Evidence-based Surgery for Chronic Rhinosinusitis with and without Nasal Polyps

Abstract

Meta-analysis of both large outcome studies as well as cohort studies support the safety and efficacy of Endoscopic Sinus Surgery for Chronic Rhinosinusitis. The efficacy of endoscopic sinus surgery is demonstrated in the improvement of both disease-specific and generic QOL as well as objective measures. However, this must be interpreted together with a well-recognized long-term 15-20 % revision rate, seen more often in patients with ASA trias and cystic fibrosis as well as osteitis and previous surgery. The effect of surgery is higher in managing nasal obstruction (effect size 1.7) and less so hyposmia (effect size 0.8). Allergy has an additive role on the symptomatology of CRS; however, its role if any on the outcome of ESS for CRS is unclear. The concurrent presence of aspiring sensitivity and asthma is associated with increased disease burden and more revision surgeries. Improved phenotyping of CRS may lead in the future to better tailoring of surgical treatments.

How Often is Sinus Surgery Performed for Chronic Rhinosinusitis with versus without Nasal Polyps?

“…The longer OR time was most likely due to increased burden of disease, increased bleeding, and decreased visualization during surgery for CRSwNP compared with CRSsNP, as previously documented. [34][35][36] Our study faced many of the challenges associated with analyzing administrative data. There was a disparity in the collected variables across states.…”

Can a panel of clinical, laboratory, and pathological variables pinpoint patients with sinonasal polyposis at higher risk of recurrence after surgery?

“…Masterson et al [4] described a similar revision rate of 12.3% in patients undergoing surgery for CRSwNP limited to the anterior ethmoid. A long-term revision rate of 15%-20% was recently reported [5].…”

Management of the upper airway in cystic fibrosis

“…A systematic review of evidence-based sinus surgery outcomes noted that CF patients report improvement in quality of life measures following ESS, but at a lower rate and for shorter duration than non-CF CRS patients [71]. ESS also conferred significant benefit in both sinus symptoms and quality of life in CF children according to a recent meta-analysis [72].…”