In-office endoscopic nasal polypectomy: prospective analysis of patient tolerability and efficacy

Abstract

Purpose In-office rhinologic procedures have become popularised in the last decade, especially in North America. Endoscopic nasal polypectomy under local anaesthesia offers instant relief in selected patients with obstructive chronic rhinosinusitis with nasal polyps. We aimed to analyse patient tolerability during the procedure while measuring its effectiveness. Methods A prospective study of patients who underwent in-office microdebrider-assisted polypectomy under local anaesthetic from September 2018 to November 2019 in a Spanish tertiary hospital was performed. The tolerability was measured by monitoring vital signs during the procedure and using a visual analogue scale posteriorly. The effectiveness was calculated through patient-reported outcomes (SNOT-22) and endoscopic evaluation 1 and 6 months follow-up. Results Forty-four patients were included, with a mean age of 60.7 years. The mean visual analogue scale score was 2.76 out of 10 points. Vital signs were steady overall, with a statistically significant reduction (p < 0.001) in systolic pressure during the procedure. Presyncope and epistaxis were among the few mild complications. However, we registered one major complication that required intensive care admission. There was a 64% reduction in the SNOT-22 score in the first month, with a maintained effect after 6 months. Patients with asthma and a higher polyp load were the subgroups that required more time to achieve significant improvement. Conclusions In-office polypectomy is a very effective technique that alleviates obstructive symptoms in patients with nasal polyposis, and it is generally safe and well tolerated when performed by an expert. However, rhinologists must be aware of potentially severe complications.

Impact of Prolonged Operative Time on Complications Following Endoscopic Sinonasal Surgery

“…Another limitation of this study was that the ACS‐NSQIP does not include cases of in‐office procedures. Some ESNS cases (both non‐sinus and sinus) can be safely performed in the office with fewer anesthetic requirements, thus reducing OT 37,38 . We were not able to include these cases in our analysis, and it is possible that the true median OT in ESNS procedures was lower than what was reported in this study.…”

“…Some ESNS cases (both non-sinus and sinus) can be safely performed in the office with fewer anesthetic requirements, thus reducing OT. 37,38 We were not able to include these cases in our analysis, and it is possible that the true median OT in ESNS procedures was lower than what was reported in this study. Furthermore, a significant proportion of patients included in the study did not have diagnosis codes (e.g.…”

Evaluating the Quality and Safety of In-Office Rhinologic Procedures: A YO-IFOS Pilot Study

“…Office-based rhinology is gaining traction among American Rhinologic Society (ARS) members, with increased adoption across various practice settings [1]. This trend, however, is not fully understood in other parts of the world [5,6].…”

“…Additionally, more extensive procedures such as ethmoidectomies (35%), middle meatal antrostomies (31%), sphenoidotomies (24%), and frontal sinusotomies (21%) were reported. The volume of IORPs has increased over the last five years, but practice patterns and training implementation outside North America are less known [5,6].…”

Managing Chronic Rhinosinusitis with Nasal Polyps in the Elderly: Challenges and Solutions

“… 86 While balloon sinuplasty is not indicated in patients with nasal polyps, some are pursuing in-office polypectomy for CRSwNP. 87 Patients undergoing in-office procedures can be medicated with oral pain medication and anxiolytics prior to the procedure; however, these medications should only be given after reviewing medications taken by the patient. Generous use of both topical and injected local anesthetics can make many procedures tolerable in the clinic setting.…”