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Surgery For Sinus Misery: Better, But Still No Cure

Rating

4 Star

Surgery For Sinus Misery: Better, But Still No Cure

Our Review Summary

While we typically wouldn’t advise reporters to focus exclusively on a single patient’s experience, as this story about endoscopic surgery for treating sinus infections did, the result here is a winner thanks to the patient’s familiarity with the subject and unusually dispassionate perspective. She is the relatively rare patient in a health story who acknowledges being disappointed with the outcome of a new treatment. 

Notable strengths of the story include its measured tone, its extensive discussion of nonsurgical alternatives, and its emphasis on the incremental benefits experienced by most patients (e.g. surgery is "rarely a cure"). The story could have provided a bit more information about the different types of sinus problems people suffer from (e.g. sinusitis with and without polyps, etc) and what kinds of studies support endoscopic surgery for chronic sinus infections. It also failed to provide enough detail regarding the costs and harms of the treatment. 

   

 

Why This Matters

Chronic sinusitis is a common problem that has a significant impact on quality of life. Chronic sinus infections can be painful, result in significant medical expenditures, and lead to lost productivity due to work absences.

Although endoscopic sinus surgery has some advantages over older, more invasive techniques that caused scarring and required longer recovery periods, it is important for patients to have realistic expectations about the benefits of surgery and whether they are worth the risks. As this story makes clear, the benefits of surgery remain marginal enough that they are worthwhile only for the most severe cases.  

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

A comment about the overall cost of endoscopic sinus surgery, as well as insurance coverage and likely out-of-pocket expenses for patients, would have been appropriate in this story. In addition, the costs associated with the equipment and upkeep are also important considerations. However, the story didn’t mention costs.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

This story focuses almost exclusively on the experience of one patient, a practice we generally think should be avoided. In this case, however, the patient in question was a health columnist with the Boston Globe who brings a well-informed and appropriately skeptical perspective to the story. Whereas many stories seek out patients who embody the best possible outcome for a new technology or procedure, this patient describes an incremental benefit that was "disappointing" in size but in the end, still worth the trouble. Instead of getting 5 or more sinus infections per year, she now gets 3 or 4 infections that are not as bad as before. In addition, the story emphasizes that surgery is "rarely a cure" and should be viewed as a "last resort" for most patients with sinus problems.  We wish more stories were this measured in their assessment of medical benefits.

  

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story refers off-handedly to the possibility of "poking through to the brain or into the orbit of an eye," but it fails to explain that these events are very rare but real risks of the surgery. While extremely unlikely, it’s possible for surgeons to accidentally damage the optic nerve, resulting in blindness, or to puncture the base of the skull, resulting in cerebrospinal fluid leakage. Other less serious, but more common complications are also possible. The story didn’t mention any of them.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

While we appreciated this story’s carefully calibrated tone and conspicuous lack of hype, we felt its discussion of the evidence was inadequate. The story  quotes a surgeon who says that endoscopic surgery improves quality of life for patients "probably in over 90 percent of the cases." But we’re not given enough information to determine how this estimate was formulated or if it is representative of typical patient outcomes. The surgeon might be talking about his own personal experience treating patients, which could be much better than average if he’s an experienced surgeon working at a top-tier institution. 

Adding to our concerns, there is at least some published evidence suggesting that endoscopic sinus surgery is less effective than this story indicates. For example, a systematic review of randomized controlled trials couldn’t find evidence that the procedure was more effective than medical therapy. Granted, this review included only 3 studies and could have involved slightly different procedures than the one discussed in this story. But if there is more persuasive evidence to substantiate the procedure’s benefits, the story should have referred to it directly instead of passing along the surgeon’s second-hand estimates.   

Does the story commit disease-mongering?

Satisfactory

There was no disease-mongering in this story. The story makes it clear that the surgery being described is a last-ditch approach for people with intractable problems.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story relies heavily on the perspective of Judy Foreman, the health columnist and patient, and her surgeon, Ralph Metson, neither of whom have any conflicts of interest that we could identify. While it would have been nice to hear from an expert who wasn’t involved in this particular case, the story does enough to satisfy the criterion. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The story’s sidebar gives detailed descriptions of alternatives to surgery, including nasal irrigation and corticosteroid nasal sprays.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story states that about 300,000 people a year undergo sinus surgery, making it one of the most commonly performed procedures in the U.S.  However, it does not provide statistics on the number or percentage of those procedures that are performed endoscopically and the type of hospital setting in which they are done. Enodoscopic surgery with CT guidance as described in the story may be out of the reach of smaller community based practitioners. We’ll call this satisfactory, but some additional detail would have been appropriate. 

Does the story establish the true novelty of the approach?

Satisfactory

The story didn’t attempt to oversell the novelty of this procedure.

Does the story appear to rely solely or largely on a news release?

Satisfactory

It is clear that this story didn’t rely on a news release.

Total Score: 7 of 10 Satisfactory

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