{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T01:55:55Z","timestamp":1782784555564,"version":"3.54.5"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4\u00a0weeks post-ESS, and 6\u00a0months post-ESS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6\u00a0months post-ESS were as follows: rhinologic symptoms (t-test\u2009=\u20097.22, p-value\u2009=\u2009\u2009&lt;\u20090.001); extra-nasal rhinologic symptoms (t-test\u2009=\u20094.87, p-value\u2009=\u2009\u2009&lt;\u20090.001); ear\/facial symptoms (t-test\u2009=\u20096.34, p-value\u2009=\u2009\u2009&lt;\u20090.001); psychological dysfunction (t-test\u2009=\u20091.99, p-value\u2009=\u20090.049); and sleep dysfunction (t-test\u2009=\u20095.58, p-value\u2009=\u2009\u2009&lt;\u20090.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6\u00a0months post-ESS. Rhinologic symptoms had the largest effect size (<jats:italic>d<\/jats:italic>\u2009=\u20091.12), whereas psychological dysfunction had the least effect size (<jats:italic>d<\/jats:italic>\u2009=\u20090.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4\u00a0weeks post-ESS was observed between allergic and non-allergic patients (t\u2009=\u2009\u2212\u20092.16, df\u2009=\u200966, p\u2009=\u20090.035).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Prospective observational.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12893-021-01269-1","type":"journal-article","created":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T12:05:22Z","timestamp":1623153922000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7708-8368","authenticated-orcid":false,"given":"Salma S.","family":"Al Sharhan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed H.","family":"Al Bar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahad Y.","family":"Assiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assayl R.","family":"AlOtiabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deemah M.","family":"Bin-Nooh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fozia K.","family":"AlSugair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada F.","family":"AlRashidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmalik S.","family":"AlSaied","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal A.","family":"Alghamdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"key":"1269_CR1","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1111\/j.1398-9995.2011.02646.x","volume":"66","author":"D Hastan","year":"2011","unstructured":"Hastan D, Fokkens WJ, Bachert C, et al. Chronic rhinosinusitis in Europe\u2014an underestimated disease. A GA2LEN study. Allergy. 2011;66:1216\u201323.","journal-title":"Allergy"},{"key":"1269_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4193\/Rhin20.401","volume":"58","author":"WJ Fokkens","year":"2020","unstructured":"Fokkens WJ. European position paper on rhinosinusitis and nasal polyps. Rhinology. 2020;58:1\u2013464.","journal-title":"Rhinology"},{"key":"1269_CR3","doi-asserted-by":"publisher","first-page":"2007","DOI":"10.1002\/lary.24630","volume":"124","author":"L Rudmik","year":"2014","unstructured":"Rudmik L, Smith TL, Schlosser RJ, et al. Productivity costs in patients with refractory chronic rhinosinusitis. Laryngoscope. 2014;124:2007\u201312.","journal-title":"Laryngoscope"},{"key":"1269_CR4","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1002\/alr.20008","volume":"1","author":"J Stankiewicz","year":"2011","unstructured":"Stankiewicz J, Tami T, Truitt T, et al. Impact of chronic rhinosinusitis on work productivity through one-year follow-up after balloon dilation of the ethmoid infundibulum. Int Forum Allergy Rhinol. 2011;1:38\u201345.","journal-title":"Int Forum Allergy Rhinol"},{"key":"1269_CR5","doi-asserted-by":"publisher","first-page":"328","DOI":"10.2500\/aap.2013.34.3675","volume":"34","author":"AM Halawi","year":"2013","unstructured":"Halawi AM, Smith SS, Chandra RK. Chronic rhinosinusitis: epidemiology and cost. Allergy Asthma Proc. 2013;34:328\u201334.","journal-title":"Allergy Asthma Proc"},{"key":"1269_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12901-016-0030-8","volume":"16","author":"E Noon","year":"2016","unstructured":"Noon E, Hopkins C. Outcomes in endoscopic sinus surgery. BMC Ear Nose Throat Disord. 2016;16:1\u201310. https:\/\/doi.org\/10.1186\/s12901-016-0030-8.","journal-title":"BMC Ear Nose Throat Disord"},{"key":"1269_CR7","doi-asserted-by":"publisher","first-page":"2199","DOI":"10.1097\/01.mlg.0000182825.82910.80","volume":"115","author":"TL Smith","year":"2005","unstructured":"Smith TL, Mendolia-Loffredo S, Loehrl TA, et al. Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. 2005;115:2199\u2013205.","journal-title":"Laryngoscope"},{"key":"1269_CR8","doi-asserted-by":"publisher","first-page":"824","DOI":"10.12816\/0038180","volume":"68","author":"F Al-safran","year":"2017","unstructured":"Al-safran F, Al-bar M, Almazrua A, et al. The introduction and validation of Arabic Sino\u2014nasal outcome test (A-Snot-22). Egypt J Hosp Med. 2017;68:824\u20138.","journal-title":"Egypt J Hosp Med"},{"key":"1269_CR9","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1177\/0194599816664879","volume":"155","author":"P Kohli","year":"2016","unstructured":"Kohli P, Naik AN, Farhood Z, et al. Olfactory outcomes after endoscopic sinus surgery for chronic rhinosinusitis: a meta-analysis. Otolaryngol Head Neck Surg. 2016;155:936\u201348.","journal-title":"Otolaryngol Head Neck Surg"},{"key":"1269_CR10","first-page":"183","volume":"31","author":"VJ Lund","year":"1993","unstructured":"Lund VJ, Mackay IS. Staging in rhinosinusitus. Rhinology. 