| Objective: 1) To investigate the risk factors with the postoperative recurrence and to provide some references for the prognosis of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery. 2) To investigate the prevalence and psychopathological characteristics of patients with chronic rhinosinusitis(CRS) and to find the associated factors leading to psychological problems. 3) To investigate the impact of surgical treatment to psychiatric disorders of patients with chronic rhinosinusitis. Methods: 1) The case ducuments of 459 cases of chronic rhinosinusitis with nasal polyps who were treated surgically in the Department of Otolaryngology of the First Affiliated Hospital of Xinjiang Medical University from January 2010 to May 2016 was retrospectively analyzed, and these patients were divided into primary group(344 cases) and recurrence group(115cases). Ten factors including patients' age, gender, nation, smoking habits, alcoholic drinking habits, disease duration, combination with asthma, combination with allergic rhinitis, the eosinophil percentage of peripheral blood were collected and taken into account, histopathologically classification of nasal polyps which were statistically analyzed to filter out significant variables, Screened associated factors were selected by multifactor logistic regression analysis.Risk factors of postoperative recurrence of chronic rhinosinusitis with nasal polyps were found. 2) Between January 2013 and May 2014.A total of 124 patients diagnosed with chronic rhinosinusitis in the Department of Otolaryngology of the First Affiliated Hospital of Xinjiang Medical University were recruited. The psychological investigation and evaluation were done using a series of questionnaire instruments.The instruments included symptom self-rating depression scale(SDS), self-rating anxiety scale(SAS), symptom checklist-90(SCL-90), and the visualanalogue scale(VAS) and Lund-Kennedy and Lund-Mackay computed tomography score.All the data were analyzed by SPSS19.0 software. The measurement data were expressed as((?) ±s). The comparison between the two groups was analyzed by two independent samples t test, and the correlation between the measurement data was analyzed by spearman correlation analysis. The risk factors affecting the mental health of the patients were identified, P<0.05 was statistically significant. 3) January 2013 to January 2016, A total of 78 patients diagnosed with chronic rhinosinusitis in the Department of Otolaryngology of the First Affiliated Hospital of Xinjiang Medical University were recruited. Patients were interviewed before and three months after endoscopic surgery;Endoscopy were reviewed, and questionnaires were completed about Visual analogue Scale(VAS), L-K scores?Self-Rating Anxiety Scale(SAS) and Self-Rating Depression Scale(SDS) to evaluate the effect of nasal endoscopic surgery on subjective symptom?objective examination and mental healthy. All the data were analyzed by SPSS19.0software. The data of measurement data were expressed as( c±s). The t test was used to compare the depression group and the non-depression group, anxiety group and non-anxiety group. The data were analyzed by paired sample t test before and after the operation. chi-square test was used for comparison of Statistical data. with P<0.05 for the difference was statistically significant. Results: 1) The results revealed the disease duration, combination with asthma, combination with allergic rhiniti, histopathologically classification of nasal polyp tissue showed significant difference between two groups(P<0.05). There were four significant factors, including asthma, allergic rhinitis, peripheral blood eosinophils, and Eosinophilic nasal polyps.These four factors were analysed by multifactor regression analysis, we found combination with asthma were and histopathologically eosinophilic nasal polyp were relevant with postoperative recurrence of chronic rhinosinusitis with nasal polyps. 2) 124 valid questionnaires were collected, 71(57.3%) were male and 53(42.7%) were female. The average age was 43.7 years(18-69years). The average duration of disease was 5.6 years(0.5-25 years). There were 76patients(61.3%) with CRSsNP and 48 patients(38.7%) with CRSwNP. 116 patients(93.5%) were first onset cases and 8 patients(6.50%) with a prior history of surgery.Among the CRS patients, SAS score was normal in 86 cases(69.4%), mild, moderate and severe abnormalities in 38 cases(30.6%); the average score of SAS was(36.27±10.34);SDS score was normal in 78 cases(62.9%), mild, moderate and severe abnormalities in 46cases(37.1%), the average score of SDS was(49.02±9.83); The SAS scores of the national norm were(29.78±10.07) and the average score of SDS was(41.88±10.57). Thescore of SAS and SDS in 124 patients was statistically higher than that of national norm,the difference was statistically significant(P<0.05). SAS score was positively correlated with nasal congestion and olfactory descent(P<0.05), but not correlated with purulent nasal discharge, head and face pain, headache, L-M score and L-K score(P>0.05). SDS score was no positively