Maxillary Sinus Puncture: A Traditional Procedure in Decline—Insights from SHIP
Abstract
1. Introduction
- SHIP-START: The original cohort with baseline data collected between 1997 and 2001, followed by START-2 (2008–2012) and START-3 (2014–2016);
- SHIP-TREND: An independent cohort established in 2008 (TREND-0: 2008–2012) to refresh the population sample;
- SHIP-NEXT: Launched in 2021 but excluded from this analysis due to ongoing data collection.
Objective
2. Materials and Methods
2.1. Study Design and Population
- SHIP-START, the first cohort, with baseline data collected in 1997–2001 (START-0; n = 4308). We used follow-up data from START-2 (2008–2012; n = 2333) and START-3 (2014–2016; n = 1717);
- SHIP-TREND-0, the baseline data of an independent second cohort recruited in the same region (2008–2012; n = 4420).
2.2. Assessment of Sinonasal History and Interventions
- Have you ever had your nasal septum straightened? (0 = no, 1 = yes);
- If yes, when? (open-ended response);
- Have you ever undergone a maxillary sinus puncture?* (0 = no, 1 = yes);
- If yes, when? (open-ended response);
- Have you ever had surgery on the paranasal sinuses?* (0 = no, 1 = yes);
- If yes, when? (open-ended response).
2.3. Quality-of-Life Instruments
- SNOT-20-D: This 20-item questionnaire evaluates symptom burden and quality-of-life impact in individuals with sinonasal complaints. It includes items on nasal obstruction, facial pressure, and olfactory function. The German version (SNOT-20-D) is a standardized translation of the original SNOT-20 developed by Piccirillo et al. [8] and was the best-available tool at the time of SHIP-START for sinonasal health assessment in a German-speaking population. Higher scores indicate greater symptom severity; a mean score of ≥0.8 was defined as the minimal clinically important difference (MCID);
- EQ-5D-3L: This is a standardized measure of general health across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Index scores were calculated using German-specific value sets [9,10], with higher values indicating better health. The EQ-5D is validated for use in CRS research and general populations [11];
- SF-12: This a concise, validated tool for assessing subjective physical and mental health. It produces two summary scores (physical and mental component summaries). Higher scores reflect better perceived health status [12].
2.4. Use of AI Tools
2.5. Statistical Analysis
- Years since MSP;
- Age at MSP;
- Interaction: years since × age at MSP;
- Interaction: age at MSP × sex.
3. Results
3.1. Cohort Characteristics and MSP Prevalence
3.2. Longitudinal Consistency and MSP Timing
3.3. Impact of MSP on Quality of Life
4. Discussion
4.1. Significance of the Study
4.2. Historical Trends and Age Distribution
4.3. Reliability of Self-Reported MSP and Recall Bias
4.4. Impact on Quality of Life
4.5. Confounding Variables
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
MSP | Maxillary Sinus Puncture |
ARS | Acute Rhinosinusitis |
CRS | Chronic Rhinosinusitis |
SNOT-20-D | Sinonasal Outcome Test (20-item, German version) |