1993;31:183\u20134.","journal-title":"Rhinology"},{"key":"1269_CR11","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1002\/alr.21408","volume":"4","author":"AS Deconde","year":"2014","unstructured":"Deconde AS, Mace JC, Bodner T, et al. SNOT-22 quality of life domains differentially predict treatment modality selection in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4:972\u20139.","journal-title":"Int Forum Allergy Rhinol"},{"key":"1269_CR12","unstructured":"IBM SPSS Statistics for Windows, Version 20.0. Armonk: IBM Corp. 2011. https:\/\/www.ibm.com\/support\/pages\/how-cite-ibm-spss-statistics-or-earlier-versions-spss."},{"key":"1269_CR13","doi-asserted-by":"publisher","first-page":"22","DOI":"10.5144\/0256-4947.2018.22","volume":"38","author":"F Alanazy","year":"2018","unstructured":"Alanazy F, Dousary SA, Albosaily A, et al. Psychometric Arabic Sino-Nasal Outcome Test-22: validation and translation in chronic rhinosinusitis patients. Ann Saudi Med. 2018;38:22\u20137.","journal-title":"Ann Saudi Med"},{"key":"1269_CR14","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1001\/archotol.130.3.329","volume":"130","author":"N Bhattacharyya","year":"2004","unstructured":"Bhattacharyya N. Symptom outcomes after endoscopic sinus surgery for chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg. 2004;130:329\u201333. https:\/\/doi.org\/10.1001\/archotol.130.3.329.","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"1269_CR15","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1001\/jamaoto.2014.1045","volume":"140","author":"AS DeConde","year":"2014","unstructured":"DeConde AS, Bodner TE, Mace JC, et al. Response shift in quality of life after endoscopic sinus surgery for chronic rhinosinusitis. JAMA Otolaryngol Head Neck Surg. 2014;140:712\u20139.","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"1269_CR16","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1111\/j.1749-4486.2009.01995.x","volume":"34","author":"C Hopkins","year":"2009","unstructured":"Hopkins C, Gillett S, Slack R, et al. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol. 2009;34:447\u201355.","journal-title":"Clin Otolaryngol"},{"key":"1269_CR17","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1046\/j.1365-2753.2001.00298.x","volume":"7","author":"B Middel","year":"2001","unstructured":"Middel B, Stewart R, Bouma J, et al. How to validate clinically important change in health-related functional status. Is the magnitude of the effect size consistently related to magnitude of change as indicated by a global question rating? J Eval Clin Pract. 2001;7:399\u2013410.","journal-title":"J Eval Clin Pract"},{"key":"1269_CR18","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1177\/194589240501900214","volume":"19","author":"NFN Stoikes","year":"2005","unstructured":"Stoikes NFN, Dutton JM. The effect of endoscopic sinus surgery on symptoms of Eustachian tube dysfunction. Am J Rhinol. 2005;19:199\u2013203.","journal-title":"Am J Rhinol"},{"key":"1269_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/all.12040","volume":"68","author":"PW Hellings","year":"2013","unstructured":"Hellings PW, Fokkens WJ, Akdis C, et al. Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today? Allergy. 2013;68:1\u20137.","journal-title":"Allergy"},{"key":"1269_CR20","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1053\/hn.1999.v120.a95228","volume":"120","author":"JD Osguthorpe","year":"1999","unstructured":"Osguthorpe JD. Surgical outcomes in rhinosinusitis: what we know. Otolaryngol Neck Surg. 1999;120:451\u20133. https:\/\/doi.org\/10.1053\/hn.1999.v120.a95228.","journal-title":"Otolaryngol Neck Surg"},{"key":"1269_CR21","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.otohns.2009.10.009","volume":"142","author":"TL Smith","year":"2010","unstructured":"Smith TL, Litvack JR, Hwang PH, et al. Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg. 2010;142:55\u201363. https:\/\/doi.org\/10.1016\/j.otohns.2009.10.009.","journal-title":"Otolaryngol Head Neck Surg"},{"key":"1269_CR22","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.amjoto.2014.09.003","volume":"36","author":"C Adnane","year":"2015","unstructured":"Adnane C, Adouly T, Zouak A, et al. Quality of life outcomes after functional endoscopic sinus surgery for nasal polyposis. Am J Otolaryngol. 2015;36:47\u201351. https:\/\/doi.org\/10.1016\/j.amjoto.2014.09.003.","journal-title":"Am J Otolaryngol"},{"key":"1269_CR23","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1177\/0194599818773065","volume":"159","author":"PT Le","year":"2018","unstructured":"Le PT, Soler ZM, Jones R, et al. Systematic review and meta-analysis of SNOT-22 outcomes after surgery for chronic rhinosinusitis with nasal polyposis. Otolaryngol Head Neck Surg. 2018;159:414\u201323.","journal-title":"Otolaryngol Head Neck Surg"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01269-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-021-01269-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01269-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T12:06:41Z","timestamp":1623154001000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/s12893-021-01269-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,8]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1269"],"URL":"https:\/\/doi.org\/10.1186\/s12893-021-01269-1","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,8]]},"assertion":[{"value":"21 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The ethical approval was obtained from the research ethical committee; institutional review board of Imam Abdulrahman bin Faisal University of research (IRB No. UGS-2018-01-312).The study observed confidentiality and privacy of subjects. Written informed consent was obtained preoperatively from every eligible participant. In addition, a parental written consent was obtained from parents of participants\u2009<\u200918\u00a0years old. The document was prepared in Arabic for convenience.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"There are no conflicts of competing interest to be disclosed regarding this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"288"}}