Quality-of-Life Outcomes Following Endoscopic Resection of Sinonasal Inverted Papilloma

Abiri, Arash; Hong, Ellen M.; Dilley, Katelyn K.; Nguyen, Theodore V.; Salmon, Mandy K.; Grose, Elysia M.; Tripathi, Siddhant H.; Venkatesh, Sanjena; Kim, Yohan; Lee, Daniel J.; Douglas, Jennifer E.; Eide, Jacob G.; Kshirsagar, Rijul S.; Phillips, Katie M.; Sedaghat, Ahmad R.; Lee, John M.; Tong, Charles C.L.; Adappa, Nithin D.; Palmer, James N.; Kuan, Edward C.

Abstract

​​​​​​​Objectives: There is growing interest in assessing patient quality of life (QOL) following treatment of sinonasal tumors, including inverted papilloma (IP). We aimed to elucidate the natural history of postoperative QOL outcomes in IP patients treated with surgery. Methods: Cases of sinonasal IP treated surgically at 4 tertiary academic rhinology centers were retrospectively reviewed. SNOT-22 scores were used to evaluate QOL preoperatively and postoperatively (1, 3, 6, 12 months). Repeated-measures ANOVA assessed for differences in mean scores over time. Linear regression identified factors associated with QOL longitudinally. Results: 373 patients were analyzed. Mean preoperative SNOT-22 score was 20.6 ± 20.4, which decreased to 16.3 ± 18.8 (p = 0.041) and 11.8 ± 15.0 (p < 0.001) at 1 and 3 months postoperatively, respectively. No further changes in SNOT-22 scores occurred beyond 3 months postoperatively (p > 0.05). When analyzed by SNOT-22 subdomains, nasal, sleep, and otologic/facial subdomain scores (all p < 0.05) demonstrated improvement at 12-month follow-up compared with preoperative scores; this was not observed for the emotional subdomain score (p = 0.800). Recurrent cases were associated with higher long-term SNOT-22 scores (β = 7.08; p = 0.017). Age, sex, degree of dysplasia, prior surgery, primary site, and smoking history did not correlate with symptoms (all p > 0.05). Conclusions: QOL outcomes related to IP resection are largely driven by nasal, sleep, and otologic/facial subdomains, though patients appear to experience enduring improvement as early as 3 months postoperatively. Recurrent disease is a major driver of negative QOL. Level of evidence: 4 Laryngoscope, 135:579-585, 2025.