As noted in both the EPOS 2012 and in the (more recent) ICARS 2016, there is a paucity of evidence on the effectiveness of surgery for recurrent acute rhinosinusitis (RARS). The authors used a control group of patients with CRSsNP, a disease where the efficacy of FESS has been clearly demonstrated to assess the cost-effectiveness of FESS for patients with RARS. All patients were enrolled as part of a bigger study on FESS outcomes and had initially adequate medical treatment. The patients underwent a variety of procedures that were presumably tailored to their disease, including MMA, ethmoidectomy, frontal sinusotomy and sphenoidectomy. As expected, both the radiological and the endoscopic score were significantly better in the RARS group. The authors found that both the reduction in QOL preoperatively and the improvement in QOL postoperatively (as measured with SF-6D = Medical Outcomes Study Short Form-6D survey) was comparable between the two groups. The gains in health utility scores were similar to improvements that patients with obstructive sleep apnoea report one year after initiating continuous positive airway pressure therapy in osteoarthritis patients (0.10) undergoing total hip arthroplasty. This is an interesting study, with the potential to add significant evidence to the utility of surgery for such patients.

Health utility values for patients with recurrent acute rhinosinusitis undergoing endoscopic sinus surgery: a nested case control study.
Steele TO, Mace JC, Dedhia R, et al.
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Christos Georgalas

Academic Medical Center, The Netherlands.

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