Introduction

Chronic rhinosinusitis significantly affects the quality of life by interfering with general health, vitality, and social functioning, and causes a decrease in productivity in the workforce. Chronic rhinosinusitis represents an important healthcare problem worldwide. Rhinosinusitis is defined as a group of disorders characterized by inflammation of the mucosa of the nose and paranasal sinuses. Environmental and host-related factors are involved in the spread of rhinosinusitis [1]

Chronic rhinosinusitis is a disorder characterized by inflammation of the mucosa of the nose and paranasal sinuses for at least 12 consecutive weeks duration. Due to Inflammation of the nasal and paranasal mucosa, ostial obstruction and retention of secretions occur, which further leads to secondary infection. Inflammation causes mucociliary dysfunction thereby continuing the condition. Various local and systemic factors can contribute to the pathogenesis of chronic rhino-sinusitis. Chronic sinusitis may be associated with nasal polyposis. Sinonasal allergy is often a simultaneous finding. Chronic rhinosinusitis may present with or without a polyp.

The symptoms are divided into major and minor categories. Major Symptoms and Signs include- Facial pain & pressure, Facial congestion &fullness, Nasal obstruction &blockage, Nasal discharge &purulence, Discolored posterior drainage, Hyposmia & anosmia, Purulence on nasal examination, Fever (acute rhinosinusitis only).

Minor Symptoms and Signs include- Headache, Fever (nonacute rhinosinusitis), Halitosis, Fatigue, Dental pain, Cough, Ear pain, pressure & fullness.

For the diagnosis of rhinosinusitis, either two major factors or one major and two minor factors are required.

Functional endoscopic sinus surgery (FESS) is a minimally invasive technique in which the sinus Ostia is opened under direct visualization, to restore sinus ventilation and normal function. Functional endoscopic sinus surgery adjuvant to medical treatment is the surgical treatment of diseases of the nose and sinuses refractory to medical treatment [2]

There is a variety of tools that are used to assess symptomatic improvement after functional endoscopic sinus surgery.

Sinonasal outcome test-22: The SNOT-22 is a validated, self-administered questionnaire that is used to assess chronic rhinosinusitis patients [3]

Toma S, and Hopkins C propose a statistically validated definition for stratification of the SNOT-22, with Mild being defined on the SNOT-22 score as 8–20 inclusive, Moderate as > 20–50, and Severe as > 50 [4]

This study aims to assess the symptomatic profile in patients with chronic rhinosinusitis before and after functional endoscopic sinus surgery. various methods have been designed to evaluate the quality of life and symptomatic improvement after functional endoscopic sinus surgery among which Sino-nasal outcome test-22 is the most valid questionnaire, a modification of pre-existing SNOT-20 score, used in this study.

Materials and Methods

Source of Data

The data regarding cases collected from admitted patients in the department of ENT, Dr. S.N. Medical College, jodhpur from February 2021 to September 2022. A total of 50 patients were included in our study who underwent functional endoscopic sinus surgery. Informed consent was taken from individual participants.

Inclusion Criteria

  1. 1)

    Diagnosed patients of chronic rhinosinusitis with or without sinonasal polyposis, aged between 18 and 60 years who gave consent for surgery and underwent surgery (functional endoscopic sinus surgery).

  2. 2)

    Patients whose phone numbers were accessed from records.

  3. 3)

    Patients whose data was collected on follow-up visits in OPD.

Exclusion Criteria

  1. 1)

    Patients whose data could not be taken as communication with them could not be made.

  2. 2)

    Patients lost to follow-up in OPD.

  3. 3)

    Patients with asthma, and atopy were excluded the from study.

Evaluation and Assessment

The patient’s symptoms were assessed by the SNOT-22 questionnaire (Annexure 1) preoperatively. All the patients underwent functional endoscopic sinus surgery. Symptom scoring of all patients was done with SNOT-22 score postoperatively at 1 month and 3 months follow-up.

Observations and Results

A total of 50 patients were included in our study, 42 patients were telephonically communicated and followed up, and 8 patients were lost to follow-up, so 42 patients’ data were analyzed. Data were collected with regard to demographic details, and preoperative and postoperative SNOT-22 score of individual patients. The same was analyzed and has been presented here.

In our study, the highest-rated symptom in the nasal symptoms was blockage/congestion of the nose with a mean score of 4.67 and the lowest-rated symptom was cough with a mean score of 0.10. The maximum difference between preoperative and postoperative scores was in blockage/congestion of the nose (4.52) and the least was in cough (0.10). (Table 1 & Graph 1)

Table 1 Comparison of nasal symptoms mean scores preoperatively and postoperatively at 1 month & 3 months
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Graph 1
figure 1

Comparison of mean scores preoperatively and postoperatively for nasal symptoms

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In our study, the highest-rated symptom in the otologic symptoms was facial pain and pressure with a mean score of 2.64 and the lowest-rated symptom was dizziness with a mean score of 0.02. The maximum difference between preoperative and postoperative scores was in facial pain and pressure (2.21) and the least being in dizziness (0.02). (Table 2 & Graph 2)

Table 2 Comparison of otologic symptoms mean scores preoparatively and postoperatively at 1 month & 3 months
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Graph 2
figure 2

Comparison of mean scores preoperatively and postoperatively for otological symptoms

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In our study, the highest-rated symptom in sleep symptoms was difficulty falling asleep with a mean score of 3.07 and the lowest-rated symptom was Frustrated & restless, irritable with a mean score of 1.57. The maximum difference between preoperative and postoperative scores was in difficulty falling asleep (3.02) and the least being of frustrated & restless, irritable. (1.57). (Table 3 & Graph 3)

