Endoscopic surgery, medicine combo effective for chronic sinusitis with nasal polyps: Lancet
Netherlands: Endoscopic sinus surgery (ESS) plus medical therapy is more effective than medical therapy alone in chronic rhinosinusitis with nasal polyps (CRSwNP) patients, the minimally clinically important difference however was not met, says a recent study.
Although long-term follow-up data are required whether the effect persists, the current results form the basis for further development of evidence-based guidelines, Evelijn S Lourijsen, Department of Otorhinolaryngology, Amsterdam UMC, location Academic Medical Centre, Amsterdam, Netherlands, and colleagues wrote in their study published in The Lancet Respiratory Medicine.
Chronic rhinosinusitis with nasal polyps is an eosinophilic inflammatory disease that significantly impairs the quality of life due to severe congestion, anosmia, facial pain and pressure, and nasal drainage. Beacuse the lack of effective medical treatment frequently leads to ESS it becomes frustrating for both patients and clinicians, with as many as 30% of surgery patients requiring further revisional surgeries.
For patients with CRSwNP, ESS is a common operation when medical therapy alone is insufficient. There has been no publication of randomized controlled trials on the efficacy of ESS. Dr. Lourijsen and the team, therefore, aimed to assess the efficacy of ESS plus medical therapy versus medical therapy alone in patients with CRSwNP in an open-label, pragmatic trial.
The trial included 238 Dutch patients with CRSwNP. They were randomized to ESS with usual care or to usual medical care alone (typically, chronic nasal steroids with saline rinses and short bursts of oral steroids and antibiotics).
In an open-label, pragmatic trial, 238 Dutch patients with CRSwNP were randomized to ESS with usual care or to usual medical care alone (typically, chronic nasal steroids with saline rinses and short bursts of oral steroids and antibiotics). The primary outcome was disease-specific health-related quality of life (HRQoL) at 12 months of follow-up.
The findings of the study were as follows:
- After 1 year, improvement was statistically significant, but not clinically significant, better in the surgery group (a 5-point difference on a 110-point rhinosinusitis-specific quality-of-life scale).
- A more robust 15-point difference between groups was noted at 3 months.
- A total of 23 patients in the medical group eventually required ESS.
- About half of all patients had uncontrolled symptoms after 1 year, with anosmia being most troublesome.
The study confirms what is seen in clinical practice: ESS gives good short relief of CRSwNP, but improvement typically wanes over time.
Lourijsen ES et al. Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: A multicentre, randomised, controlled trial. Lancet Respir Med 2022 Apr; 10:337. https://doi.org/10.1016/S2213-2600(21)00457-4.