Predictive Factors of Depression on Outcomes in Chronic Rhinosinusitis after Endoscopic Sinus Surgery

Abstract

Objective: The improvement in quality of life after endoscopic sinus surgery (ESS) has been well documented. However, oftentimes patients’ mental health is not assessed, ignored, or attributed to other causes. There is a lack of evidence that chronic rhinosinusitis can cause mental anguish and depression, which affects outcomes after FESS.

Method: Patients were selected from a busy rhinology tertiary care center. Prior to ESS, participants were given a depression scale and a SNOT-20 sinonasal symptomatology questionnaire, and endoscopic scores were noted. Participants repeated questionnaires at 6 weeks and 3 months after ESS. Endoscopic scores were noted at all three visits.

Results: The most useful instrument to predict outcomes was the SNOT-20 scale. The SNOT-20 scale was highly correlated with the HDS. ESS did not result in any significant changes in a patient’s score on HDS, but it did improve SNOT-20 scales. Patients with lower preoperative values on HDS had significantly better surgical outcomes as defined by Lund-Kennedy and SNOT-20. Higher preoperative values on HDS had significantly less improvement on Lund-Kennedy and SNOT-20.

Conclusion: The data presented here confirm a high incidence in depressive-like symptoms in patients who have CRS. We have demonstrated that patients with moderate and severe depression on HDS have worse outcomes after ESS independent of their preoperative scores. We also demonstrated SNOT-20 to be highly correlated to HDS.