Sinus surgery beneficial for immunodeficient chronic rhinosinusitis patients: Study
Canada: Endoscopic sinus surgery (ESS) is beneficial for patients with chronic rhinosinusitis (CRS) and immunodeficiency, suggests a recent study in the journal International Forum of Allergy & Rhinology.
Immunodeficiency is a risk factor for recalcitrant chronic rhinosinusitis. No consensus has been formed on effective treatment modalities for immunodeficient CRS patients. The review by Jonathan Yip, University of Toronto, Toronto, ON, Canada, and colleagues aimed to evaluate the existing evidence on the treatment outcomes and its limitations in patients with CRS and immunodeficiency.
For the purpose, the researchers searched the online databases from inception to April 2019. It included studies reporting measurable medical or surgical treatment outcomes for adult patients with CRS and underlying primary or secondary immunodeficiency.
Of the 2459 articles screened, 13 studies met the inclusion criteria -- 2 prospective double‐blind placebo‐controlled trials, 2 prospective case‐control studies, 2 prospective cohort studies, and 7 case series.
Key findings of the study include:
- Antibiotic monotherapy was not linked with significant improvement in clinical, radiographic, or endoscopic outcomes.
- Immunoglobulin replacement therapy may potentially reduce the frequency of acute or chronic sinusitis in patients with primary immunodeficiency (PID) but may not improve their sinonasal symptoms.
- Outcomes from endoscopic sinus surgery were reported in 8 studies, which found that surgery was linked with improvement in symptoms, disease‐specific quality of life, endoscopy scores, and radiographic scores.
- The average reported ESS revision rate was 14%.
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"Patients with CRS and immunodeficiency likely benefit from ESS based on the available evidence," wrote the authors. "Data supporting medical therapy in this targeted population is limited overall, but there may be a potential role for immunoglobulin therapy in patients with PID and CRS."
The study titled, "Medical and surgical treatment outcomes in patients with chronic rhinosinusitis and immunodeficiency: a systematic review," is published in the journal International Forum of Allergy & Rhinology.
DOI: https://onlinelibrary.wiley.com/doi/abs/10.1002/alr.22647
