***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To implore the positive effects of endoscopic sinus surgery on the symptoms and quality of life ( QOL ) of patients with chronic rhinosinusitis ( CRS ) and their changing regularity of symptoms and QOL . METHODS A prospect i ve , r and omized and controlled trial was conducted to survey symptoms and QOL status of 120 CRS patients undergoing endoscopic sinus surgery , in contrast to that of 200 healthy individuals passing health examination , at the baseline and at 3- and 6-months postoperatively by visual analog score ( VAS ) symptom instrument and QOL instruments including medical outcome study short-form 36-items health survey ( SF-36 ) and sino-nasal outcome test-20 ( SNOT-20 ) . RESULTS In the 3 months follow-up setting s , total of individual symptom severity scores and global symptom severity scores of VAS , such domains as role physical and general health of SF-36 and total of the 20 items scores and the most important 5-item scores of SNOT-20 all began to get better markedly ( P < 0.05 ) ; in the 3 - 6 months follow-up setting s , the indices above stayed fixed ( P > 0.05 ) ; and in the 6-months follow-up setting s , indices of symptoms and QOL status entirely improved from the baseline , with SF-36 showing no scoring difference between CRS patients and healthy individuals , whereas VAS showed that abnormal nasal drainage and decreased sense of smell were still left and SNOT-20 showed that abnormal nasal drainage and lack of good sleep left , inferior to that of healthy objects significantly ( P < 0.05 ) . CONCLUSIONS On the whole CRS patients undergoing endoscopic sinus surgery recover symptomatically and come back to normal level of QOL status at the 6 months postoperatively , but such significant problems as abnormal nasal drainage , decreased sense of smell and lack of good sleep still remain and need to be treated Background Chronic rhinosinusitis ( CRS ) is a common disease that has a significant impact on quality of life ( QOL ) . The aim of this study was to evaluate the longer-term effects of combined medical and surgical therapy for CRS on overall health status and QOL . Methods We used a prospect i ve study that utilized the Short-Form 36 Survey at baseline presentation and at a mean time of 3 years  post-functional endoscopic sinus surgery  to assess the general health status of patients who presented for their initial visit from 1996 to 1998 . Of the 200 r and omly selected patients , 150 respondents completed follow-up surveys ( a 75 % response rate ) . Results Eighty-nine ( 59.3 % ) women and 61 ( 40.7 % ) men were included in the study . Baseline QOL scores indicated significant differences between patients with CRS and published norms in 6/8 subscale parameters ( role physical , bodily pain , general health , social function , vitality , and mental health ) . Significant improvement in all six categories was maintained at the end of the study period ( p < 0.05 ) with QOL scores within limits of published norms for the general population . Conclusion Our data indicate that functional endoscopic sinus surgery , combined with appropriate postoperative care , is effective at maintaining a significant improvement in the overall general health status of patients for at least 3 years after surgical intervention and that the overall scores return to a range of normative values for the general population OBJECTIVE The objective of this study was to determine if endoscopic sinus surgery ( ESS ) is effective in the management of  chronic recurrent rhinosinusitis ( CRRS ) .  METHODS A consecutive series of patients with CRRS diagnosed according to stringent criteria was prospect ively examined before and at least 1 year after ESS .  Paranasal sinus computed tomography scans were staged and ESS was performed targeting radiographic disease and the ostiomeatal complex . Preoperative and postoperative disease severities in terms of symptom scores , medicine utilization , and re source factors were assessed using the rhinosinusitis symptom inventory ( RSI ) . Improvements in RSI symptom domains , medical and economic re source factors were determined using effect sizes and statistical comparison before and after ESS . RESULTS Nineteen patients ( mean age , 42.3 years ) completed the study with a mean follow up of 19.1 months . The mean Lund score was 3.42 ( st and ard deviation , 4.09 ) . Statistically significant decreases in nasal ( -36.1 ) , facial ( -28.4 ) , oropharyngeal ( -34.6 ) , systemic ( -24.7 ) , and total ( -31.9 ) RSI symptom domain scores were observed ( all P < .003 ) with