Endoscopic sinus surgery improves cognitive dysfunction in patients with chronic rhinosinusitis

Jeremiah A. Alt, Jess C. Mace, Timothy L. Smith, Zachary M. Soler

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background: Patients with chronic rhinosinusitis (CRS) have been found to have cognitive deficit, as identified using the Cognitive Failures Questionnaire (CFQ), but the exact etiology of cognitive decline is unknown. In this study we aimed to determine whether improvement in concomitant inflammation and disease burden in CRS, using endoscopic sinus surgery (ESS), improves cognitive deficit. We also sought to identify comorbid conditions that effect improvement likelihood. Methods: Study participants (n = 247) with and without nasal polyposis (CRSwNP, CRSsNP) were prospectively enrolled in this multi-institutional, observational outcomes study. Pre- and postoperative cognitive dysfunction was evaluated using the CFQ instrument. Quality of life (QOL) and disease burden was also evaluated using the Rhinosinusitis Disability Index (RSDI), the 22-item SinoNasal Outcome Test (SNOT-22), nasal endoscopy, computed tomography, and the 2-item Patient Health Questionnaire (PHQ-2). Results: Average CFQ total scores improved significantly (p = 0.012) after ESS for patients with follow-up (n = 141). Participants with CRSwNP (n = 51) reported significant postoperative improvements in mean CFQ total scores (p = 0.002) and CFQ distractibility and blunders domain scores (p ≤ 0.006). No significant postoperative improvement for any average CFQ score was found in CRSsNP (p > 0.086). The magnitude of postoperative improvement in CFQ total and domain mean scores was statistically similar between CRSsNP and CRSwNP (p > 0.115). Depressive disorder, identified using PHQ-2 screening, was the only comorbid condition significantly associated with measurable cognitive deficit (p < 0.001). Conclusions: Patients with CRS have measurable cognitive decline, and ESS may modestly improve cognitive deficit/CFQ scores. Future investigations are needed to further elucidate the underlying mechanisms responsible for cognitive deficit in patients with CRS and significant associations with depression.

Original languageEnglish (US)
Pages (from-to)1264-1272
Number of pages9
JournalInternational Forum of Allergy and Rhinology
Issue number12
StatePublished - Dec 1 2016


  • chronic disease
  • chronic pain
  • cognition
  • quality of life
  • rhinitis
  • rhinosinusitis
  • sinusitis
  • sleep

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology


Dive into the research topics of 'Endoscopic sinus surgery improves cognitive dysfunction in patients with chronic rhinosinusitis'. Together they form a unique fingerprint.

Cite this