Sinonasal outcome under aspirin desensitization following functional endoscopic sinus surgery in patients with aspirin triad

Abstract

Recalcitrant forms of recurrent nasal polyposis are problematic for patients as for rhinosurgeons. In aspirin-sensitive patients, aspirin desensitization is supposed to prevent recurrence by targeting the metabolism of arachidonic acid. Aspirin-sensitive patients (n = 65) following aspirin desensitization after functional endoscopic sinus surgery (FESS) for recurrent nasal polyposis under daily intake of 500-mg aspirin were compared to a post-FESS group (n = 81) of aspirin-sensitive individuals using exclusively topical mometasone. Quality of life (QoL) scores including sinonasal, pulmonal and general QoL items as well as endoscopic endonasal examination findings were evaluated during the postoperative follow-up period. After a follow-up period of minimum 18 months, a significant improvement in nasal obstruction, rhinorrhea, post nasal drip, sense of smell, facial pain, sleep quality and further general QoL items in desensitized patients was found compared to aspirin-sensitive controls. Improvement in sinonasal symptoms was evident, whereas the severity of asthmatic symptoms showed no significant changes. Although the pathophysiology of aspirin sensitivity is still not fully understood and the therapy is not sufficiently investigated, aspirin desensitization seems to have a positive effect on QoL scores concerning sinonasal symptoms and should be regarded as a possible postoperative treatment modality for recurrent nasal polyposis in aspirin-sensitive individuals.

Long‐term Sinonasal Outcomes of Aspirin Desensitization in Aspirin Exacerbated Respiratory Disease

“…No significant decline was observed in either endoscopic or SNOT-22 score between 1 month and 30 months postdesensitization. Our findings are consistent with a recently published report by Havel et al, 12 who reported favorable subjective and objective long-term outcomes using validated instruments in 56 patients followed for an average of 35 months. Using a target maintenance dose of 500 mg/day, Havel et al found very good tolerance with minimal attrition due to untoward side effects of aspirin.…”

Clinical benefits of aspirin desensitization in patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease are not related to urinary eicosanoid release and are accompanied with decreased urine creatinine

“…Desensitization in our patients was not performed as it is recommended just after sinus surgery, and patients had massive mucosal hypertrophy. 40 We, therefore, can speculate that ASA treatment after desensitization is not capable of reversing existing mucosal hypertrophy but only affects inflammation and mucosal edema or prevents regrowing of nasal polyps and delay their recurrence. 18,41 It is also possible that the duration of treatment was too short to affect mucosal hypertrophy.…”

Endoscopic sinus surgery improves aspirin treatment response in aspirin‐exacerbated respiratory disease patients

“…A confounder in the treatment protocol may be the length of time between preceding ESS, if one exists, and the initiation of aspirin therapy. Although some studies that showed response and benefit of aspirin therapy tested patients who had ESS 3-6 weeks before aspirin therapy, 22,25 other studies showed no any correlation between preceding ESS time and initiation of aspirin therapy. 6,18,24 In our cohort, 20% of patients failed the initial desensitization protocol due to GI intolerance or persistent bronchospasm, similar to the 17% reported by Cahill et al 23 A third of the patients were able to complete desensitization but reported no change or worsening of respiratory symptoms on aspirin maintenance therapy.…”

“…Treatment outcomes after aspirin treatment in responders and nonresponders are summarized in Figure 1. Nineteen patients classified as "responders" had a significant increase in the ACT score after 4 weeks of treatment compared with baseline (23 [IQR, [21][22][23][24][25] vs 20.5 [IQR, [17][18][19][20][21][22], p < 0.01) and a significant decline in RQLQ score compared with baseline (2.5 [IQR, 1.5-3.0] vs 1.2 [IQR, 0.5-2.0], p < 0.05). Twenty-one patients classified as "nonresponders" had a decline in ACT score at 4 weeks compared with baseline (15 [IQR, [12][13][14][15][16][17][18] , p = 0.05), although this outcome was of borderline significance.…”