Health Locus of Control in Patients with Chronic Rhinosinusitis After Endoscopic Sinus Surgery: A Pilot Study

BackgroundHealth locus of control (HLC) reflects an individual's perception of what influences their health and is categorized into four loci: Internal (IHLC), Chance, Powerful Others, and Doctors (DHLC). In other chronic conditions, HLC has been shown to impact patient recovery outcomes. However, its role in sinonasal disease remains unexamined. This pilot study investigates the influence of HLC on post-operative sinonasal outcomes in patients with chronic rhinosinusitis (CRS).MethodsMultidimensional Health Locus of Control Form C surveys (MHLC-C), demographics, and pre- and post-operative SNOT-22 surveys were collected from 81 adult patients with CRS who underwent endoscopic sinus surgery and attended ≥ 3 post-operative visits. Associations between MHLC-C scores and changes in SNOT-22 scores were analyzed.Results81 patients were enrolled in the study. Greater DHLC scores were positively correlated with pre-operative SNOT-22 scores (β = 2.26, P = 0.011) and negatively correlated with change in SNOT-22 post-operatively (β = -1.83, P = 0.026). When split by median scores into high and low scoring groups, the high DHLC group was associated with improved post-operative SNOT-22 scores (P = 0.009; 95% CI, -19.70 to -2.98), with statistically significant improvements in the ear/facial, psychological, and sleep subdomains (P = 0.015, 0.023, 0.025, respectively).ConclusionA higher DHLC was associated with greater improvements in SNOT-22, and with significant improvements in 3 of the 5 SNOT-22 subdomains. This outcome differs from studies in other fields that suggest improved outcomes with greater IHLC alignment, and may be explained by nuance in the patient-provider relationship and various treatment modalities unique to the management of CRS.