{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:29:23Z","timestamp":1777386563418,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2020,3,13]],"date-time":"2020-03-13T00:00:00Z","timestamp":1584057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Rhinol\ufffdAllergy"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Previous research have suggested that chronic rhinosinusitis (CRS) patients with lower symptomatic scores, demonstrated by a 22-item Sinonasal Outcome Test (SNOT-22) score &lt;20, may not achieve meaningful quality of life improvement following endoscopic sinus surgery (ESS). However, indications for ESS are continuing to be defined and many low SNOT-22 scoring patients still undergo elective surgery for CRS and other benign sinonasal pathologies. The outcomes for these patients have not been previously studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We screened 2829 ESS procedures from 2010\u20132018 to identify patients with a preoperative SNOT-22 score &lt;20. We reviewed disease characteristics, preoperative Lund\u2013Mackay (LM) scores, and pre- and postoperative SNOT-22 scores in patients with at least 3 months\u2019 follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of all surgical ESS patients screened, 114 had low preoperative SNOT-22 scores (4.0%). Indications for these surgeries included CRS (50.0%), odontogenic sinus disease (11.4%), mucocele (10.5%), recurrent acute sinusitis (7.0%), fungal ball (5.3%), and silent sinus syndrome (4.4%). Specifically, among CRS patients, 45.6% had pulmonary comorbidities and\/or systemic immunodeficiencies. Moreover, 100% of CRS patients with nasal polyps and 73.1% of CRS without polyps had LM scores &gt;5. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction ( P\u2009&lt;\u2009.001) postoperatively, whereas those with scores between 10 and 14 had a 5.4 point reduction ( P\u2009&lt;\u2009.001), and preoperative scores &lt;9 resulted in no significant decrease in postoperative symptom scores ( P\u2009=\u2009.98). Overall, there was a 3.3 point SNOT-22 reduction among all patients at 3 months postoperatively ( P\u2009&lt;\u2009.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1945892420912159","type":"journal-article","created":{"date-parts":[[2020,3,14]],"date-time":"2020-03-14T00:41:43Z","timestamp":1584146503000},"page":"502-507","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Indications and Outcomes for Patients With Limited Symptoms Undergoing Endoscopic Sinus Surgery"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3322-5287","authenticated-orcid":false,"given":"Arifeen S.","family":"Rahman","sequence":"first","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter H.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Alapati","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zara M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol H.","family":"Yan","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California"},{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, University of California San Diego, San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,3,13]]},"reference":[{"key":"bibr1-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200405000-00027"},{"key":"bibr2-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199409000-00006"},{"key":"bibr3-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21446"},{"key":"bibr4-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/alr.20101"},{"key":"bibr5-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1177\/0194599810391852"},{"key":"bibr6-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25180"},{"key":"bibr7-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-4486.2009.01995.x"},{"key":"bibr8-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26157"},{"key":"bibr9-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21408"},{"key":"bibr10-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21769"},{"key":"bibr11-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25318"},{"key":"bibr12-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22184"},{"key":"bibr13-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1097\/ICU.0000000000000106"},{"key":"bibr14-1945892420912159","doi-asserted-by":"crossref","unstructured":"Magalh\u00e3es C, Baptista M, Lopes G, et\u00a0al. Silent sinus syndrome: an underdiagnosed entity [published online ahead of print August 27, 2015].\n                      BMJ Case Rep\n                      . doi:10.1136\/bcr-2015-210548","DOI":"10.1136\/bcr-2015-210548"},{"key":"bibr15-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22028"},{"key":"bibr16-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25305"},{"key":"bibr17-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21789"},{"key":"bibr18-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0b013e3282f2c9aa"},{"key":"bibr19-1945892420912159","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200018050-00001"},{"key":"bibr20-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2001.119324"},{"key":"bibr21-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21458"},{"key":"bibr22-1945892420912159","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2010.07.014"}],"container-title":["American Journal of Rhinology &amp; Allergy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1945892420912159","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1945892420912159","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1945892420912159","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:36:33Z","timestamp":1777368993000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1945892420912159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,13]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,7]]}},"alternative-id":["10.1177\/1945892420912159"],"URL":"https:\/\/doi.org\/10.1177\/1945892420912159","relation":{},"ISSN":["1945-8924","1945-8932"],"issn-type":[{"value":"1945-8924","type":"print"},{"value":"1945-8932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,13]]}}}