Surgical Versus Medical Interventions in CRS and Nasal Polyps: Comparative Evidence Between Medical and Surgical Efficacy

Abstract

CRS with nasal polyps (CRSwNP) is a subgroup of CRS, where polyps can be visualised in the middle meatus. In the general population, the prevalence is estimated to lie between 0.2 and 4 %. Up to 15 % of patients with asthma have nasal polyps and up to 45 % of patients with nasal polyps have asthma. The management of CRSwNP involves primary medical management, with surgery normally reserved for recalcitrant cases. Surgical techniques for CRSwNP range from simple polypectomy and endoscopic sinus surgery (ESS) to radical nasalisation with removal of the middle turbinates. We have reviewed the comparative literature regarding medical and surgical interventions in CRSwNP, with emphasis on outcomes, complications, cost-effectiveness and on the timing of surgery. Similar outcomes are reported for medical and surgical management, but there is sufficient evidence to support the role of surgery once symptoms have failed to adequately respond. There is insufficient evidence to define the optimal timing and extent of surgery.

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

“…31,32 Surgical techniques for CRSwNP range from simple polypectomy to extensive surgery with mega maxillary antrostomies and removal of the middle turbinates, and there currently is insufficient evidence to define the optimal timing and extent of surgery. 33 Although patients with CRSwNP were less likely than patients with CRSsNP to have a balloon device used during their surgery, 6% of patients with CRSwNP did have a balloon device used during their surgery to open one or more sinuses.…”

Establishing utility values for the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) using a crosswalk to the EuroQol–five‐dimensional questionnaire–three‐level version (EQ‐5D‐3L)

“…The mapping models developed for the SNOT‐22 in this study can be used to calculate EQ‐5D‐3L‐based QALYs associated with different CRS‐related health states. This would be highly useful for future researchers wanting to conduct comparative effectiveness research into the various medical and surgical treatments available for CRS . These mapped values are likely superior to those derived from generic PROM instruments alone, such as the EQ‐5D or 6‐dimension Short Form Health Survey (SF‐6D) .…”

Management of chronic rhinosinusitis with steroid nasal irrigations: A viable nonsurgical alternative in the COVID‐19 era

“…Recurrent doses of systemic steroids may have a worse impact on the quality of life (QOL) than the CRS itself, 2 and systemic steroid use should be minimized 3 . Ideally, symptoms should be managed medically without such side effects and, if possible, ESS should be avoided or number of surgeries minimized 4 …”