Nasal Polyp Surgery Research Articles

Effectiveness and Outcomes of Endoscopic Sinus Surgery for Nasal Polyps: A Systematic Review

Objectives: To investigate the effectiveness and outcomes of endoscopic sinus surgery (ESS) in patients with nasal polyps. Methods: A thorough search was conducted for pertinent literature using PubMed, SCOPUS, Web of Science, Science Direct, and Wiley Library. Rayyan QRCI was used throughout this extensive procedure. Results: Our results included nine studies with a total of 780 patients, and 490 (62.8%) were males. The follow-up duration ranged from 4 months to 24 months. All of the included patients underwent ESS for chronic sinusitis with nasal polyps (CRSwNP). Patients with CRSwNP and refractory CRSwNP reported better self-evaluated olfactory function after using ESS, experienced a higher reduction in polyp load, and better quality of life. Conclusion: Patients with CRSwNP reported significant improvements in quality of life and major symptoms when using ESS. The quality of the available data, as established in this evaluation, is low enough to make firm recommendations for the best course of surgical therapy. From a precision medicine perspective, high-quality studies are needed to phenotype these patients in order to identify which ones will benefit most from each type of medicinal and surgical therapy, including a combination of both, with long-term efficiency being a crucial result.

Effect of Dupilumab on Radiological Remission in Patients with Chronic Rhinosinusitis with Nasal Polyp: A One Step Forward Toward Clinical Remission.

While achieving complete radiological improvement in patients with nasal polyps is often observed following surgical resection, the impact of biologic therapy, specifically dupilumab, on polyp size is an area of great interest. The objective of this study was to assess the effect of dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) by assessing nasal polyps using the computed tomography (CT) staging system, Lund-Mackay score (LMS). A two-year prospective cohort study was conducted on 29 patients diagnosed with CRSwNP and asthma and eligible for dupilumab as an add-on therapy. The study involved comprehensive assessments of patients before biologic initiation and after the study. These assessments included clinical, laboratory, and radiological evaluations. Dupilumab treatment reduces LMS across sinuses (p<0.001) and improves nasal obstruction (p=0.001). Blood eosinophil count (BEC) predicts persistent sinus obstruction, doubling the likelihood per unit increase (odds ratio: 1.67, p=0.02). BEC levels identify persistent nasal obstruction (AUC: 76%, p=0.04), with a cutoff point above 255.5 cells per microliter, revealing a sensitivity of 100% and a specificity of 42%. The probability of persistent nasal obstruction at the 20th month is 55%, regardless of prior nasal polyp surgery (p=0.41). Dupilumab led to significant radiological improvements in patients with CRSwNP, demonstrating a potential role of radiological remission, irrespective of prior nasal polyp surgery. Additionally, BEC levels may guide the likelihood of persistent nasal obstruction.

Dupilumab Versus Mepolizumab for Chronic Rhinosinusitis With Nasal Polyposis: An Indirect Treatment Comparison

BackgroundDupilumab and mepolizumab have shown efficacy and safety in treating chronic rhinosinusitis with nasal polyps (CRSwNP). ObjectiveWithout available results from head-to-head randomized control trials (RCTs) comparing dupilumab with other biologics, we conducted an indirect treatment comparison (ITC) with mepolizumab. MethodsA systematic literature review identified RCTs of biologics in CRSwNP. A Bucher ITC was performed, including nasal polyp score (NPS; range 0–8), nasal congestion (NC; 0–3), loss of smell (LOS; 0–3), University of Pennsylvania Smell Identification Test (UPSIT; 0–40), visual analog score (VAS; 0–10), Sino-Nasal Outcome Test (SNOT-22; 0–110), systemic corticosteroids (SCS) use or surgery for nasal polyps (NPs), and binary responder analyses for NPS and SNOT-22 improvement by ≥1/≥2 and ≥8.9, respectively. Matching-adjusted indirect comparisons (MAIC) were conducted as supporting analyses. ResultsSINUS-24/-52 (SYNAPSE-like subpopulation only) and SYNAPSE were identified for ITC. At 24 weeks, change from baseline in NPS and proportion of patients with a binary responder outcome of NPS improvement ≥1 were significantly (P<0.05) greater in patients receiving dupilumab versus mepolizumab. At 52 weeks, improvements in NPS, NC, LOS, UPSIT, and VAS were significantly (P<0.05) greater for dupilumab versus mepolizumab. Proportion of patients achieving binary responder outcomes of NPS and SNOT-22 improvement by ≥1/≥2 and ≥8.9, respectively, was significantly (P<0.05) higher, while SCS use was significantly (P<0.05) reduced, for dupilumab versus mepolizumab. Surgery rate was numerically reduced with dupilumab versus mepolizumab. The MAIC analyses confirmed these results. ConclusionsDupilumab was associated with greater improvements in CRSwNP-related outcomes versus mepolizumab.

