{"doi":"10.1002/alr.23511","title":"Long‐Term Implications of Short‐Term Symptom and Radiographic Severity Outcomes After ESS in CRS Patients","abstract":"Chronic rhinosinusitis (CRS) is a syndrome defined by both symptomatic presentation and objective findings, such as those visible on endoscopy and computed tomography (CT). These symptoms, endoscopic and radiographic measures, are important for guiding surgical decision-making and are widely used for post-operative surveillance. The severity of CRS symptoms, CT findings, and endoscopic findings respectively, are quantified using validated tools like the sinonasal outcomes test-22 (SNOT-22), the Lund–Mackay (LM), and the modified Lund–Kennedy (MLK) scores. Studies have shown that preoperative SNOT-22 and LM scores, whether categorized by quartiles or arbitrary ranges, generally show significant improvement following endoscopic sinus surgery (ESS) [1-4]. However, we are not aware of any studies demonstrating pre-ESS SNOT-22 scores predicting post-ESS scores. Although most studies focus on pre-ESS scores, there is limited analysis of the implications of post-operative measures on long-term outcomes. Notably, although higher post-ESS SNOT-22 scores have been found to predict the need for future revision ESS, we were unable to find any studies that studied the predictability of long-term outcomes using post-ESS treatment outcomes despite routine surveillance of these measures [5]. Furthermore, a study demonstrated that endoscopic scores tend to worsen between 6 and 12 months after ESS, raising questions on the long-term stability of both symptom and radiographic findings [6]. Here we aim to investigate post-ESS long-term stability and prognostic value of short-term symptom and radiographic status in predicting long-term symptom outcomes. 1. SNOT-22 and LM scores are stable between 6–12 months (short-term) and 18–60 months (long-term) after ESS. 2. Short-term SNOT-22 prognosticates long-term SNOT-22 outcomes. Adding radiographic measures modestly improves accuracy. A prospective study of adult CRS patients who underwent ESS was conducted at Northwestern Medicine between 2017 and 2023. A total of 113 patients with (n = 48) and without nasal polyps (n = 65) with CT-proven bilateral disease LM≥4 were included. Excluded patients <18 or >85 years, with very minimal evidence of inflammation on CT, recurrent acute sinusitis, on anticoagulants or having coagulation disorder, received solid organ transplant and on immunosuppressants, and history of infectious diseases like Hepatitis B or Hepatitis C. They were followed up at 6–12 (V1, short-term) and 18–60 (V2, long-term) months post-ESS. At each visit, patients completed the SNOT-22 questionnaire and underwent a CT scan and endoscopy, with scores analyzed [2]. These were considered as both continuous and binary categorical variables. The Wilcoxon matched-pair test compared mean SNOT-22 and LM scores between V1 and V2, whereas the Spearman correlation assessed score correlations at both time points. Binary classification of SNOT-22 and LM was defined as <17 and <4, respectively, for symptomatic and radiographic normalization based on studies that found that these were the mean scores of patients without CRS [7, 8]. Contingency tables with normal (SNOT-22<17, LM<4) versus abnormal status (SNOT-22≥17, LM≥4) were utilized. Chi-square analysis evaluated V1 SNOT-22's long-term symptom prediction alone and with V1 LM status. Data were analyzed using Prism 9. The study involved a total of 113 patients, of which 42.48% had nasal polyps. SNOT-22, LM, and MLK scores were evaluated at two follow-up points: short-term, with a mean duration of 8 months and a long-term, with a mean duration of 34 months. Endoscopic MLK scores had highly significant moderate positive correlation with LM scores cross-sectionally at V1 and V2 (Figure S1). Mean SNOT-22 scores decreased significantly (p < 0.0001) from pre-ESS (45.97 ± 19.99) (Figure S2a) but showed no significant difference between V1 (19.06 ± 15.95) and V2 (20.67 ± 17.41) (Figure 1a). Similarly, mean LM scores were significantly (p < 0.0001) lower than pre-ES","journal":"International Forum of Allergy & Rhinology","year":2025,"id":560387,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9563,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1393816,"name":"Zhidi Luo","orcid":"0009-0006-7475-179X","position":1,"is_corresponding":false},{"id":1030022,"name":"Siyuan Dong","orcid":"0009-0009-5713-4951","position":2,"is_corresponding":false},{"id":246814,"name":"Caroline P.E. Price","orcid":"0000-0002-9590-7419","position":3,"is_corresponding":false},{"id":1262544,"name":"Regan L. Harmon","orcid":null,"position":4,"is_corresponding":false},{"id":848058,"name":"Junqin Bai","orcid":"0000-0001-6012-2809","position":5,"is_corresponding":false},{"id":1128852,"name":"Brooke N. Gleason","orcid":"0009-0008-5614-4990","position":6,"is_corresponding":false},{"id":480724,"name":"David B. Conley","orcid":"0000-0002-2611-6795","position":7,"is_corresponding":false},{"id":480725,"name":"Kevin C. Welch","orcid":"0000-0003-4863-7206","position":8,"is_corresponding":false},{"id":520504,"name":"Stephanie S. Smith","orcid":"0000-0002-0605-3993","position":9,"is_corresponding":false},{"id":386199,"name":"Robert C. Kern","orcid":"0000-0002-8995-9175","position":10,"is_corresponding":false},{"id":212508,"name":"Lutfiyya N. Muhammed","orcid":"0000-0001-8655-1484","position":11,"is_corresponding":false},{"id":1451503,"name":"Aditi Agarwal","orcid":"0009-0006-8532-6094","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-19T02:55:42.883572Z","pmid":"39812330","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}