Evaluation of the quality of life before and after functional endoscopic sinus surgery among patients with nasal polyps by means of SF-36 questionnaire

INTRODUCTION

Sinonasal pathology is one of the most frequent cause of the disease which impairs quality of life. The most common symptoms of diseases of the nose and paranasal sinuses are nasal obstruction or congestion, anterior and posterior nasal discharge, epistaxsis, hyposmia or anosmia, headache, snoring, facial pain, facial pressure. These symptoms may be due to anatomical obstruction of ostium, septal deviation, concha bullosa, paradoxic middle turbinate, nasal polyps, chronic rhinosinusitis (CRS).¹

Functional surgical treatment by endoscopic sinus surgery (FESS) is presently the most preferred treatment for CRS.^2,3 and is based on hypothesis that diseased sinonasal mucosa can get reverted if ventilation and drainage are improved, thus restoring mucociliary clearance.⁴ In general, patients QOL improves after FESS.

The most widely used instrument for general health and the best example of a “generic” HR-QOL instrument is the Medical Outcome Study Short-form 36-item Health Survey.⁵ Disease specific instruments have been shown to be superior to generic health-status instruments when the burden of disease studied is lower than the threshold detected by a generic HR-QOL questionnaire.⁶

METHODS

This prospective hospital-based study was conducted in the Postgraduate Department of Otorhinolaryngology, Head and Neck Surgery, Government SMHS Hospital, Srinagar from January 2019 to December 2019. All patients attending the department were included after fulfilling the inclusion criteria.

Inclusion criteria

Patients who underwent FESS for nasal polyps. Patients aged 18 years or above.

Written informed consent was taken from all the patients. Detailed history was taken and complete ENT examination was done. Non-contrast enhanced computed tomography was done as and when required

In all patient’s disease specific quality of life measurement was done using SF-36 scale. This was done on three occasions- preoperatively, 3 months and at 6 months after surgery.

Data was entered in Microsoft Excel spreadsheet. Continuous variables were summarized as mean and standard deviation. Categorical variables were summarized as percentages. Comparison of SF-36 scores before and after rhinologic surgeries were done using Paired ‘T’ test. Two-sided p values were reported and a p<0.05 was considered as statistically significant.

RESULTS

A total of 69 patients underwent FESS in our institution during study period. The SF-36 questionnaire was given pre and post operatively among patients with nasal polyps who met inclusion criteria. SF-36 scale changed from 79.35 pre-operatively to postoperative score of 83.62 at 3 months, 86.88 at 6 months.

Our study included 45 (65.2%) females and 24 (34.7%) males. Females outnumbered the males in our study.

Table 1 shows SF-36 values preoperatively, total as well as sub-scale wise. Role function physical and role functional emotional having 100% preoperative values.

Table 2 shows that SF-36 values at 3 months, total as well as subscale wise. There was mean value of 100 for sub scale, physical function, role functional physical and role functional emotion. All subscales showed significant improvement.

Table 3 shows that SF-36 values at 6 months, total as well as subscale wise. There was mean 100 for subscale-physical function, role function physical and role functional emotional. All subscales showed significant improvement.

DISCUSSION

Quality of life (QOL) is an important assessment in clinical interventions. QOL is a subjective evaluation of the effects of a disease or therapeutic effects of its treatment on patient’s health and several patients with the same objective conditions may have different QOLs. It includes not only symptoms of the disease but also a wide spectrum of daily life activities such as social and physical activities, practical and emotional problems, and general feeling of patients related to their disease.⁷

In the present study the measurement of General health related quality of life (QOL) was performed using the Short Form-36 Health Survey (SF-36). The SF-36 Health Survey consists of a questionnaire with 36 items organized into several subject areas. Each item represents a scale in itself or part of a scale. The SF-36 Health Survey records eight aspects of subjective health, using different item numbers: Physical functioning (PF-10 items), Role Functioning Physical (RP-4 items), Bodily pain (BP- 2 items), General health (GH-5 items), Vitality (VT- 4 items), Social Functioning (SF-2 items), Role Functional Emotional (RE- 3 items), and Mental Health (MH- 5 items).

In the study General quality of life using SF-36 was seen improved after surgical intervention in all patients with total mean 79.53, 83.62, 86.88 preoperative, at 3 months and at 6 months respectively with p value <0.001.

General HR-QOL using SF-36 showed maximum improvement in sub scales, in general health with preoperative value of 46.51 to postoperative value of 69.22 at 6 months, in social function with preoperative value of 76.95 to postoperative value of 90.23 at 6 months and in mental health with preoperative value of 59.38 to postoperative value of 70.18. Similar results were stated in study conducted by Sahlstrand-Johnson⁸ and Soler et al.²

CONCLUSION

General health related quality of life measured with SF-36 in patients undergoing nasal surgeries showed improvement, total as well as sub scale wise

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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