Real-Life Study of Patient Preference for Dupilumab or Revision Surgery for Recurrent Chronic Rhinosinusitis with Nasal Polyps.

(1) Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high rate of recurrence in patients, despite therapy with local corticosteroids and functional endoscopic sinus surgery. Dupilumab, a recombinant monoclonal human IgG4 antibody directed against the IL-4 receptor α that inhibits both IL-4 and IL-13 signal transduction, is available for symptomatic therapy. Patient preference between repeated surgery and injection therapy with Dupilumab is not known. (2) Methods: Patients who had experienced at least one surgical intervention for nasal polyps and were treated with Dupilumab for at least 3 months completed a retrospective patient questionnaire. (3) Results: In a cohort of 75 previously operated CRSwNP patients, 91.5% preferred therapy with Dupilumab to repeated surgery for nasal polyps. Preference for Dupilumab in the subgroups of patients with concomitant Non-steroidal Anti-inflammatory Drugs Exacerbated Respiratory Disease (N-ERD) (n = 32), patients with concomitant asthma (n = 25), and patients without concomitant disease (n = 18) was 100%, 96%, and 72%, respectively. (4) Conclusions: Patient preference for Dupilumab over repeat surgery is strongest in previously operated CRSwNP patients with concomitant asthma or N-ERD, but remains very high in patients without concomitant disease.

Real-World Cost of Nasal Polyps Surgery and Risk of Major Complications in the United States: A Descriptive Retrospective Database Analysis.

Endoscopic nasal polyp (NP) surgery is a treatment option for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Previous studies report NP surgery costs of $8000-13,000 and risk of major complications of NP surgery of ~0.1-1%. Limited contemporary data for costs and complications associated with NP surgery in US clinical practice are available. IQVIA PharMetrics Plus claims data were used to identify patients with NP surgery in 2019 with ≥3 years continuous baseline health-plan enrollment prior to index date (date of first eligible NP surgery) and ≥30 days continuous enrollment after index (follow-up). In this descriptive analysis, total costs of NP surgery were estimated as all medical costs on the index date (or during the entire hospital stay for patients who received surgery in the inpatient setting). Total medical costs (all-cause) were estimated for all medical services occurring from the index date to the index date +9 or +29 days (10-day and 30-day). Major complication was defined as cerebrospinal fluid (CSF) leak, orbital injury, or major hemorrhage within 30 days of index. Of 6311 patients, median age was 46 years (interquartile range: 34-56); 59.7% were male; 88.2% had no NP surgery in the prior 3 years; 63.7% had allergic rhinitis, and 37.1% had asthma. Mean (SD) total medical cost of surgery was $14,697 (11,679) and mean (SD) 10-day total medical cost was $15,401 (11,968). Major complications occurred in 102 (1.7%) patients. Total medical costs and 10-day costs were higher in patients with major complications than those without ($23,605 [19,264] vs $15,251 [11,741]). In this descriptive analysis, NP surgery costs and rates of major surgical complications were updated using recent real-world data in the US. Results indicated that NP surgery complication rates were numerically higher than previously reported.

Foreign Body Granuloma in the Maxillofacial Region: Report of an Unusual Case

This paper aimed to present a clinical case presenting an unusual periapical radiolucent lesion, its approach and treatment, and as an element of differential diagnosis in periapical pathology. Foreign body granuloma (FBG) is a tissue reaction that is triggered by the deposit of a foreign material affecting the skin and internal organs that the immune system tries to delimit and, if possible, eliminate. FBG may constitute a complication of a surgical procedure or a new pathology for the patient, which precedes an iatrogenic event causing diagnostic difficulties. This study presented an unusual periapical radiolucent lesion in a male patient with a periapical radiolucent area found in panoramic radiography; the lesion was enucleated, histopathologically confirming an FBG, which was the result of a biomaterial used in surgery for nasal polyps and deviated septum performed years before. This case shows us a very unusual presentation of an FBG within the maxillary bone after surgery for nasal polyps and deviated septum. The appropriate use of the available imaging tools and histopathological study and interpretation is emphasized, to be able to carry out a successful long-term treatment with the lowest chances of recurrence. In addition, an interdisciplinary approach is very important, which leads us to the comprehensive treatment of the patient. The proper use of diagnostic and imaging methods that we currently have, as well as knowledge of differential diagnoses, is essential to successfully diagnose and treat injuries in the maxillofacial area.

