Issue link: https://viewer.e-digitaledition.com/i/79665
++++++++++++++++++++++++++++++++++++ + + ++++++++++++++++++++++++++++++++++++ OTOLARYNGOLOGY SPOTLIGHT +++ +++ Surgery: Rhinosinusitis A Productive Alternative to PATIENTS ENDURING THE ACHES AND SWELLING OF RECURRENT ACUTE RHINOSINUSITIS (RARS) EXPERIENCE GREAT DISCOMFORT THAT CAN LEAD TO WORK ABSENTEEISM AND DIMINISHED QUALITY OF LIFE. A PROGRESSIVE STUDY WEIGHS THESE BURDENS AGAINST THOSE OF SURGERY AND OFFERS SOME INTRIGUING SUGGESTIONS. T HE MAY 2012 issue of Otolaryngology–Head and Neck Surgery contains the com- parative study, which examines work productivity to establish a threshold for when patients should look beyond conservative medical therapy and consider surgical treatment. The study's authors recognized that RARS impacts other factors related to quality of life and made no pretense that productivity and quality of life are directly proportional, but they considered absenteeism a valid starting place to bring patients into the discussion about treatment options. Because rhinosinusitis affects more than 30 million people each year, the potential loss in total productivity resulting from the disease is staggering. The authors note that not all patients with RARS take days off work during each episode, but they observe that the disease can lead to "partial productivity." Given that these partially productive workdays do not allow patients the rest they need to recover from illness, periods with low quality of life lengthen. Facts and Findings According to the study, the time burden of endoscopic sinus surgery — together with postoperative care — is three to fi ve workdays. In a pure time comparison, this far outshines the burden of the disease, as each infection can last as many as four weeks. However, time is neither the only nor primary factor in determining productivity. The authors suggested that suffering more than four episodes of RARS in one year costs more in overall productivity than does sinus surgery. However, many patients confuse upper respiratory tract infections with RARS, so the authors advocated for six episodes as an appropriate threshold for surgery. As physicians discuss treatment options with RARS patients, they might do well to mention productivity loss. Because this factor affects each patient differently, it cannot be prescribed as an authoritative need for surgery. Nonetheless, the study shows that sinus surgery may be an option for acute rhinosinusitis, not only chronic cases. ■ 6 | Central New York MD NEWS ■ MDNEWS.COM EVALUATING THE PRODUCTIVITY FACTOR AS PHYSICIANS DISCUSS endoscopic sinus sur- gery with patients experiencing recurrent acute rhinosinusitis (RARS), productivity may be one of the key elements in weighing the benefi ts of surgery. Discussing productivity loss from RARS versus from surgery requires recognizing the elements of personal work effi ciency: + Cost is a factor for many patients, as the money some will spend on surgery is com- parable to the losses they would sustain by missing work. + Emotional burdens of surgery, even endoscopic surgery, often outweigh the annoyances of illness, but the frustrations of recurrent conditions mount with each episode. + Time away from work will vary with each episode of RARS, but patients will certainly be absent for at least a few days if they undergo surgery.