European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 5, pp 1139–1147 | Cite as

Predictive factors of a beneficial quality of life outcome in patients undergoing primary sinonasal surgery: a population-based prospective cohort study

  • Antti I. Alakärppä
  • Timo J. Koskenkorva
  • Petri T. Koivunen
  • Olli-Pekka Alho



To assess predictive factors of a beneficial quality of life (QoL) outcome after primary sinonasal surgery.


A population-based prospective cohort study among 160 adult patients undergoing primary sinonasal surgery (76 septoplasties, SP; 84 endoscopic sinus surgeries, ESS) was conducted. We collected QoL data using the Sinonasal Outcome Test-22 (SNOT-22) before and after surgery. A beneficial QoL outcome was defined as a SNOT-22 score change ≥ 9 points 12 months after surgery. Various demographic, clinical and symptom-related factors predicting a beneficial QoL outcome were sought using binary logistic regression analysis.


The mean age of the patients was 39 years (range 18–61) and 82 (51%) were males. The SNOT-22 score change varied markedly after SP (range − 17 to + 80) and ESS (range − 20 to + 58), but on average it improved (median + 15 after SP and + 16 after ESS). 41 patients (64%) achieved beneficial QoL outcome after SP and 46 (66%) after ESS. In a multivariate analysis, poor QoL before surgery (preoperative SNOT-22 ≥ 20 points) predicted a beneficial QoL outcome after SP and ESS (adjusted odds ratio 10; 95% confidence interval 1.6–64 and 12; 2.5–55, respectively) and a senior surgeon operating after SP (9.9; 1.5–67). On receiver operating characteristic curve analysis, the integer threshold value for the preoperative SNOT-22 score that gave the highest sensitivity (74%) and specificity (70%) was 30.


QoL change after primary SP and ESS varies. A preoperative SNOT-22 score of at least 30 best predicted a beneficial QoL outcome after both procedures.


Septoplasty Endoscopic sinus surgery Quality of life Septal deviation Chronic rhinosinusitis Sinonasal surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest or external funding.