A comparison of use microdebrider with conventional endoscopic surgery for nasal polyps

Background: Nasal polyps are chronic and benign inflammatory lesions that arise from the mucous membrane of the nasal cavity and paranasal sinuses. And it represents a challenge in treatment due to its uncertain causes and recurrent relapse. Because of that the surgical treatment is considered as the best choice for the removal of nasal polyps. And, it contains endoscopic sinus surgery using either conventional instruments or the microdebrider which is an automatic device used to remove the obstructing tissue. And, it represents a modern technology in the treatment of nasal polyps. Objectives: Studying and comparing the microdebrider assisted endoscopic surgery and conventional methods using sinus endoscopes in the surgical management of nasal polyps, and evaluating the advantages of the microdebrider. Methods: The study was a comparative prospective study conducted at the department of ENT, tishreen university hospital, lattakia, Syria done between 2020 to 2021. 76 patients (46 male and 30 females) were enrolled in the study and divided into two groups depending on the used surgical method. Group1: conventional endoscopic sinus surgery method, Group2: microdebrider assisted endoscopic surgery. Then, comparing the results during and after 3 months of the surgery. Results: There were a significant difference between study groups in the mean time required for surgery (shorter in group2 with p-value &lt;0.01) and the average intraoperative blood loss (less in group2 with p-value&lt;0.01). Endoscopic sinus surgery with the microdebrider noted a low rate of postoperative synechiae formation after three monthes and there is no significant difference between the two groups in recurrence of nasal polyps after three monthes. Conclusion: Using the microdebrider in the surgical treatment of nasal polyposis is an effective and safe method because it has the advantage of saving time, decreasing blood loss during surgery, and reducing the rate of postoperative synechiae formation. but there is no significant difference in recurrence between the microdebrider and conventional methods.

The comparation of different oral corticosteroids withdrawal methods for nasal polyp surgery.

To compare the efficacy and adverse events of different oral corticosteroids (OCSs) withdrawal methods for chronic rhinosinusitis with nasal polyp after endoscopic sinus surgery (ESS). This was a randomized prospective study conducted from Oct 2019 to Jan, 2021. 35 patients who underwent ESS were randomly divided into 2 groups. Regular group (n = 18) received 0.4mg/kg/day of methylprednisolone orally for 10 days, tapering group (n = 17) received 0.4mg/kg/day of methylprednisolone orally for 7 days, followed by progressive reduction of 8 mg of methylprednisolone per week for 3 weeks. The visual analogue scale (VAS) score, the Lund-Kennedy endoscopy (LKE) score, and the E score were assessed preoperatively and at half and 1, 2, and 12 months postoperatively. Statistical analyses were performed using SPSS. There was no statistical difference in the baseline characteristics between the 2 groups. The postoperative VAS scores and LKE scores of patients were significantly improved from those preoperatively (P-values < 0.05). There was no statistical difference in the LKE score, E score, and VAS score between the 2 groups both preoperatively and postoperatively (P-values > 0.05). There was no statistical difference in adverse events between the 2 groups (P-values > 0.05). The combination of OCSs and ESS can improve the clinical symptoms of patients and the recovery of nasal mucosa. There was no difference between the 2 drug withdrawal methods in efficacy and adverse events. Drug withdrawal gradually is more complicated therefore, in clinical practice, OCSs withdrawal directly would be the better option for patients.

Surgical Ciliated Cyst of the Posterior Maxilla in an Old Male, Mimicking Residual Cyst or Odontogenic Keratocyst: A Case Report

Surgical ciliated cysts of the maxilla arise from respiratory epithelium that lodges in the maxilla after radical maxillary or sinus surgery. This case report was conducted in 2020 in Mashhad Dental School, Mashhad University of Medical Science, Mashhad, Iran. We present here an unusual case of surgical ciliated cyst of a 73-year-old adult male patient with a history of nasal polyp surgery 40 years ago. Early diagnosis due to CBCT and Clinical examination was a residual cyst or OKC (odontogenic keratocyst). The histopathology result of this lesion surprised us after the excisional biopsy and enucleation. The clinical examinations and radiographs of the jaw lesions may lead the maxillofacial surgeons to misdiagnosis and mistreatment. Therefore, it is obligatory to notice all aspects of these lesions carefully.