EQ-5D-3L | EuroQol 5-Dimension, 3-Level |
SF-12 | 12-Item Short Form Health Survey |
MCID | Minimal Clinically Important Difference |
SHIP | Study of Health in Pomerania |
ESS | Endoscopic Sinus Surgery |
EDMM | Endoscopically Directed Middle Meatal Culture |
QoL | Quality of Life |
CI | Confidence Interval |
OR | Odds Ratio |
DFG | Deutsche Forschungsgemeinschaft |
BMBF | Federal Ministry of Education and Research (Germany) |
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START-2 | |||||||
---|---|---|---|---|---|---|---|
Variable | N | Overall | Men | Women | <40 Years | 40–60 Years | >60 Years |
Sex [women] | 2332 | 1235 (53.0) | – | – | 148 (57.4) | 581 (54.4) | 506 (50.3) |
Age [years] | 2332 | 57.4 (13.7) | 58.3 (13.8) | 56.5 (13.5) | 35.8 (2.5) | 50.2 (6.1) | 70.5 (6.8) |
Allergies [yes] | 2309 | 217 (9.4) | 73 (6.7) | 144 (11.8) | 24 (9.3) | 105 (9.9) | 88 (8.9) |
Current smoking [yes] | 2323 | 484 (20.8) | 232 (21.2) | 252 (20.5) | 81 (31.4) | 309 (29.0) | 94 (9.4) |
EQ-5D-3L index | 2301 | 0.9 (0.2) | 0.9 (0.1) | 0.9 (0.2) | 0.9 (0.1) | 0.9 (0.1) | 0.9 (0.2) |
SF12 general health | 2318 | 3.0 (0.7) | 3.0 (0.7) | 3.0 (0.7) | 3.4 (0.7) | 3.1 (0.7) | 2.9 (0.6) |
SF12 physical health | 2262 | 47.0 (9.1) | 46.9 (9.3) | 47.1 (8.9) | 50.7 (7.0) | 48.5 (8.3) | 44.4 (9.7) |
SF12 mental health | 2262 | 52.5 (8.7) | 54.0 (7.7) | 51.2 (9.3) | 51.7 (8.6) | 51.9 (8.7) | 53.4 (8.6) |
SNOT-20-D summary score | 1247 | 13.1 (12.2) | 11.0 (10.5) | 15.1 (13.4) | 15.1 (12.8) | 14.0 (12.8) | 11.2 (10.8) |
SNOT-20-D mean score | 1247 | 0.7 (0.6) | 0.6 (0.5) | 0.8 (0.7) | 0.8 (0.6) | 0.7 (0.6) | 0.6 (0.5) |
SNOT-20-D MCID [yes] | 1247 | 407 (32.6) | 161 (26.3) | 246 (38.7) | 66 (43.7) | 226 (34.9) | 115 (25.7) |
Maxillary sinus puncture [yes] | 2306 | 258 (11.2) | 116 (10.7) | 142 (11.6) | 9 (3.5) | 111 (10.5) | 138 (14.0) |
Age at puncture [years] | 218 | 35.7 (15.8) | 37.7 (17.9) | 34.2 (13.6) | 26.8 (5.4) | 30.7 (12.1) | 40.2 (17.3) |
Time since puncture [years] | 218 | 25.1 (15.2) | 25.7 (16.7) | 24.6 (14.0) | 9.1 (5.2) | 20.7 (12.5) | 29.7 (15.9) |
TREND-0 | |||||||
Variable | N | Overall | Men | Women | < 40 years | 40–60 years | > 60 years |
Sex [women] | 4420 | 2275 (51.5) | – | – | 582 (53.8) | 990 (52.1) | 703 (48.9) |
Age [years] | 4420 | 52.0 (15.5) | 52.6 (15.7) | 51.3 (15.2) | 31.4 (5.1) | 50.3 (6.1) | 69.6 (5.7) |
Allergies [yes] | 4248 | 1245 (29.3) | 443 (21.4) | 802 (36.8) | 372 (34.8) | 557 (29.8) | 316 (24.1) |
Current smoking [yes] | 4398 | 1183 (26.9) | 624 (29.3) | 559 (24.7) | 458 (42.5) | 593 (31.2) | 132 (9.3) |
EQ-5D-3L index | 4369 | 0.9 (0.1) | 0.9 (0.1) | 0.9 (0.2) | 0.9 (0.1) | 0.9 (0.1) | 0.9 (0.2) |
SF12 general health | 4404 | 3.1 (0.7) | 3.1 (0.7) | 3.0 (0.7) | 3.4 (0.7) | 3.1 (0.7) | 2.8 (0.6) |
SF12 physical health | 4310 | 47.3 (8.8) | 47.6 (8.7) | 47.0 (9.0) | 51.4 (6.1) | 47.6 (8.6) | 43.7 (9.4) |
SF12 mental health | 4310 | 52.4 (8.6) | 53.8 (7.9) | 51.2 (9.1) | 51.5 (7.8) | 52.0 (9.0) | 53.8 (8.6) |
SNOT-20-D summary score | 2422 | 13.8 (12.0) | 12.3 (11.3) | 15.4 (12.4) | 14.2 (12.0) | 14.3 (12.5) | 12.8 (10.9) |
