after a sinus lift. Dental implant removal may not be a requirement for successful treatment of CRS associated with sinus lift procedures.

Project description:BACKGROUND:Chronic rhinosinusitis frequently occurs in people with cystic fibrosis. Several medical interventions are available for treating chronic rhinosinusitis in people with cystic fibrosis; for example, different concentrations of nasal saline irrigations, topical or oral corticosteroids, antibiotics - including nebulized antibiotics, dornase alfa and modulators of the cystic fibrosis transmembrane conductance regulator (CFTR) (such as lumacaftor, ivacaftor or tezacaftor). However, the efficacy of these interventions is unclear. OBJECTIVES:The objective of this review is to compare the effects of different medical interventions in people diagnosed with cystic fibrosis and chronic rhinosinusitis. SEARCH METHODS:We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference abstract books. Date of last search of trials register: 22 May 2019.We also searched ongoing trials databases, other medical databases and the reference lists of relevant articles and reviews. Date of latest additional searches: 20 May 2019. SELECTION CRITERIA:Randomized and quasi-randomized trials of different medical interventions compared to each other or to no intervention or to placebo. DATA COLLECTION AND ANALYSIS:Two review authors independently assessed trials identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with Cochrane methods and to independently rate the quality of the evidence for each outcome using the GRADE guidelines. MAIN RESULTS:We identified no trials that met the pre-defined inclusion criteria. The searches identified 47 trials, none of which were eligible for inclusion in the current version of this review. AUTHORS' CONCLUSIONS:We identified no eligible trials assessing the medical interventions in people with cystic fibrosis and chronic rhinosinusitis. High-quality trials are needed which should assess the efficacy of different treatment options detailed above for managing chronic rhinosinusitis, preventing pulmonary exacerbations and improving quality of life in people with cystic fibrosis.

Project description:OBJECTIVES/HYPOTHESIS:Previous studies have shown declines in productivity due to chronic rhinosinusitis (CRS) are correlated with disease-specific quality-of-life (QOL) measures. However, it is unclear which symptom domains contribute primarily to productivity loss. This investigation sought to assess the association between CRS-specific QOL subdomain impairment and productivity loss. STUDY DESIGN:Prospective, multi-institutional, observational cohort study. METHODS:There were 198 patients with refractory CRS enrolled between August 2012 and June 2015. Baseline QOL measures were obtained across five subdomains of the 22-item SinoNasal Outcome Test (SNOT-22). Lost productivity time was determined from patient-reported measures of annual absenteeism, presenteeism, and lost leisure time, and then monetized using annual daily wage rates from the 2012 US National Census and 2013 Department of Labor statistics. RESULTS:Productivity losses correlated with impairments in both SNOT-22 psychological dysfunction (Spearman correlation coefficient [Rs] = 0.428, P < .001), and sleep dysfunction domain scores (Rs = 0.355, P < .001). Higher SNOT-22 total scores also significantly correlated with increased monetized productivity losses (Rs = 0.366, P < .001). The mean annual productivity cost was $11,820/patient, whereas patients with comorbid immunodeficiency ($23,285/patient), tobacco use ($23,195/patient), and steroid dependency ($18,910/patient) reported higher than average annual productivity costs. Multivariate linear regression found maximum annual productivity costs in adjusted psychological ($13,300/patient, P < .001) and sleep dysfunction ($9,275/patient, P < .001) domains. CONCLUSIONS:Impairments in sleep and psychological SNOT-22 domains correlate with productivity losses. Patients with comorbid immunodeficiency, smoking, and steroid dependency had higher than average productivity losses. Targeted management of psychological and sleep dysfunction in combination with standard symptom control may improve patient-centered care and reduce the annual economic burden of CRS. LEVEL OF EVIDENCE:2c. Laryngoscope, 128:23-30, 2018.

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Productivity changes following medical and surgical treatment of chronic rhinosinusitis by symptom domain.

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Productivity changes following medical and surgical treatment of chronic rhinosinusitis by symptom domain.

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