Anaphylaxis in a Patient Undergoing FESS for Nasal Polyposis: Revisting Samter’s Triad

Patients with nasal polyposis frequently have associated bronchial asthma and hypersensitivity to NSAIDs. When the three conditions co-exist, it is referred to as the Samter’s triad. Patients with Samter’s triad are an important subset of those with aspirin-exacerbated respiratory disease (AERD). We present a case of a young female patient undergoing endoscopic sinus surgery for nasal polyps, who although did not show any other features of AERD, went on to develop florid anaphylaxis to diclofenac administration intra-operatively. After adequate resuscitation and intensive care stay, the patient made a complete recovery. NSAIDs must be avoided in patients with nasal polyps, despite showing no other features of this syndrome. Other analgesic agents that can be used include IV paracetamol and opioids like tramadol.

Efficacy and safety of benralizumab in chronic rhinosinusitis with nasal polyps: A randomized, placebo-controlled trial

Eosinophilic inflammation has been implicated in the pathogenesis, severity, and treatment responsiveness of chronic rhinosinusitis with nasal polyps (CRSwNP). We sought to assess the efficacy and safety of benralizumab-mediated eosinophil depletion for treating CRSwNP. The phase 3 OSTRO study enrolled patients with severe CRSwNP who were symptomatic despite treatment with intranasal corticosteroids and who had a history of systemic corticosteroid (SCS) use and/or surgery for nasal polyps (NP). Patients were randomized 1:1 to treatment with benralizumab 30mg or placebo every 4 weeks for the first 3 doses and every 8weeks thereafter. Coprimary end points were change from baseline to week 40 in NP score (NPS) and patient-reported mean nasal blockage score reported once every 2 weeks. The study population comprised 413 randomized patients (207 in the benralizumab group and 206 in the placebo group). Benralizumab significantly improved NPS and nasal blockage score compared to placebo at week 40 (P≤ .005). Improvements in Sinonasal Outcome Test 22 score at week 40, time to first NP surgery and/or SCS use for NP, and time to first NP surgery were not statistically significant between treatment groups. Nominal significance was obtained for improvement in difficulty in sense of smell score at week 40 (P=.003). Subgroup analyses suggested influences of comorbid asthma, number of NP surgeries, sex, body mass index, and baseline blood eosinophil count on treatment effects. Benralizumab was safe and well tolerated. Benralizumab, when added to standard-of-care therapy, reduced NPS, decreased nasal blockage, and reduced difficulty with sense of smell compared to placebo in patients with CRSwNP. ClinicalTrials.gov NCT03401229.

Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis: A systematic review and network meta-analysis

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory condition of the upper airways. Optimal management is unclear. We compared the effects of mAbs and aspirin desensitization (ASA-D) for treatment of CRSwNP. We searched the Medline, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, US Food and Drug Administration, and the European Medicines Agency databases from inception to August 4, 2021, for randomized controlled trials comparing the effects of mAbs and ASA-D for CRSwNP. We conducted network meta-analysis of sinusitis symptoms, heath-related quality of life, rescue oral corticosteroids and surgery, endoscopic and radiologic scores, and adverse events. We used the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach to assess certainty of evidence. PROSPERO CRD42020177334. Twenty-nine randomized controlled trials evaluating 8 treatments (n= 3461) were included in the network meta-analysis. Compared to placebo, moderate to high certainty evidence showed that health-related quality of life (SNOT-22) improved with dupilumab (mean difference [MD] -19.91 [95% confidence interval (CI) -22.50, -17.32]), omalizumab (MD -16.09 [95% CI -19.88, -12.30]), mepolizumab (MD -12.89 [95% CI -16.58, -9.19], ASA-D (MD -10.61 [95% CI -14.51, -6.71]), and benralizumab (MD -7.68 [95% CI -12.09, -3.27]). The risk of rescue nasal polyp surgery likely decreased with dupilumab (risk difference [RD] -16.35% [95% CI -18.13, -13.48]), omalizumab (RD -7.40% [95% CI -11.04, -2.43]), mepolizumab (RD -12.33% [95% CI -15.56, -7.22]), and ASA-D (RD -16.00% [95% CI -19.79, 0.21]; all moderate certainty). Comparisons among agents show with moderate to high certainty that dupilumab ranks among the most beneficial for 7 of 7 outcomes, omalizumab for 2 of 7, mepolizumab for 1 of 7, and ASA-D for 1 of 7. Multiple biologics and ASA-D credibly improve patient-important outcomes, with clinically important differences in effects among agents; dupilumab uniquely ranks among the most beneficial for all outcomes studied.

