Evaluation of chronic rhinosinusitis classification and prognostic factors in patients undergoing endoscopic sinus surgery

Subject: Evaluation of Chronic Rhinosinusitis Classification and Prognostic Factors in Patients Undergoing Endoscopic Sinus Surgery Objective: It is aimed to divide the patients who underwent endoscopic sinus surgery (ESS) for primary chronic rhinosinusitis (CRS) into subtypes according to the EPOS 2020 classification and to examine the degree of CRS control and quality of life by using the EPOS control criteria of these different subtypes. Another aim is to determine the effects of prognostic factors accompanying patients on disease control, quality of life and radiological scores. Methods: Patients who underwent ESC for primary CRS 2-9 years before the study (n=210) were included. Preoperative examination, intraoperative, radiological and pathological findings of the patients were evaluated and classified into different CRS subtypes. A questionnaire asking about control symptoms according to EPOS control criteria and CRS symptom visual analog scale (VAS) and sinonasal outcome test (SNOT-22) questionnaires were applied to the patients. Results: It was determined that 27.6% of the patients had controlled, 40% partially controlled and 32.4% uncontrolled CRS. The rate of uncontrolled disease was found to be higher in allergic fungal rhinosinusitis (AFRS) and eosinophilic CRS (ECRS) subtypes, although not significantly, compared to other subtypes. It was observed that control levels and radiological Lund Mackay, Kennedy Osteit score, SNOT-22 and CRS symptom VAS scores were correlated. It was found that the prevalence of asthma, aspirin sensitivity, and Samter's triad were higher in women than in men, and they showed less improvement in SNOT-22 scores (p<0.05). When prognostic factors were evaluated, it was found that bilateral spread, allergy, aspirin sensitivity, Samter's triad, serum and tissue eosinophilia, and presence of revision were associated with uncontrolled disease. Conclusion: According to the EPOS control criteria, approximately one out of four patients has controlled disease. In order to better interpret and support these results, prospective studies in which patients are evaluated with an adequate follow-up period before and after surgery are needed. Keywords: chronic rhinosinusitis subtype, disease control, endoscopic sinus surgery, eosinophilic chronic rhinosinusitis, central compartment atopic disease, allergic fungal rhinosinusitis