Characteristics of recurrent chronic rhinosinusitis after previous surgical therapy

Our findings emphasize the role of a thorough diagnostic evaluation preoperatively and a targeted long-term medical therapy following any sinonasal surgery for inflammatory disease. Early onset of long-term aspirin desensitization can address a very predominant inflammatory stimulus in a large number of our patients in an effort to prevent recurrent chronic rhinosinusitis (CRS) after successful surgical therapy.

Postoperative recurrence of CRS, regardless of the ongoing evolution of diagnostic and surgical techniques, still poses an unsolved problem.

This investigation was designed to further characterize the role of aspirin intolerance (AI) and inhalant allergies as persistent inflammatory stimuli in the postoperative period and secondly to analyze the correlation between preoperative computed tomographic (CT) scores and the actual intraoperative findings. A total of 143 patients with recurrent CRS were included in this retrospective analysis, who all underwent revision sinus surgery at our institution after one or multiple previous operations. Charts were analyzed for the incidences of AI and inhalant allergies, CT scores, and intraoperative scores.

In all, 66/143 patients had inhalant allergies and 55/143 were diagnosed with AI. The risk of recurrent CRS was found to be highest in the group with AI, along with the shortest interval between previous surgical interventions and the need for revision. In a subgroup of 34 cases, correlations between CT and intraoperative endoscopy scores were poor in 79%. Interestingly, at the time of recurrence the frontal sinuses were diseased in 17.6% of cases, where they had been healthy at the time of the initial intervention.