  1. 1.
    Siegel NS, Gliklich RE, Taghizadeh F et al (2000) Outcomes of septoplasty. Otolaryngol Head Neck Surg 122(2):228–232CrossRefPubMedGoogle Scholar
  2. 2.
    Alakarppa AI, Koskenkorva TJ, Koivunen PT et al (2016) Quality of life before and after sinonasal surgery: a population-based matched cohort study. Eur Arch Otorhinolaryngol. PubMedGoogle Scholar
  3. 3.
    Smith TL, Mendolia-Loffredo S, Loehrl TA et al (2005) Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 115(12):2199–2205CrossRefPubMedGoogle Scholar
  4. 4.
    Hytonen ML, Lilja M, Makitie AA et al (2012) Does septoplasty enhance the quality of life in patients?. Eur Arch Otorhinolaryngol 269.
  5. 5.
    Zhang Z, Linkin DR, Finkelman BS et al (2011) Asthma and biofilm-forming bacteria are independently associated with revision sinus surgeries for chronic rhinosinusitis. J Allergy Clin Immunol 128(1):221–223. CrossRefPubMedGoogle Scholar
  6. 6.
    Litvack JR, Griest S, James KE et al (2007) Endoscopic and quality-of-life outcomes after revision endoscopic sinus surgery. Laryngoscope 117(12):2233–2238. CrossRefPubMedGoogle Scholar
  7. 7.
    Watelet JB, Annicq B, Van Cauwenberge P et al (2004) Objective outcome after functional endoscopic sinus surgery: Prediction factors. Laryngoscope 114(6):1092–1097. CrossRefPubMedGoogle Scholar
  8. 8.
    Smith TL, Litvack JR, Hwang PH et al (2010) Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg 142(1):55–63. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Katotomichelakis M, Simopoulos E, Tripsianis G et al (2014) Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery. Eur Arch Otorhinolaryngol 271(4):733–741. CrossRefPubMedGoogle Scholar
  10. 10.
    Steele TO, Mace JC, Smith TL (2015) Does comorbid anxiety predict quality of life outcomes in patients with chronic rhinosinusitis following endoscopic sinus surgery? Int Forum Allergy Rhinol 5(9):829–838. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Fokkens WJ, Lund VJ, Mullol J et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23(23):3 (p preceding table of contents, 1–298)PubMedGoogle Scholar
  12. 12.
    Blomgren K, Alho OP, Ertama L et al (2005) Acute sinusitis: Finnish clinical practice guidelines. Scand J Infect Dis 37(4):245–250PubMedGoogle Scholar
  13. 13.
    Hopkins C, Gillett S, Slack R et al (2009) Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 34(5):447–454. CrossRefPubMedGoogle Scholar
  14. 14.
    Morley AD, Sharp HR (2006) A review of sinonasal outcome scoring systems—which is best? Clin Otolaryngol 31(2):103–109. CrossRefPubMedGoogle Scholar
  15. 15.
    Dietz de Loos DA, Segboer CL, Gevorgyan A et al (2013) Disease-specific quality-of-life questionnaires in rhinitis and rhinosinusitis: review and evaluation. Curr Allergy Asthma Rep 13(2):162–170. CrossRefPubMedGoogle Scholar
  16. 16.
    Buckland JR, Thomas S, Harries PG (2003) Can the Sino-nasal Outcome test (SNOT-22) be used as a reliable outcome measure for successful septal surgery? Clin Otolaryngol Allied Sci 28(1):43–47CrossRefPubMedGoogle Scholar
  17. 17.
    Poirrier AL, Ahluwalia S, Goodson A et al (2013) Is the Sino-Nasal Outcome test-22 a suitable evaluation for septorhinoplasty? Laryngoscope 123(1):76–81. [doi]CrossRefPubMedGoogle Scholar
  18. 18.
    Wild D, Grove A, Martin M et al (2005) Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health 8(2):94–104. CrossRefPubMedGoogle Scholar
  19. 19.
    Stammberger H, Posawetz W (1990) Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 247(2):63–76CrossRefPubMedGoogle Scholar
  20. 20.
    Chowdhury NI, Mace JC, Bodner TE et al (2017) Investigating the minimal clinically important difference for SNOT-22 symptom domains in surgically managed chronic rhinosinusitis. Int Forum Allergy Rhinol. Google Scholar
  21. 21.
    Akobeng AK (2007) Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 96(5):644–647CrossRefPubMedGoogle Scholar
  22. 22.
    Hopkins C, Rudmik L, Lund VJ (2015) The predictive value of the preoperative Sinonasal Outcome Test-22 score in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 125(8):1779–1784. CrossRefPubMedGoogle Scholar
  23. 23.
    Hong SD, Lee NJ, Cho HJ et al (2015) Predictive factors of subjective outcomes after septoplasty with and without turbinoplasty: can individual perceptual differences of the air passage be a main factor? Int Forum Allergy Rhinol 5(7):616–621. CrossRefPubMedGoogle Scholar
  24. 24.
    Rudmik L, Soler ZM, Mace JC et al (2014) Using preoperative SNOT-22 score to inform patient decision for endoscopic sinus surgery. Laryngoscope. Google Scholar
  25. 25.
    Bliven BD, Kaufman SE, Spertus JA (2001) Electronic collection of health-related quality of life data: validity, time benefits, and patient preference. Qual Life Res 10(1):15–22CrossRefPubMedGoogle Scholar
  26. 26.
    Gwaltney CJ, Shields AL, Shiffman S (2008) Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: a meta-analytic review. Value Health 11(2):322–333. CrossRefPubMedGoogle Scholar
  27. 27.
    Hopkins C, Slack R, Lund V et al (2009) Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope 119(12):2459–2465. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Antti I. Alakärppä
    • 1
    • 2
  • Timo J. Koskenkorva
    • 1
    • 2
  • Petri T. Koivunen
    • 1
    • 2
  • Olli-Pekka Alho
    • 1
    • 2
  1. 1.Department of Otorhinolaryngology and Head and Neck SurgeryOulu University Hospital, OYSOuluFinland
  2. 2.PEDEGO Research UnitUniversity of OuluOuluFinland

Personalised recommendations