Endoscopic Sinus Surgery Improves Quality of Life in Recurrent Acute Rhinosinusitis: JAMA
Finland: A small randomized trial found that endoscopic sinus surgery (ESS) significantly improved disease-specific quality of life in patients with recurrent acute rhinosinusitis, while conservative medical therapy alone provided minimal benefit.
Current guidelines recommend antibiotics, intranasal corticosteroid sprays, and saline nasal irrigation for individual episodes, with ESS considered for patients experiencing multiple recurrences each year. Although the study supports the effectiveness of surgery in improving patient outcomes, its early termination resulted in a small sample size and less precise estimates of treatment benefit.
The findings were reported in a study published in JAMA Otolaryngology–Head & Neck Surgery by Heidi Kaski from the Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, and colleagues.
Recurrent acute rhinosinusitis (RARS) is marked by repeated episodes of sinus inflammation separated by symptom-free intervals and can substantially impair quality of life. However, evidence directly comparing surgical and medical treatment has been limited.
To address this, researchers conducted an open-label randomized clinical trial involving adults with physician-diagnosed RARS that remained uncontrolled despite conservative treatment. Eligible patients had at least three episodes within six months, four within one year, or two annually for three consecutive years.
The study enrolled 59 patients at Oulu University Hospital, Finland, between May 2020 and June 2024. Participants had a mean age of 40 years, and most were women. Thirty patients received endoscopic sinus surgery (ESS) plus standard medical therapy, while 29 received medical therapy alone. Patients were followed for six months.
The primary outcome was change in quality of life measured using the SinoNasal Outcome Test-22 (SNOT-22). Secondary outcomes included symptom burden, healthcare utilization, antibiotic use, work or study absences, and treatment-related adverse events.
The trial revealed the following findings:
- Patients who underwent endoscopic sinus surgery showed significantly greater improvement in sinonasal quality of life than those receiving medical treatment alone.
- The improvement in SNOT-22 scores at six months was more than 22 points greater in the ESS group compared with the medical therapy group.
- Secondary outcome analyses largely supported the primary findings, indicating broader patient-related benefits with surgery.
- Medical treatment alone did not result in clinically meaningful improvements during the study period.
- ESS was generally well tolerated, with only four patients requiring treatment for surgical complications.
- Reported complications included three postoperative infections and one case of scar tissue formation with septal perforation.
- No major treatment-related adverse events were observed.
The authors concluded that endoscopic sinus surgery (ESS) combined with medical therapy provides better outcomes than medical treatment alone in adults with recurrent acute rhinosinusitis. Despite the relatively small sample size, the trial offers randomized evidence supporting ESS as an effective and generally safe option for patients whose recurrent sinus infections remain inadequately controlled with conservative treatment.
Reference:
Kaski H, Alakärppä A, Laajala A, et al. Endoscopic Sinus Surgery for Recurrent Acute Rhinosinusitis: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online June 18, 2026. doi:10.1001/jamaoto.2026.1537
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