The impact of medical therapy on cognitive dysfunction in chronic rhinosinusitis

Background: Cognitive dysfunction in chronic rhinosinusitis (CRS) is often overlooked despite potentially broad implications. Earlier work has demonstrated decreased cognitive function in CRS patients at baseline. In this study we sought to prospectively evaluate the impact of initial, appropriate medical therapy on subjective and objective cognitive function, fatigue, and workplace productivity. Methods: Adult patients with CRS were prospectively enrolled and completed a robust battery of pretreatment quality-of-life and neurocognitive testing, before undergoing appropriate medical therapy with follow-up testing at 6 weeks. Patient-reported cognitive function was assessed using the Cognitive Failures Questionnaire (CFQ), whereas fatigue was measured with the Fatigue Severity Scale (FSS). Objective cognitive function was assessed using the Automated Neuropsychological Assessment Metrics (ANAM) platform and workplace productivity using the Clinical Trials version of the World Health Organization Health and Work Performance Questionnaire (ctHPQ). Results: Twenty-seven patients were enrolled. Patients demonstrated posttreatment improvement scores on the FSS (4.32 ± 1.78 to 3.28 ± 1.65; p = 0.003), Pittsburgh Sleep Quality Index (8.62 ± 5.06 to 6.85 ± 4.11; p = 0.014), and CFQ (38.56 ± 16.40 to 33.04 ± 14.35; p = 0.046). Objective neurocognitive tests of mathematical processing and Stroop Reaction Test Block 3 improved after medical therapy (19.79 ± 5.61 to 21.3 ± 6.87; p = 0.029 and 43.06 ± 15.66 to 50.42 ± 19.34; p = 0.002, respectively). Measures of workplace productivity did not change significantly. Conclusion: Appropriate medical therapy improves several measures of cognitive dysfunction in patients with CRS. Sustainability of results should be evaluated with larger, prolonged studies.