Release: Embargoed until September 26
Contact: Ken Satterfield
(in New Orleans: 9/23-29 at 504-670-5409) [email protected]
CHRONIC SINUSITIS SUFFERERS MAY HAVE GOOD REASONS TO ALWAYS FEEL BAD
An outcomes research study at the Vanderbilt University Asthma, Sinus, and Allergy Program finds that medical treatment for recurrent acute sinusitis is effective; those with the chronic disease are not so lucky
NEW ORLEANS -- Chronic sinusitis is an increasingly common cause of physician visits in the United States. It is presently the principal diagnosis of two percent of all visit. Patients with sinusitis are generally divided into those with infrequent acute disease, recurrent acute, and chronic illness.
Otolaryngologist--head and neck surgeons believe that infrequent episodes of the disease can be easily treated. On the other hand, acute and recurrent sinusitis present patients with different symptoms, treatment protocols, and outcomes. To examine this dilemma of how best to manage patient care for recurrent and chronic sinusitis, a team of ear, nose, and throat specialists, all experienced in treating sinusitis, developed an outcomes research study.
Outcomes research is the study of the therapeutic result of multiple treatments on a specific illness or disease. This investigation differs from traditional research in that it focuses on the effectiveness of a treatment used outside the laboratory, during normal circumstances in a community practice. This contrasts to traditional medical research where randomized treatments are examined to study the efficacy (or benefits) of a specific treatment. Heretofore, few studies have examined sinusitis treatments using outcomes-based surveys. Additionally, past research did not compare the treatment outcomes of chronic versus recurrent sinusitis, relapsing and recurrent disease.
To classify treatment according to severity, a logical method is used which has been applied to a comprehensive disease management approach to describe an effective method of treatment. With this, the research effort, "Outcome Analysis of Recurrent Acute and Chronic Sinusitis Management: A Proposed Classification and Treatment Protocol with Results" aimed to (1) confirm and compare the morbidity, or rate of sinusitis to other debilitating illnesses; (2) propose a classification and treatment regimen for difficult-to-treat patients; (3) compare the outcome of medical (non-surgical) management of recurrent and chronic sinusitis using outcomes-based analysis. The authors of the study are George M. Converse IV, MD, James A. Duncavage, MD, Bobo Tanner, MD, John Murray, MD, and James Bracikowski, MD, all from the Vanderbilt University Medical Center, Nashville, TN.
The results were presented before the American Academy of Otolaryngology--Head and Neck Surgery Foundation Annual Meeting and Oto Expo being held September 26-29, at the Ernest N. Morial Convention Center in New Orleans, LA. At the gathering, the Academy's 11,000 members will have the opportunity to hear the latest research in the diagnosis and treatment of disorders of the ear, nose, throat, and related structures of the head and neck.
Methodology:
The study was conducted at the Vanderbilt Asthma, Sinus and Allergy Program, a comprehensive management disease center. One hundred sixty-three adult subjects were enrolled in the study between November, 1997, and October, 1998. All adult subjects who met diagnostic criteria were included in the research regardless of previous history of nasal or sinus surgery. The diagnostic workup included history, physical examination, nasal endoscopy, and CT scans. Clinical assessment of each subject was made by the authors; each patient was categorized to recurrent acute or chronic disease.
To measure outcomes, the researchers utilized the widely accepted Medical Outcome Short-form 36 Item Health Survey (SF-36). Used to measure general good health, the SF-36 assesses health functions in eight categories: physical functioning (PF), role functioning-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-functioning emotional (RE), and mental health (MH).
The SF-36 survey was administered to each patient at the time of initial visit. Subjects were treated according to the center's clinical guidelines. Follow-up visits ranged from 22-42 days with a mean of 33.2 days; the survey was given again at the time of the follow-up visit.
Results:
Post-treatment scores in patients with chronic disease did not reach the average value of previously recorded norms for the general population. Recurrent acute patients, on the other hand, reached an SF-36 score that was without statistical difference from the general population. Other findings from the outcomes survey included:
When a disease management concept with defined protocols is applied to the treatment of chronic and recurrent acute sinusitis, patients improve. Specifically, physical role functioning and vitality show the most response to treatment. However, recurrent acute patients clearly show a more superior response to medical management than patients with chronic disease.
Even after treatment, the chronic patient fails to improve to the level of the general population in almost all domains of the SF-36. This leads the researchers to contend that chronic sinusitis sufferers have few medical options for cure.
A comprehensive, multi disciplinary approach to treatment is needed to demonstrate significant improvement in symptoms. For sinusitis, the researchers developed specific treatment guidelines which encompass antimicrobial therapy and anti-inflammatory and allergic treatment.
Classifying to specific criteria (recurrent acute versus chronic) enables physicians to gauge what medical management would be effective. For patients who do not respond to medical treatment, surgical intervention may be necessary.
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Editor's Note: For a copy of this study or an interview with Dr. Converse, contact Ken Satterfield at 703-519-1563 (through 9-21); 9/23-29, call the Annual Meeting Newsroom at 504-670-5409.
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