(1233) The Advent Approach: Optimizing Nasal Outcomes in Sleep and Chronic Rhinosinusitis at Lower Cost

Introduction: A healthy and functioning nose requires a patent nasal airway, healthy sinuses, and minimally inflamed nasal/sinus mucosa. The aim of this study was to assess the results of in-office balloon sinus dilation (BSD) and radiofrequency (RF) procedures on breathing and sleep using the Nasal Obstruction Symptom Evaluation (NOSE) and Epworth Sleepiness Scale (ESS) patient reported outcomes.

Methods: This is a retrospective cohort study. Data was reviewed for 1212 patients who had filled out the NOSE and ESS questionnaires at the Computed Tomography (CT) visit and post in-office BSD and nasal procedures from ADVENT clinics between 8/16/2021 and 10/31/2023. Included were patients with nasal sinus symptoms and/or radiographic findings consistent with chronic rhinosinusitis.
Procedures performed in the office setting included turbinate reduction, polypectomy, and BSD. The objectives were to measure whether ADVENT’s protocol improved patients' perceived breathing function and sleepiness based on the NOSE and ESS scores, respectively. Endpoints were the difference between the scores reported during the CT visit (baseline) and follow-up surveys conducted at least 4 weeks post-procedure. Data was aggregated to determine average and median scores for the group.

Results: In-office treatment resulted in an average improvement in the NOSE score of 30 points - from 50 at baseline to 20 post-treatment. Severe or extreme symptoms, NOSE score >/= 55, improved from an average of 70 to 25.
Patients with excessive sleepiness, ESS score >/= 11, improved by an average of 5.6 points, with 67% converting from an abnormal to normal score.

Conclusions: The combination of BSD and RF reduction of the nasal swell bodies and inferior turbinates, in office under local anesthesia provides comparable results, based on NOSE and ESS scores, to more traditional methods completed under general anesthesia in an ASC setting. Adopting this pathway will significantly increase access and advance the care of nasal and sleep patients employing procedures with lower risk, lower cost, and faster recovery without narcotic analgesia.