The effects of endoscopic sinus surgery on level of fatigue in patients with chronic rhinosinusitis

Background: Fatigue is a common symptom of chronic rhinosinusitis (CRS), but the response of fatigue to endoscopic sinus surgery (ESS) is rarely studied. Methods: A prospective, open cohort of adult patients undergoing ESS for CRS was studied using 10-cm fatigue visual analog scales (VASs), Lund-MacKay computed tomography (CT), and Lund-Kennedy nasal endoscopy scoring. Results: Two hundred seventy-two patients, followed for a mean (±SD) of 16.5 ± 8.5 months after ESS, noted significant fatigue improvement with an effect size defined as large by Cohen (0.8 [95% CI, 0.5-1.3]). Neither preoperative CT scores nor preoperative endoscopy scores correlated with preoperative fatigue severity. Compared with the mean preoperative fatigue score (6.1 ± 2.9 cm), preoperative fatigue was more severe in women (6.9 ± 2.6 cm; p < 0.001) patients with depression (7.7 ± 2.4 cm; p < 0.001) and patients with fibromyalgia (7.9 ± 2.2 cm; p = 0.013), but less severe in patients with nasal polyposis (5.4 ± 3.2 cm; p = 0.009). Significantly greater postoperative reduction in fatigue was noted in patients with fibromyalgia when compared with study patients without fibromyalgia (effect size = 1.8 [95% CI, 1.6-2.2]; p > 0.001) with final fatigue severity scores similar to the entire study group. Similarly, patients with severe fatigue (n = 112; mean VAS score, 8.8 ± 0.8 cm) showed a more pronounced improvement than patients less severely fatigued (n = 160; mean VAS score 4.2 ± 2.4 cm; effect size = 2.2 [95% CI, 2.0-2.9]; p > 0.001). Conclusion: Fatigue improves after ESS, with significantly greater improvement in patients with fibromyalgia and in patients that are more severely fatigued at presentation.