Minimally invasive sinus surgery becoming more common in medicare population

Sinus surgery performed using an endoscope appears to be increasingly common for the management of chronic sinus disease among Medicare beneficiaries, according to a report in the May issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

Chronic rhinosinusitis is characterized by infection and inflammation of the sinus cavities and nose that lasts longer than three months, according to background information in the article. Symptoms include congestion, runny nose, headache, facial pressure and loss of smell. "Mainstays of medical management for sinusitis include antibiotic therapy, systemic and topical intranasal steroids and nasal saline irrigations," the authors write. "A subset of patients with chronic rhinosinusitis in whom medical management fails undergo surgery, sometimes repeatedly, for treatment of their disease."

Endoscopic sinus surgery, a minimally invasive technique, was introduced in the United States in 1985, the authors note. To examine trends in rates of the procedure, Giridhar Venkatraman, M.D., M.B.A., of Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and colleagues studied a sample of Medicare beneficiaries age 65 to 99.

From 1998 to 2006, the rate of beneficiaries diagnosed with chronic rhinosinusitis declined by 1.4 percent. However, the rate of endoscopic sinus surgery increased 20 percent, from 0.72 per 1,000 patients to 0.92 per 1,000 patients. Over the same time, open sinus surgery rates declined 40 percent, from 0.20 per 1,000 patients to 0.11 per 1,000 patients.

When the researchers analyzed patients by age group—ages 65 to 69, 70 to 74, 75 to 79, 80 to 84 or 85 and older—the per capita rate of chronic sinusitis diagnoses remained the same. However, all age groups had increases in endoscopic sinus surgery rates.

"Our findings indicate that endoscopic sinus surgery is increasingly becoming the mainstay of chronic rhinosinusitis management in the Medicare population," the authors write. "Because of the uncertainty regarding the outcomes of surgical vs. medical management, the root causes of the observed increase in endoscopic sinus surgery rates need to be investigated. Given that sinusitis is a common diagnosis necessitating physician visits, comparative effectiveness studies examining medical vs. surgical management would be warranted."

(Arch Otolaryngol Head Neck Surg. 2010;136[5]:426-430. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Dr. Venkatraman has received a Harmes Surgical Scholar Award, Dartmouth Hitchcock Medical Center. Co-author David Goodman receives funding support from the Robert Wood Johnson Foundation and the National Institute on Aging. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.