Methodologic assessment of studies on endoscopic sinus surgery.

Area of Science:

• Otolaryngology
• Surgical Efficacy Assessment
• Evidence-Based Medicine

Background:

• Chronic rhinosinusitis is commonly treated with functional endoscopic sinus surgery (ESS).
• The efficacy of ESS compared to medical management or older surgical techniques is debated.
• Published literature requires critical evaluation regarding its support for ESS claims.

Purpose of the Study:

• To critically analyze the methodological quality of published studies on the efficacy of functional endoscopic sinus surgery (ESS).
• To identify limitations in the methodology of studies evaluating ESS for chronic rhinosinusitis.

Main Methods:

• A systematic literature search was conducted using MEDLINE for English-language primary studies (1987-2001) on sinusitis surgery/therapy and endoscopy, with >100 patients.
• 29 studies met initial criteria, with 6 additional studies identified from reference lists.
• Articles were assessed using 4 core methodological criteria (inclusion/exclusion, control group, intervention, outcome measure) and 8 additional criteria.

Main Results:

• Only 3 out of 35 studies met all 4 core methodological criteria for efficacy assessment.
• A control group was utilized in just 4 studies evaluating ESS for chronic sinusitis.
• Studies met an average of 7.2 criteria, with a range of 2 to 11, indicating variable methodological rigor.

Conclusions:

• The lack of control groups is a significant limitation in assessing the comparative efficacy of ESS.
• Methodological weaknesses prevent robust scientific comparison of ESS with medical therapy or alternative surgical procedures.
• The described methodological criteria can serve as a framework for evaluating intervention studies in other medical fields.