Quality-of-life outcomes after sinus surgery in allergic fungal rhinosinusitis versus nonfungal chronic rhinosinusitis

Background:  Given the differences in pathophysiology between Allergic Fungal Rhinosinusitis (AFRS) and other CRS (chronic rhinosinusitis) subgroups, it remains unclear on whether these patients respond differently to a combination of surgical and medical treatment.  Objective: The aim of this study was to evaluate differences in quality of life (QoL) outcomes for a cohort of patients undergoing endoscopic sinus surgery (ESS) for CRS.  Methods:  This retrospective review included CRS patients who underwent ESS between 2010 and 2013. QoL was measured using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, SNOT-22 scores before ESS and 1, 3, 6, 9, and 12-months post-ESS. Groups tested were CRS with nasal polyposis (CRSwNPs), CRS without nasal polyposis (CRSsNPs), and patients with AFRS. A linear mixed effects regression model was utilized to calculate the adjusted mean QoL differences.  Results: Among the 250 patients included, 61.6% had CRSwNPs (n=154), 28.8% had CRSsNPs (n=72) and 9.6% had allergic fungal rhinosinusitis (n=24). Significant differences were seen in SNOT-22 scores between pre and post-operative visits and between the aetiological subgroups (p<0.001). Multivariate analysis revealed significantly greater improvement in QoL for patients with allergic fungal rhinosinusitis in comparison to those with CRSsNPs at 9-months [change in SNOT-22 = 22.6, 95% CI 1.2 – 44.1, p<0.03] and 12-months follow-up [change in SNOT-22 = 20.2, 95% CI 0.5 – 39.9, p<0.04].  Conclusions: Patients with allergic fungal rhinosinusitis experience a more prolonged QoL benefit from surgical and targeted medical intervention compared to those with CRSsNPs. This may reflect the severity of inflammation that they present with compared to other CRS subtypes.