Table 3 Comparison of sleep symptoms mean scores preoperatively and postoperatively at 1 month & 3 months
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Graph 3
figure 3

Comparison of mean scores preoperatively and postoperatively for sleep symptoms

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In our study, the highest-rated symptom in the emotional symptoms was embarrassed with a mean score of 1.86 and the lowest-rated symptom was sad with a mean score of 1.74. The maximum difference between preoperative and postoperative scores was in embarrassed (1.86) and the least being of sad (1.74). (Table 4 & Graph 4)

Table 4 Comparison of emotional symptoms mean scores preoperatively and postoperatively at 1 month & 3 months
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Graph 4
figure 4

Comparison of mean scores preoperatively and postoperatively for emotional symptoms

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In our study, the preoperative and post-operative SNOT 22 questionnaire scores of the 42 patients who came for the follow-up were compared and analyzed separately. The mean total SNOT 22 score preoperatively was 45.64(S.D.= 12.41), while the mean postoperative score at 1 month was 6.57 (S.D.= 4.16), and at 3 months was 2.52 (S.D.= 2.07). (Table 5 & Graph 5)

Preoperatively 64.24% of the patients had a grand total score of 20–50 (showing a moderate impact on quality of life) and 35.71% of patients having a score > 50 (showing a severe impact on quality of life). After functional endoscopic sinus surgery, these numbers were reduced and all the patients in the study had scores below 20.

Table 5 Comparison of total mean SNOT-22 score preoperatively and post operatively at 1 month & 3 months
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Graph 5
figure 5

Comparison of total mean snot-22 scores preoperatively and postoperatively

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Discussion

Most of the patients in our study belonged 18–30 years (40.48%) of age with a mean age of 35.42 years. In the study conducted by Nikakhlagh et al. [5] mean age was 39 years. In our study male to female ratio is 1.1:1. There is male predominance (52.38%) in our study. In a study conducted by Nikakhlagh et al. [5] 62.2% were male and 37.8% were female. In the study conducted by Bharath M et al. [6] 73% were males and 27% were females.

The application of a QOL (Quality of life) instrument like SNOT 22 in the preoperative evaluation of patients with CRS enabled us to make valid, objective comparisons of the preoperative and postoperative status of these patients using the derived scores.

In our present study, all patients had SNOT 22 scores exceeding 20, making it evident that the underlying disease process had significantly affected these patients necessitating surgery.

The mean preoperative SNOT 22 score of patients with CRS in our study was 45.64 (S.D = 12.41) ). The mean postoperative score at 1 month and 3 months was 6.57 = 4.16 and 2.52 = 2.07 respectively. The mean difference was 39.07 in preoperative and postoperative scores at 1 month. The mean difference was 43.11 in preoperative and postoperative scores at 3 months. The score of all evaluated patients improved after surgery (p < 0.0001). This shows a significant improvement in the symptom complex and the quality of life. In a study conducted by Bharath M et al. [6], the mean preoperative SNOT-20 score was 56.93 ± 9.61. The postoperative mean SNOT-20 score reduced to 24.90 ± 7.96 at 1 month and 18.35 = 8.94 at 3 months postoperatively with p-value < 0.001.

Our analysis revealed that while all symptoms improved postoperatively, blockage/congestion of the nose was the symptom that showed the greatest improvement, followed by thick nasal discharge and postnasal discharge. In our study, we found a significant improvement in blockage/congestion of the nose similar to a study conducted by SoheilaNikakhlagh [5]. In our study, we found a similar significant improvement in thick nasal discharge with a study conducted by Bharath M et al. [6], although symptoms of sneezing and running nose often persisted in some patients with nasal allergy.

In our study there was a significant improvement in non-nasal symptoms after functional endoscopic sinus surgery which includes, facial pain& pressure, lack of good night sleep, wake up tired, wake up at night, reduced concentration and reduced productivity.

Conclusion

Preoperatively 64.24% of the patients had a grand total score of 20–50 (showing a moderate impact on quality of life) and 35.71% of patients having a score > 50 (showing a severe impact on quality of life). After functional endoscopic sinus surgery, these numbers were reduced and all the patients in the study had scores below 20. This shows that functional endoscopic sinus surgery has a positive impact on quality of life and symptom-specific improvement.

Observations in our study suggest that Functional endoscopic sinus surgery provides a significant symptom-specific improvement as well as a significant quality of life improvement in patients with chronic rhinosinusitis. SNOT-22 questionnaire provides an ideal way to understand and grade the disease severity preoperatively and compare the symptomatic improvement after functional endoscopic sinus surgery in patients with chronic rhinosinusitis.

ANNEXURE 1

DOMAINS

A. NASAL SYMPTOMS:

1. Need to blow nose

2. Running nose

3. Sneezing

4. Cough

5. Post nasal discharge

6. Thick nasal discharge

7. Sense of smell

8. Blockage/ congestion of nose

OTOLOGIC SYMPTOMS:

1. Ear fullness

2. Dizziness

3. Ear pain

4. Facial pain & pressure

SLEEP SYMPTOMS:

1. Difficulty falling asleep

2. Wake up at night

3. Wake up tired

4. Lack of good sleep

5. Fatigue

6. Reduced productivity

7. Reduced concentration

8. Frustrated, restless or irritated

EMOTIONAL SYMPTOMS:

1. Sad

2. Embarrassed

SCORE

INTERPRETATION

0

No problem

1

Very mild problem

2

Mild or slight problem

3

Moderate problem

4

Severe problem

5

Problem as bad as it can be

TOTAL SNOT-22 SCORE

INTERPRETATION

8–20

MILD

>20–50

MODERATE

>50

SEVERE