The Impact of Sinus Surgery for Chronic Rhinosinusitis on Concomitant Depression and Anxiety Symptoms: A Systematic Review and Meta‐analysis

Both anxiety and depression are prevalent among patients with chronic rhinosinusitis (CRS) and associated with poorer outcomes following treatment for CRS. However, the impact of treatment on CRS on mental health remains uncertain. Therefore, this study seeks to evaluate if surgical intervention for CRS may alleviate comorbid depression and anxiety. PubMed, Embase, and Scopus databases were searched for retrospective and prospective cohort studies, cross-sectional studies, and randomized controlled trials relating to CRS treatment using sinus surgery from inception to April 30, 2024, using the Population, Intervention, Comparison, and Outcomes (PICO) framework. Three blinded reviewers selected observational studies and randomized controlled trials investigating levels of depression and anxiety pre- and post-surgical treatment of CRS. Eleven studies comprising 3067 patients were included, of which five studies were quantitatively analyzed. After which, data were extracted from included articles into a structured proforma and the Newcastle-Ottawa Scale was used to evaluate study bias, following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and a PROSPERO-registered protocol (CRD42022351855). Meta-analyses of the ratio of means were conducted in a random-effects model. Overall, sinus surgery was associated with significant improvement in test scores of depression (ratio of means (ROM) = 1.47, 95% confidence interval [CI] = 1.03‒2.10), anxiety (ROM = 1.10, 95% CI = 0.81‒1.49), and quality of life markers, which are closely correlated to mental health outcomes. Sinus surgery for CRS may improve mental health outcomes (both depression and anxiety) for patients.