Among patients with both chronic rhinosinusitis (CRS) and aspirin-exacerbated respiratory disease (AERD), endoscopic sinus surgery (ESS) followed by aspirin desensitization was associated with a significant improvement in overall psychosocial burden, according to study results published in World Journal of Otorhinolaryngology-Head and Neck Surgery.
It is widely accepted that CRS is associated with significant functional and emotional impairment. Previous studies have shown that patients with AERD have worse disease, poorer quality of life, and higher financial costs than in those with CRS alone. Improvement in overall disease burden has been demonstrated after aspirin desensitization and ESS, but the psychosocial effect of these interventions has not been well studied. To address this gap, researchers studied the psychosocial effect of ESS followed by aspirin desensitization in patients with AERD using a validated sinonasal outcome questionnaire.
A retrospective review was conducted among all patients (n=184) with AERD who underwent ESS at a tertiary care academic medical center between November 2009 and November 2018. Patients were divided into 2 cohorts: those who underwent aspirin desensitization after surgery (n=130) and those who remained nondesensitized (n=54). Outcomes were assessed using the Sino-Nasal Outcome Test (SNOT-22). Specific attention was focused on the psychosocial domain including “reduced productivity,” “reduced concentration,” “frustrated,” “sad,” and “embarrassed.” The SNOT-22 was administered preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively.
There was a significant reduction in total SNOT-22 scores over the study period in patients who underwent aspirin desensitization compared with patients who remained nondesensitized (P =.0446). The baseline SNOT-22 score did not differ between the 2 groups (P =.9092) but was significantly different at 12 months (P =.0036). There was a marked improvement in patient productivity in the sensitized cohort over the study period (P =.0214) compared with the nondesensitized cohort.
Because of participant attrition, there was also a subgroup analysis conducted among patients who had SNOT-22 data at all time points. There was a significant reduction in total SNOT-22 scores over the study period in sensitized patients compared with nondesensitized patients (P =.0298) and a trending reduction in the psychosocial domain (P =.0547). Specifically, there was significant improvement in (Q1) “reduced productivity” (P =0.0068) and (Q2) “reduced concentration” (P =.0428) in desensitized vs the nondesensitized group. The baseline scores of Q1 and Q2 did not differ between the 2 groups (Q1: P =.7823; Q2: P =.5431) but were significantly different at 12 months (Q1: P =.0257; Q2: P =.0477).
The authors acknowledged the study limitations, including inherent limitations of a retrospective study, variability in lengths of patient follow-up, and that time points were presented as a range because of differences in postoperative follow-up and survey bias.
“AERD patients appear to benefit psychologically from a multidisciplinary approach for control of disease burden. In our analysis, complete endoscopic sinus surgery followed by aspirin desensitization resulted in a significant improvement in patient productivity and concentration,” the researchers wrote. “Future studies will aim to evaluate the psychosocial burden of AERD as it compares to other chronic conditions.”
Locke T, Sweis A, Lin T, et al. The impact of endoscopic sinus surgery and aspirin desensitization on psychological burden in aspirin-exacerbated respiratory disease. World J Otorhinolaryngol Head Neck Surg. 2020; 6:214-219.