effect sizes ranging from 0.87 to 1.63 ( strong surgical effect ) . Statistically significant decreases in antihistamine use ( -30 % , P = .031 ) , number of workdays missed as a result of CRRS ( -1.9 , P = .035 ) , and number of acute infectious episodes ( -2.5 , P = .006 ) were also observed . However , declines in weeks of antibiotic use ( -2.8 weeks , P = .293 ) and number of antibiotic courses ( -1.7 , P = .118 ) were not significant . CONCLUSIONS Patients with CRRS may substantially benefit both symptomatically and medically from ESS . Although surgery should be used cautiously in treating CRRS , further trials of ESS for CRRS are warranted BACKGROUND Chronic rhinosinusitis affects millions of North Americans and has been increasing annually since 1991 . This study aim ed to evaluate the effectiveness of functional endoscopic sinus surgery ( FESS ) done with the use of computer assistance ( CASS ) and without the use of computer assistance on patient quality of life . As of this writing , there is no published study that measures the difference in patient quality of life with and without image guidance in endoscopic sinus surgery . METHODS A nonr and omized prospect i ve study was performed on 95 patients . A 31-item quality of life ( Rhinosinusitis Outcome Measures Form [ RSOM-31 ] ) question naire was administered to patients prior to surgery and 6 months following surgery during a 3-year enrollment period . Patients assessed both rhinologic and nonrhinologic symptoms using a statistically vali date d scoring system . Statistical analysis was performed using both equal and unequal variance sample t-tests when appropriate . RESULTS Statistically significant improvement in mean score analysis between preoperative and postoperative results for all symptom subgroups was reported when the entire study population was included . When the improvement in quality of life was compared between the CASS and FESS surgical groups , the CASS group demonstrated an overall greater improvement in quality of life . CONCLUSION Quality of life restrictions in patients with chronic rhinosinusitis were greatest in the areas of nasal symptoms and sleep deprivation , which were significantly improved by endoscopic sinus surgery . Although the long-term effect of CASS as measured by patient quality of life remains relatively unknown , there appears to be a significant trend indicating greater quality of life improvement in the short- term over non-computer-assisted FESS techniques OBJECTIVE To evaluate the prevalence and severity of individual Rhinosinusitis Task Force ( RSTF ) symptoms in patients with chronic rhinosinusitis ( CRS ) undergoing functional endoscopic sinus surgery ( FESS ) .  METHODS Retrospective analysis of prospect ively collected data in 201 patients treated with FESS .  The prevalence and severity of individual RSTF major and minor symptom scores grade d on a visual analogue scale ( VAS ) were compared . Correlation between absolute improvement in individual symptom scores at 1-year postoperative was performed . RESULTS One-hundred fifty-eight of 201 patients met inclusion criteria giving a response rate of 78 % . The average age was 49.4 ( range 18 - 80 ) with a male-to-female ratio of 1.1:1 . The preoperative leading mean symptom scores were postnasal drip ( 5.8 + /- 0.3 ) , nasal obstruction ( 5.7 + /- 0.3 ) , and facial congestion ( 5.1 + /- 0.3 ) . These symptoms were also the most prevalent with 82 % , 84 % , and 79 % of patients reporting these symptoms , respectively . Postoperative symptom improvements were significant ( P < .0001 ) across all RSTF domains except fever . The highest percentage improvement was seen with facial congestion ( 93 % ) , nasal obstruction ( 92 % ) , and postnasal drip ( 85 % ) . Multivariate analysis revealed significant ( P < .0001 ) high correlation between improvements of facial pain/pressure with facial congestion ( R = 0.72 ) , facial congestion with nasal obstruction ( R = 0.65 ) , and facial pain/pressure with headache ( R = 0.72 ) . CONCLUSION The top three RSTF symptoms were postnasal drip , nasal obstruction , and facial congestion in terms of prevalence and severity . Symptom scores improved after FESS . Of these symptoms , the degree of improvement of facial pain/pressure , facial congestion , nasal obstruction , and headache are highly correlated OBJECTIVES /HYPOTHESIS The objectives of this prospect i ve , double-blind diagnostic cohort study were to explore the relationship between patients ' reported symptoms of chronic rhinosinusitis ( CRS ) and radiographic findings in CRS to define clinical