| Objective: Chronic rhinosinusitis is a chronic inflammatory disease occurring in the mucosa of nasal cavity and sinuses,The course of disease is over 12 weeks and prolonged symptoms significantly influence the quality of life of patients.Nasal obstruction is usually the most common and obvious symptom in patients with CRS.Endoscopic sinus surgery,which can effectively relieve mucosal inflammation and improve quality of life,has become a major surgical method for the treatment of CRS in recent years.The purpose of this study was to analyze the correlation between subjective and objective evaluation of nasal obstruction in patients with CRS,and to explore the effect of anatomic characteristics of nasal cavity and nasal sinuses on postoperative evaluation of nasal obstruction in patients with CRS,and to make recommendations for effective management and control in patients with CRS.Methods: This was a retrospective analysis.134 patients with CRS admitted to the Department of Otolaryngology&Head and Neck Surgery,The Affiliated Hospital of Qingdao University from August 2020 to April 2022 were enrolled,including 86 males and 48 females,with the age from 18 to 72 years old.All patients underwent preoperative blood routine examination,acoustic rhinometry,paranasal sinus CT,nasal endoscopy,electronic fiber rhinolaryngoscopy and skin prick test.The subjective evaluation of nasal obstruction,anatomic characteristics and mucosal inflammatory state inflammation of nasal cavity and nasal sinuses were evaluated by visual analogue scale,Lund-Mackay CT score,Lund-Kennedy endoscopic scoring system,inferior turbinate grading system and nasal septum deviation score.Patients were divided into marked remission group(VAS =0)and and moderate remission group(0<VAS<5)according to the VAS score of nasal obstruction 1 year after ESS.Characteristics of postoperative self-management,including duration of postoperative nasal medication,frequency of nasal endoscopic cleaning within6 months after surgery,compliance with non-blowing nose,and acoustic rhinometryreview and nasal endoscopy review were collected.We analyzed the changes of subjective and objective evaluation of nasal obstruction of patients from 2 groups before and after ESS.Spearman rank correlation analysis was used to analyze the correlation between subjective and objective evaluation of postoperative nasal obstruction.We analyzed the differences of clinical baseline data such as anatomical characteristics of nasal cavity and nasal sinuses,mucosal inflammatory characteristics of nasal cavity and postoperative self-management characteristics of patients between the two groups.Based on the results of univariate analysis,binary and multivariate Logistic regression analysis was performed to determine the independent factors affecting the evaluation of nasal obstruction after ESS.p<0.05 was considered statistically significant.The predictive value of independent factors for evaluation of nasal obstruction after ESS was evaluated by receiver operating characteristic curve.Results:(1)Finally,a total of 132 patients with CRS were included in statistical analysis.We found that the VAS score of subjective nasal obstruction was decreased(p<0.05).The nasal volume of 0~6 centimeters and nasal minimal cross-sectional area were increased(p<0.05);Correlation analysis showed that postoperative VAS score of nasal obstruction was not correlated with acoustic rhinometry parameters,but was positively correlated with the results of nasal endoscopic review.(2)Multi-factor logistic regression analysis showed that higher preoperative nasal endoscopic Lund-Kennedy polyp score,higher preoperative septal deviation score and higher preoperative grade of inferior turbinate mean the likelihood of marked remission of nasal obstruction after ESS(p<0.05).(3)The results of receiver operating characteristic curve show that the efficacy of forecasting the evaluation of nasal obstruction after ESS by preoperative endoscopic Lund-Kennedy polyp score is up to 79.2%.The efficacy of inferior turbinate grade is up to 81.5% and the efficacy of nasal septum deviation score is up to 77.1%.Conclusion and significance: ESS can effectively improve the nasal obstruction of patients with CRS.The VAS score of postoperative nasal obstruction was not correlated with acoustic rhinometry parameters,but was positively correlated with the results of nasal endoscopic review.As an evaluation tool for nasal obstruction,the VAS score of subjective nasal obstruction,acoustic rhinometry and anatomical structure measurement under nasal endoscope have different emphasises.Lund-Kennedy endoscopic score of nasal polyp,inferior turbinate grading system and nasal septum deviation score were independent factors affecting the evaluation of nasal obstruction of patients with CRS after ESS.If preoperative nasal endoscopic Lund-Kennedy polyp score was over 2 points,preoperative inferior turbinate grade was over 5 points,or preoperative nasal septum deviation score was over 3 points,the nasal obstruction of patients with CRS would significantly relieved after ESS,which can provide reference for clinicians and patients to choose reasonable surgical treatment. |
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