Assessing effects of modification of middle meatal silastic splint after endoscopic sinus surgery for nasal polyps: A randomized controlled study

PurposeTo investigate the efficacy of middle meatal silastic splint in preventing adhesions after bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP), and to assess nasal symptoms and endoscopic findings in splinted and non-splinted sides. MethodsAfter completion of ESS, silicon silastic splints were randomly inserted in the middle meatus of one nasal side, while no stent in the other side (control). The surgeon was blinded to the side selection, and splint insertion until removal after 1 week. Patients were followed -up after 1 week, 1 and 6 months. Each side of the nasal cavity was assessed for adhesions, crusting, pus, pain, nasal obstruction, and nasal discharge by endoscopic examination and visual analogue scale. ResultsForty-nine patients (98 nasal sides) were included. At the 1st week visit, there was no significant difference between the splinted and non-splinted sides for all investigated parameters.After 1- month, adhesions were seen in 10% of the splinted sides, while it was in 26% of the non-splinted sides (P = 0.037).At the 6 -month follow-up visit, the adhesions rate remained 10% in the splinted sides, however the rate increased to 32% in the non-splinted sides (P = 0.007). All other examined parameters remained statistically insignificant between both sides throughout the follow -up visits. ConclusionsMiddle meatal silastic splint is significantly reducing middle meatal adhesions with low complication rate in CRSwNP patients undergoing ESS. Our results support its usage when the middle turbinate is unstable or traumatized during surgery.

Can the systemic immune inflammation index preoperatively predict nasal polyp subtypes?

Chronic rhinosinusitis with nasal polyps can be classified as eosinophilic or neutrophilic based on the major inflammatory cell type in the tissue. There is a need for predictive parameters to enable rhinologists to identify the type of nasal polyp in a patient without surgery. The aim of the present study was to test the predictive value of the markers of inflammation to estimate eosinophilic nasal polyps. The study analyzed 299 patients who underwent sinus surgery for nasal polyps from 2012 to 2019. Patients were divided into two groups according to pathology results (eosinophilic polyps = group 1, neutrophilic polyps = group 2). The values of preoperative complete blood count, systemic immune inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were compared. In our series, results of ROC analyses for both mean eosinophil count and systemic immune inflammation index were statistically significant. For the eosinophil count (AUC = 0.681, p < 0.001) and systemic immune inflammation index (AUC = 0.621, p = 0.001). Patients with an eosinophil cut-off value of 0.25 cells × 109/L had ORs of 49.27 (95% CI 11.68-207.81) and sensitivity: 0.69, specificity: 0.64. Patients with a systemic immune inflammation index cut-off value of 332.39 had ORs of 1.003 (95% CI 1.002-1.004) and sensitivity: 0.84, specificity: 0.39. The systemic immune inflammation index and absolute blood eosinophil count could be used to predict nasal polyp subtypes before surgery. We believe that systemic immune inflammation index should also be studied to estimate postoperative recurrence.

Dupilumab: A Review in Chronic Rhinosinusitis with Nasal Polyps.

Dupilumab (Dupixent®) is a fully human IgG4 monoclonal antibody against the interleukin (IL)-4receptor α (IL-4Rα) subunit, which is shared by the type I IL-4 and the type II IL-4/IL-13 receptor complexes. By binding to and blocking this subunit, dupilumab inhibits IL-4 and IL-13, which are the major drivers of human type 2 inflammatory disease [e.g. asthma, atopic dermatitis and chronic rhinosinusitis with nasal polyps (CRSwNP)]. Dupilumab, administered subcutaneously, is the first biological therapy to be approved for the treatment of adults with inadequately controlled CRSwNP in the EU and the USA. In two placebo-controlled, multinational, phase III studies of 24 and 52weeks' duration, the addition of dupilumab (300mg every 2weeks) to the intranasal corticosteroid treatment of adults with severe, inadequately controlled CRSwNP was generally well tolerated and improved nasal polyp size, sinus opacification and health-related quality of life (HR-QOL), relieved the major symptoms of CRSwNP (nasal congestion or obstruction, nasal discharge and loss of smell) and reduced the use of systemic corticosteroids and the need for nasal polyp surgery. Improvements in nasal polyp size, sinus opacification and nasal congestion or obstruction were achieved regardless of the presence of comorbid asthma or NSAID-exacerbated respiratory disease, or a history of previous nasal polyp surgery, with patients with comorbid asthma also demonstrating improvements in lung function and asthma control regardless of their baseline eosinophil count. Thus, add-on subcutaneous dupilumab is a valuable treatment option for adults with inadequately controlled CRSwNP.

