Effects of depression on quality of life improvement after endoscopic sinus surgery

Nearly 14 percent of Americans suffer from chronic sinusitis and may have the following symptoms for 12 weeks or more; facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, and periodic high fever. If antibiotics are not effective, these symptoms can lead to endoscopic sinus surgery to clear clogged sinuses.

Depression negatively impacts outcomes of care in chronic disease and has been associated with increased risk of morbidity and mortality. The prevalence of depression in patients with CRS is estimated to be in the range of 20-25%. High levels of depression in patients with CRS have been associated with increased utilization of healthcare resources, including more antibiotic use, physician visits, and missed workdays.

The study included face-to-face interviews with 76 patients who were enrolled prior to having endoscopic sinus surgery and followed postoperatively for at least 6 months post-operatively, including 8 patients with depression and 45 patients without depression.

Patients completed standard medical history intake documentation and underwent a physical examination. Demographic data and presence or absence of other clinical characteristics including nasal polyposis, asthma, allergies, aspirin intolerance, and smoking were documented and confirmed through physical examination when appropriate. Computed tomography and endoscopy findings were recorded and patients were asked to report a history of depression on the intake form and any anti-depressant medication they were using.

"Depression is common and underreported in patients with CRS. Depression significantly impacts patients' quality of life," said study author Jamie Litvack, MD, MS. "Depressed patients with CRS report worse disease-specific and general health-related QOL than other CRS patients, but experience comparable post-operative improvement in quality of life after endoscopic sinus surgery. Perhaps with better diagnosis and treatment of depression in this subset of patients, their outcomes of care can be further improved."

The Institutional Review Board at Oregon Health & Science University provided approval of study protocol and the informed consent process.