correlated with nasal obstruction, head and face pain, headache,L-M score and L-K score(P > 0.05), but correlated with purulent nasal discharge and olfactory descent(P<0.05). The scores of somatization, interpersonal sensitivity, anxiety and depression were higher in SCL-90 than that in Chinese norm, the difference was statistically significant(P < 0.05). The somatization of CRS patients was positively correlated with nasal obstruction, olfactory disturbance, and purulent nasal discharge(P<0.05). Interpersonal sensitivity positively correlated with olfactory disturbance, and purulent nasal discharge(P<0.05). There was a positive correlation between depression and purulent nasal discharge and olfactory regression(P < 0.05). There was a positive correlation between depression and purulent nasal discharge and olfactory regression(P<0.05). The incidence of anxiety and depression in women and CRSwNP was higher than that in men and CRSsNP respectively,the differences were statistically significant(P<0.05). The scores of SCL-90 of females were higher in interpersonal sensitivity, anxiety and depression than that in males(P<0.05). In CRSwNP patients, the scores of SCL-90 were higher than that in CRSsNP in somatization, psychosis, anxiety factor scores, with statistically significant differences(P < 0.05). 3) Subjective symptom score nasal obstruction, purulent nasal discharge, head and face pain, olfactory loss, headache, L-K score, anxiety self-evaluation, depression self-rating score postoperative were significantly lower than that before surgery in 78 cases, the difference was statistically significant(P<0.05). There were 25 cases(32.0%) in the preoperative anxiety state, including 16 males, 9females and 53 non-anxious patients(68.0%), including 29 males, 24 females and 5postoperative anxiety patients(6.0%), 2 male, 3 female, non-anxious 73(94.0%), 43 male,30 female, the incidence of anxiety before surgery was significantly higher than that after operation(P<0.05). There were 28(35.9%) patients with depressive state before surgery,17 were men and 11 were women. Fifty patients(64.1%) were non-depressed, 28 were male and 22 were female. Seven patients were with depression(9%), included 4 males and3 females. 71(91%) cases were without depression, included 41 males and 30 females. The incidence of depression was lower than that before operation(P < 0.05). There were significant differences in the incidence of depression between the two groups(P<0.05).The scores of nasal obstruction, purulent nasal discharge, head and face pain, headacheand Lund-Kennedy score of anxiety group were significantly improved after operation(P<0.05). The scores of postoperative olfactory decline decreased significantly(P>0.05).The scores of postoperative nasal obstruction, purulent nasal discharge, head and face pain,olfactory deterioration, headache score and postoperative Lund-Kennedy score were significantly improved in the non-anxiety group compared with those before the operation,and the difference was statistically significant(P<0.05). The comparison of subjective and objective scores between the anxiety group and the non-anxiety group showed that the nasal obstruction, purulent nasal discharge, head and face pain, olfactory headache and Lund-Kennedy scores were lower in the postoperative anxiety group than in the non-anxiety group.There was no significant difference between the two groups(P>0.05).The scores of nasal obstruction, purulent nasal discharge, head and face pain, olfactory deterioration and headache scores and Lund-Kennedy score of depression group were significantly lower than those before operation(P<0.05). The nasal congestion, purulent nasal discharge, head and face pain, olfactory deterioration, headache and Lund-Kennedy score were significantly improved in non-depressive group(P<0.05). Postoperative the depressed group, nasal congestion, purulent nasal discharge, head and face pain, and headache scores were higher than the non-depressed group, there was statistical significance in head and face pain and olfactory deterioration(P < 0.05). The Lund-Kennedy score of depression group was lower than that of non-depression group,but there was no statistically significant difference between the two groups(P > 0.05).Conclusion: 1) disease duration, combination with asthma, combination with allergic rhinitis, histopathologically classification of nasal polyp tissue may be associated with postoperative recurrence of chronic rhinosinusitis with nasal polyps.Among them,combination with asthma, histopathologically eosinophilic nasal polyp were most important. 2) High prevalence of Psychiatric disorders was found in CRS patients.The female patients and CRS with nasal polyps patients have high incidence for mental disorders. 3) Endoscopic surgery can effectively alleviate symptom of patients with chronic rhinosinusitis and ease anxiety and depression, but it can not totally solve the psychological disorder of patients, it is necessary to give professional psychological intervention when necessary. |
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