Biologics for chronic rhinosinusitis.

Biologics for chronic rhinosinusitis.

ASPIRIN DESENSITIZATION AND MAINTENANCE THERAPY IN A NURSING AERD PATIENT

Introduction Aspirin exacerbated respiratory disease (AERD) is characterized by upper and lower respiratory symptoms upon ingestion of aspirin and other cyclooxygenase 1 inhibitors. Aspirin is generally not used in pediatric patients due to potential risks, such as the development of Reye's syndrome. There is little data on the safety of aspirin desensitization and aspirin therapy in patients who are nursing. Case Description A nursing 30-year old woman with AERD and a long-standing history of chronic rhinosinusitis, nasal polyps, and asthma was referred by her otolaryngologist for aspirin desensitization. Maximal medical therapy, including leukotriene inhibitors, topical nasal steroids, topical antihistamines, as well as allergen immunotherapy and nasal polyp surgery, were ineffective in controlling the rhinosinusitis and nasal polyps. Total nasal symptom score (TNSSs) involving nasal congestion, sneezing, nasal itch, and nasal drainage at baseline was 12. To minimize infant exposure to aspirin during desensitization, patient had utilized pumped breast milk and infant formula. Patient underwent a two-day protocol of aspirin desensitization, starting with 40.5 mg aspirin through 325 mg. Through consultation with pediatrics, it was decided that patient would be maintained at 81 mg aspirin daily while nursing. Patient responded well with this therapy with TNSSs of 4 at one month, three months, and twelve months after desensitization with no adverse events in child or patient. Discussion Aspirin desensitization and maintenance therapy can be considered in nursing AERD patients after careful assessment of risks and benefits along with pediatric consultation. It can potentially alleviate symptoms of rhinosinusitis, asthma, and nasal polyps.

Topical Furosemide Possibly Beneficial for Reducing Recurrence Rates After Nasal Polyp Surgery

Topical Furosemide Possibly Beneficial for Reducing Recurrence Rates After Nasal Polyp Surgery

Factors Affecting Time to Revision Sinus Surgery for Nasal Polyps: A 25-Year Experience.

Factors Affecting Time to Revision Sinus Surgery for Nasal Polyps: A 25-Year Experience.

Factors affecting time to revision sinus surgery for nasal polyps: A 25‐year experience

Surgical treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) is often followed by polyp regrowth with return of symptoms. The purpose of this study is to identify clinical factors that influence the time interval to revision sinus surgery in patients with nasal polyps. Retrospective cohort study. Records of 299 individuals who underwent two or more surgeries for the diagnosis of nasal polyps by the senior author (RM) from 1987 through 2011 were reviewed. The time between surgical interventions were compared to patient demographics, comorbidities, endoscopic examination, computed tomography (CT) stage, extent of surgery, and pathologic findings. The mean time interval between polyp surgeries was 4.87 ± 3.61 years (range 0.7-18.6 years). The median time to revision surgery was shorter in patients who smoked compared to nonsmokers (2.82 vs. 4.31 years, respectively, P = .022) and longer in patients who underwent middle turbinate resection rather than preservation (4.56 vs. 3.93 years, respectively, P = .048). Kaplan-Meier survival analysis confirmed these findings, but the beneficial effect of turbinectomy appeared to dissipate by 8 years. Neither a history of asthma nor advanced CT stage influenced the time to revision surgery. The time course between sinus surgeries in patients with regrowth of nasal polyps appears to be affected by certain modifiable extrinsic factors, including smoking on the part of the patient and operative technique on the part of the surgeon. The performance of middle turbinate resection during sinus surgery appears to extend the time interval until a revision procedure is required.