SNOT-20-D mean score | 2422 | 0.7 (0.6) | 0.6 (0.6) | 0.8 (0.6) | 0.7 (0.6) | 0.7 (0.6) | 0.6 (0.5) |
SNOT-20-D MCID [yes] | 2422 | 853 (35.2) | 359 (29.5) | 494 (41.0) | 220 (36.7) | 422 (36.0) | 211 (32.5) |
Maxillary sinus puncture [yes] | 4235 | 401 (9.5) | 182 (8.8) | 219 (10.1) | 35 (3.3) | 186 (10.0) | 180 (13.8) |
Outcome | Cohort | N (No MSP) | N (MSP) | Estimate [95% CI] | p-Value |
---|---|---|---|---|---|
EQ-5D-3L index (β) | START-2 | 1919 | 238 | −0.02 [−0.04; −0.001] | 0.042 |
TREND-0 | 3692 | 397 | 0.01 [−0.01; 0.02] | 0.324 | |
SF-12 general health (β) | START-2 | 1932 | 241 | −0.06 [−0.14; 0.03] | 0.193 |
TREND-0 | 3721 | 400 | −0.05 [−0.11; 0.02] | 0.178 | |
SF-12 physical health (β) | START-2 | 1883 | 237 | −0.94 [−2.10; 0.22] | 0.112 |
TREND-0 | 3650 | 392 | −0.81 [−1.66; 0.04] | 0.060 | |
SF-12 mental health (β) | START-2 | 1883 | 237 | −1.24 [−2.41; −0.07] | 0.039 |
TREND-0 | 3650 | 392 | −0.36 [−1.25; 0.52] | 0.423 | |
SNOT-20-D mean score (β) | START-2 | 1051 | 119 | 0.28 [0.17; 0.39] | 8.9 × 10−7 |
TREND-0 | 2117 | 231 | 0.17 [0.09; 0.25] | 5.6 × 10−5 | |
SNOT-20-D MCID (OR) | START-2 | 1051 | 119 | 2.41 [1.62; 3.57] | 1.3 × 10−5 |
TREND-0 | 2117 | 231 | 1.56 [1.18; 2.07] | 5.4 × 10−6 |
Outcome | Statistic | Time Since Intervention | Age at Intervention | Time × Age Interaction | Age × Sex Interaction |
---|---|---|---|---|---|
N | 216 | 216 | 216 | 216 | |
EQ-5D-3L index | F-value | 2.81 | 2.60 | 0.20 | 1.61 |
p-value | 0.041 | 0.053 | 0.994 | 0.188 | |
N | 218 | 218 | 218 | 218 | |
SF-12 general health | F-value | 0.80 | 2.10 | 0.64 | 0.90 |
p-value | 0.497 | 0.101 | 0.766 | 0.444 | |
N | 213 | 213 | 213 | 213 | |
SF-12 physical health | F-value | 1.24 | 1.51 | 1.18 | 3.05 |
p-value | 0.296 | 0.214 | 0.309 | 0.030 | |
N | 213 | 213 | 213 | 213 | |
SF-12 mental health | F-value | 0.92 | 1.52 | 1.05 | 0.24 |
p-value | 0.432 | 0.209 | 0.403 | 0.869 | |
N | 106 | 106 | 106 | 106 | |
SNOT-20-D summary score | F-value | 0.64 | 1.43 | 0.66 | 0.63 |
p-value | 0.593 | 0.239 | 0.740 | 0.594 |
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Paperlein, F.; Klinger-König, J.; Busch, C.-J.; Scharf, C.; Beule, A.G. Maxillary Sinus Puncture: A Traditional Procedure in Decline—Insights from SHIP. J. Clin. Med. 2025, 14, 5578. https://doi.org/10.3390/jcm14155578
Paperlein F, Klinger-König J, Busch C-J, Scharf C, Beule AG. Maxillary Sinus Puncture: A Traditional Procedure in Decline—Insights from SHIP. Journal of Clinical Medicine. 2025; 14(15):5578. https://doi.org/10.3390/jcm14155578
Chicago/Turabian StylePaperlein, Fabian, Johanna Klinger-König, Chia-Jung Busch, Christian Scharf, and Achim Georg Beule. 2025. "Maxillary Sinus Puncture: A Traditional Procedure in Decline—Insights from SHIP" Journal of Clinical Medicine 14, no. 15: 5578. https://doi.org/10.3390/jcm14155578
APA StylePaperlein, F., Klinger-König, J., Busch, C.-J., Scharf, C., & Beule, A. G. (2025). Maxillary Sinus Puncture: A Traditional Procedure in Decline—Insights from SHIP. Journal of Clinical Medicine, 14(15), 5578. https://doi.org/10.3390/jcm14155578