Evaluation of sinonasal-related quality of life of 49 patients undergoing endoscopic skull base surgery

This study aimed to assess the impact of endoscopic skull base surgery on sinonasal-related quality of life (QoL). In this summary, we focus on the effects of turbinate removal and its implications for sleep quality.

**Types of Surgery and Procedure Details:**

Endoscopic skull base surgery is a technique used to address various conditions affecting the base of the skull and surrounding areas. This procedure sometimes also involves the removal of nasal turbinates. The types of surgeries and procedures included:

**Removal of Tumors:** Both benign and malignant tumors located at the skull base.

**Reconstruction:** Repair of defects using grafts or flaps.

**Turbinate Surgery:** Partial or total removal of nasal turbinates 

**Methods:**

The study included 49 patients who completed two questionnaires:

- **Sinonasal Outcome Test-22 (SNOT-22):** Measures various aspects of sinonasal health and their impact on quality of life, including nasal symptoms, facial pain, sleep disturbances, and emotional well-being.

- **Empty Nose Syndrome 6 Item Questionnaire (ENS6Q):** Assesses symptoms related to Empty Nose Syndrome, such as nasal dryness, diminished airflow, and nasal crusting.

**Results:**

1. **Overall Quality of Life Scores:**

   - The average SNOT-22 score was 25.1, indicating moderate to severe impact on health and overall quality of life.

   - The average ENS6Q score was 6.51, with 18.4% of patients scoring above 10.5. Displaying a high risk of getting Empty Nose Syndrome (ENS) after Turbinectomy and turbinate reduction.

To get diagnosed with Empty Nose Syndrome (ENS) based on the ENS6Q, a score of 11 or higher is generally used as the threshold. The total score ranges from 0 to 30, with each of the six questions scoring up to 5 points. A score above this threshold suggests that the patient is experiencing symptoms severe enough to be considered as having ENS.

2. **Impact on Sleep:**

   - Sleep-related symptoms were notably severe across the board. Patients frequently reported issues such as difficulty falling asleep, waking up during the night, and feeling tired during the day.

   - Among the different groups, those with a history of re-radiotherapy had significantly higher scores for sleep-related issues compared to patients with no history of radiotherapy. This suggests that radiotherapy may have a long-term impact on sleep quality. These patients also had a higher SNOT-22 score related to emotional well-being.

**Conclusions / summary:**

**Turbinate Removal and Sleep:** According to the study, 18.4% of patients who had their turbinates removed or reduced by radio frequency had a score higher than 10.5 on the Questionnaire: (ENS6Q), indicating a high risk of Empty Nose Syndrome (ENS). It was also noted that turbinectomy and radiofrequency treatment led to noticeable sleep disturbances. Patients experienced significant sleep issues, which were further exacerbated in those with a history of radiofrequency treatment

**Overall Quality of Life:** The study highlights that patients undergoing this surgery generally experience moderate to severe nasal symptoms and sleep disturbances. 

**Radiotherapy Impact:** A history of radiotherapy negatively impacts quality of life, particularly affecting sleep and emotional health. Patients with re-radiotherapy history experienced worse outcomes in these areas compared to those without such history.