Does Psychological Dysfunction Impact 5‐Year Quality of Life Outcomes After Endoscopic Sinus Surgery?

Objectives In chronic rhinosinusitis (CRS) patients, psychological status influences whether symptoms are indicative of CT results and affects short‐term outcomes after endoscopic sinus surgery (ESS). Our objective was to assess the impact of psychological status on 5‐year outcomes following ESS. Methods CRS patients undergoing ESS prospectively completed 22‐item sinonasal outcome test (SNOT‐22) surveys preoperatively and postoperatively at 3 months and annually for 5 years. Patients were stratified into high and low psychological dysfunction groups based on SNOT‐22 psychological domain scores, and outcomes were compared. Results Of 1069 patients enrolled, 557 were in the high psychological dysfunction (HPD) cohort and 512 were in the low psychological dysfunction (LPD) cohort. 5‐year outcome data were available for 205 patients in the HPD and 196 patients in the LPD group. Patients with HPD were more likely to be female and have a history of prior sinus surgery, allergy, and headaches. HPD patients had significantly higher SNOT‐22 scores (61.1 vs. 32.8, p < 0.001) at baseline. Both groups had significant improvement at each postoperative timepoint and similar relative improvement (45.2% vs. 44.5% reduction at 5 years), although the HPD patients had significantly greater symptom severity at 5 years (33.5 vs. 18.2, p < 0.001). Multivariable regression revealed that preoperative psychological domain scores independently predicted higher postoperative non‐psychological SNOT‐22 scores ( β = 0.29; 95% CI: 0.11–0.47; p = 0.001). Conclusions ESS provides long‐term benefit to patients regardless of psychological dysfunction severity. However, patients with HPD experienced significantly worse symptoms before ESS and for up to 5 years postoperatively. Preoperative psychological score independently predicts postoperative symptom severity. Level of Evidence 3.