Nasal spray adherence after sinus surgery: problems and predictors

OBJECTIVES: To assess patient adherence to nasal spray regimens after endoscopic sinus surgery (ESS) and to study factors that predict adherence.

METHODS: A three-arm, randomized, blinded, controlled trial was conducted at a tertiary care academic hospital, studied via a prospective longitudinal survey, of 60 consecutive chronic rhinosinusitis patients managed with ESS and started on one of three postoperative nasal spray regimens. Structured telephone interviews were conducted after surgery over a 12-month period using a validated questionnaire that assessed both spray adherence and barriers to adherence. Patient demographics, time post-ESS, preoperative Sino-Nasal Outcome Test (SNOT) scores, Lund-Mackay scores, adherence risk factors, and polyp grades were used as covariates with logistic regression.

RESULTS: Overall, 57.4% of patients were nonadherent. Logistic regression showed that preoperative SNOT scores (p = .018, 95% CI = 0.84-0.98), time post-ESS (p = .016, 95% CI = 1.02-1.22), and the presence of an adherence risk factor (p = .03, 95% CI = 1.18-26.99) significantly predicted whether a patient was adherent and correctly classified 70.4% of all patients. Age, gender, and nasal spray regimen did not predict adherence (p > .05).

CONCLUSION: The majority of patients were nonadherent to post-ESS nasal sprays, irrespective of which nasal spray regimen they were on. Preoperative SNOT scores, time post-ESS, and the presence of an adherence risk factor predicted adherence. With this knowledge, otolaryngologists can selectively employ strategies to improve adherence in high-risk patients and possibly improve ESS outcomes.