Chronic rhinosinusitis with polyps is a chronic inflammatory pathology of the ethmoidal mucosa, with an unknown and complex etiopathogenesis til nowadays. It is quiet frequent, however its exact prevalence remains unknown, but can be estimated between 1% and 4% of general population [5]. It mostly affects young males. In fact, it manifests as functional rhinosinusal signs evolving for at least 8 to 12 weeks, which can seriously affect patient’s quality of life. These symptoms include nasal obstruction, olfaction disorders, facial pain,..etc.

Indeed, its diagnosis is endoscopic, and requires according to the EPOS the presence of at least two symptoms, one of which should be nasal obstruction or rhinorrhea associated with a minor sign such as: dysosmia or facial pain [2]. In fact, treatment is always medical, and possibly can be supplemented by a surgical procedure. It is based on long term local corticosteroid therapy with general corticosteroids and antibiotics in case of secondary infections. Surgery meanwhile is based on endonasal videosurgery. It is indicated in case of failure of well conducted medical treatment, in severe polyposis or in case of contraindication to corticosteroid therapy [5]. Although mild and benign, SNP has a major impact on patient’s quality of life on both physical as well as psychosocial level [6]. Our current study evaluates nasal blockage caused by polyps before and after surgical treatment and its impact.

Several tools have been described in literature to assess the quality of life of patients with SNP. In 1997, the ENT American Academy suggested that to better assess the effectiveness of endoscopic treatment for polyposis, two scores were used: VAS Severity Scoring and QOL Assessment [7]. While Van Owen et al. showed that the RQLQ and RSOM-31 have been the best tools used to assess the impact of the disease [8]. Finally in 2012, a new questionnaire (DYNACHRON) was developed [9]. A questionnaire with 78 items divided into 6 areas exploring at the same time all main symptoms of chronic rhinosinusitis (nasal obstruction, anterior and posterior rhinorrhea, dysosmia, facial pain and cough) and their consequences both physical and psychosocial. These items are evaluated by an analogical scale of 0 to 10 points with 0 signifying absence of discomfort and 10 signifying an unbearable discomfort.

Our study showed that patients suffering from nasal obstruction, had difficulty while breathing, and complained of discomfort during sleep and physical efforts before surgery. Next to physical impact of nasal obstruction, it also affects patient’s psychic and relational side. Nasal obstruction's degree and its impact have decreased considerably after surgery in our study. Same thing was proved in several studies in the literature [10; 12]. In fact, nasal obstruction is due to a mechanical obstacle: polyps, which block nasal airflow. This blockage disrupts nasal breathing and therefore sleep [13]. Serrano et al had suggested in this sense that the nasal obstruction caused by polyps had twice as high risk of sleep disorders [14]. These disorders can also be a consequence of inflammatory mediators releasing. Thenceforth, patients feel tired during the day, and may eventually have mood, concentration, and psychosocial troubles [15].

Thus, the DYNACHRON questionnaire not only makes it possible to globally assess the severity of symptoms and how they affect quality of life, however, it is also a reliable tool to evaluate the results of SNP treatment. Figure 3 shows in addition to the decrease in nasal obstruction and its impact after surgery, a tendency to stabilize at 6 weeks and 6 months after surgery. However, it would not allow a conclusion to be drawn about what would occur beyond the 6th month post-operative. Yet, Soler et al. found in his study a stable clinical and mental state and stationary at 6, 12, and 20 months after endoscopic sinus surgery [16]. Moreover, Hopkins et al had objectified a stabilization of the quality of life at 3, 6, 12, and 36 months after polyp surgery [17]. He on the other hand was based on another tool which is SNOT22 [18]. Therefore, we could then suggest that the time required between endoscopic surgery and stabilization of quality of life is estimated at 6 weeks.