RESUMEN
OBJECTIVE: To determine whether there is an association between the presence of asthma and a clinically aggressive disease course in patients with recurrent respiratory papillomatosis (RRP). DESIGN: Retrospective multi-institutional cohort study (level III evidence). SETTING: Two academic medical centers in the southeastern United States. PATIENTS: Adult patients with RRP treated at the Georgia Health Sciences University or at the Emory University School of Medicine between January 1998 and December 2009. Excluded from the study were adult patients who had been diagnosed as having RRP when they were a child (<18 years). MAIN OUTCOME MEASURES: The primary outcome measure was the presence of a clinically aggressive RRP disease course (defined as distal spread of disease, >4 procedures performed in 12 months, or progression to laryngeal squamous cell carcinoma). The secondary outcome measure was the frequency of required surgical interventions. RESULTS: Identified were 90 patients with RRP (age range at first diagnosis, 19.1-86.4 years). Seventeen patients had aggressive disease, and 73 patients had nonaggressive disease. Seven patients had a history of asthma, 5 of whom were using daily inhaled corticosteroids. An association was noted between the presence of asthma and aggressive RRP, which was found in 57% (4 of 7) of patients with asthma vs 16% (13 of 83) of patients without asthma (P = .02). Patients with asthma using daily inhaled corticosteroids were especially likely to have aggressive RRP, which was found in 80% (4 of 5) of corticosteroid users vs 15% (13 of 85) of nonusers (P = .004). CONCLUSIONS: Patients with asthma, particularly those using daily inhaled corticosteroids, may have a more clinically aggressive RRP course. The cause of this association is unclear, and clinical recommendations should not yet be made based on these data.
Asunto(s)
Asma/epidemiología , Recurrencia Local de Neoplasia/epidemiología , Papiloma/epidemiología , Neoplasias del Sistema Respiratorio/epidemiología , Administración por Inhalación , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Asma/tratamiento farmacológico , Carcinoma de Células Escamosas/epidemiología , Femenino , Humanos , Neoplasias Laríngeas/epidemiología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estudios Retrospectivos , Sudeste de Estados Unidos/epidemiologíaAsunto(s)
Lesiones Encefálicas/cirugía , Fosa Craneal Anterior/cirugía , Endoscopía/métodos , Cuerpos Extraños/cirugía , Heridas Penetrantes/cirugía , Accidentes de Tránsito , Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/etiología , Fosa Craneal Anterior/diagnóstico por imagen , Fosa Craneal Anterior/lesiones , Craneotomía , Cuerpos Extraños/diagnóstico por imagen , Humanos , Masculino , Nariz , Tomografía Computarizada por Rayos X , Heridas Penetrantes/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVES/HYPOTHESIS: The purpose of this study is to report on long-term outcomes in a prospective study comparing the quality-of-life outcomes in smokers and nonsmokers undergoing functional endoscopic sinus surgery. STUDY DESIGN: : Prospective clinical trial. METHODS: A total of 235 patients were prospectively enrolled at a single tertiary academic center. Preoperative Sino-Nasal Outcomes Test (SNOT)-20 scores and comprehensive demographic and smoking data were obtained. Preoperative SNOT-20 scores were compared to postoperative SNOT-20 scores. RESULTS: Long-term follow-up results were available in 111/185 nonsmokers (60%) and 26/50 smokers (52%). Nonsmokers had a mean preoperative SNOT-20 score of 26.2, a short-term follow-up score of 10.1 (mean, 3.1 months) and a long-term follow-up score of 11.4 (mean, 44.2 months). Smokers had a mean preoperative SNOT-20 score of 27.8, a short-term follow-up score of 5.7 (mean, 3.1 months) and a long-term follow-up score of 8.3 (mean, 40.3 months). The mean improvement in SNOT-20 scores for smokers was significantly greater than nonsmokers in short-term follow-up (P = .044), however, no significant difference in improvement was seen between smokers and nonsmokers at long-term follow-up. CONCLUSIONS: Both smokers and nonsmokers continue to maintain a highly significant improvement in SNOT-20 scores following endoscopic sinus surgery at long-term follow-up. Although smoking remains a well-documented cause of medical morbidity, smokers maintained an improvement in quality of life after long-term follow-up from endoscopic sinus surgery in this prospective study.
Asunto(s)
Endoscopía , Calidad de Vida , Rinitis/cirugía , Sinusitis/cirugía , Fumar/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to prospectively compare the short-term benefit of endoscopic sinus surgery for smokers and nonsmokers using a disease specific, clinically validated, quality of life outcomes measure, the Sinonasal Outcomes Test-20 (SNOT-20). STUDY DESIGN: Prospective clinical trial. METHODS: A total of 235 patients were prospectively enrolled at a single tertiary academic center. Preoperative SNOT-20 scores and comprehensive demographic data were obtained. All patients underwent endoscopic sinus surgery under the supervision of the senior author. Preoperative SNOT-20 scores were compared to short-term postoperative SNOT-20 scores. RESULTS: Short-term postoperative results were available for 221 patients for comparison. Preoperative SNOT-20 scores in 49 smokers (mean: 27.8) and 172 nonsmokers (mean: 26.2) were statistically similar. Both smokers and nonsmokers achieved a highly significant reduction in SNOT-20 scores at short-term follow-up evaluations. (P < .0005) Smokers achieved a greater reduction in SNOT-20 scores (mean difference: 22.1) at short-term follow-up compared to nonsmokers (mean difference: 16.1). This result was statistically significant (P < .044). CONCLUSIONS: This study confirms that smokers and nonsmokers achieve a highly significant short-term benefit from endoscopic sinus surgery using a clinically-validated symptom severity scale in a prospective study. Interestingly, smokers achieved a greater short-term benefit than nonsmokers did. This study calls into question the notion that current smokers are poorer candidates for endoscopic sinus surgery. Further prospective studies to confirm these results and provide long-term analysis should be performed.