ly based diagnostic criteria for CRS and to determine a classification scheme that would allow for the accurate diagnosis of patients with CRS . METHODS A prospect i ve series of adult patients undergoing evaluation for potential chronic rhinosinusitis was studied . Patients ' symptoms were tabulated with the Rhinosinusitis Symptom Inventory ( RSI ) , which records symptoms associated with CRS on a Likert scale ( 5 = maximally severe ) . Medication and re source utilization were also tabulated . Scores for nasal , facial , oropharyngeal , systemic , and total symptom domains were computed ( 100 = maximum severity ) . Concurrent paranasal sinus computed tomography was obtained for each patient and scored according to the Lund-McKay system with review er blinding . Patients were classified as normal or representing true CRS according to previously published diagnostic radiographic criteria under two analyses . In analysis 1 , Lund scores < or = 1 were considered nondiseased and scores > or = 2 were considered as representing true CRS . In analysis 2 , Lund scores < or = 3 represented normal and scores > or = 4 represented true CRS . For each analysis , univariate statistics were computed to determine differences among patients ' reported symptoms with and without true CRS . Subsequently , classification analysis using classification regression trees was conducted to determine heuristics among clinical ly based criteria for the diagnosis of CRS . RESULTS Seven hundred three adult patients were enrolled ( mean age , 43.1 years ) . The most commonly reported symptoms in order of decreasing severity and presence were nasal obstruction , nasal congestion , discharge , fatigue , headache , facial pressure , and dysosmia , all with mean severity scores > or = 2.0 . Patients were previously treated for approximately 3 months each with topical nasal steroids , oral antihistamines , and oral antibiotics . Patients missed substantial workdays ( mean , 3.8/year ) and incurred significant physician visits ( mean , 3.5/year ) as a result of CRS . The nasal symptom domain exhibited the greatest severity ( 51.8 ) followed closely by the facial symptom domain ( 47.3 ) . According to the analysis 1 , 144 ( 20.5 % ) patients were classified as normal and 559 ( 79.5 % ) as true CRS . Only the presence of polyps ( P < .001 ) and dysosmia ( P = .008 ) distinguished between normal and diseased patients ; there were no significant differences between groups for the other symptoms and RSI domains . Classification analysis revealed that the presence of polyps , absence of dental pain , and low congestion/obstruction scores in the presence of dental pain predicted true CRS . Finally , a history of extended antibiotic courses before presentation also predicted true CRS . In the second analysis , 243 ( 34.6 % ) were normal versus 460 ( 65.4 % ) with true CRS . Only polyp presence and dysosmia exhibited statistically significant differences between normal and diseased patients ( P < .001 ) . The mean RSI nasal domain was higher for true patients with CRS ( P = .01 ) . Classification analysis identified polyp presence and dysosmia score > 2 effectively predicted CRS . Fatigue < or = 2 , discharge < or = 4 , and obstruction < or = 3 further predicted for CRS . Symptoms despite a > or = 5.5-week trial of nasal steroids also predicted CRS . Other major and minor symptoms , RSI domains , and re source factors failed to influence diagnostic classification . CONCLUSIONS The diagnosis of CRS based on symptom criteria is difficult because most symptoms ( other than dysosmia ) do not distinguish between radiographically normal and diseased patients . A classification scheme for CRS based on the presence or absence of polyps is valid . It is possible to classify patients with true CRS based on symptoms , but this requires complicated heuristics . Corroborating radiographic evidence should be required to establish the diagnosis of CRS before long periods of therapy or surgical intervention OBJECTIVE To determine whether preoperative computed tomography ( CT ) stage predicts degree of symptom improvement after  endoscopic sinus surgery ( ESS ) . METHODS A series of adult patients undergoing ESS  was prospect ively evaluated with CT and the rhinosinusitis symptom inventory  ( RSI ) preoperatively and at a minimum of 12 months postoperatively . Symptom domains ( nasal , facial , oropharyngeal , systemic , and total ) were computed and both 
    Output:
    
Preoperative fatigue severity scores and improvement noted after surgery were similar to the respective values for other pooled CRS symptoms