Evidence-based surgery for chronic rhinosinusitis with and without nasal polyps

Area of Science:

• Otolaryngology
• Surgical Innovation
• Medical Research

Background:

• Chronic Rhinosinusitis (CRS) significantly impacts quality of life.
• Endoscopic Sinus Surgery (ESS) is a common treatment modality for CRS.
• Evidence synthesis is crucial for understanding ESS efficacy and limitations.

Purpose of the Study:

• To evaluate the safety and efficacy of Endoscopic Sinus Surgery (ESS) for Chronic Rhinosinusitis (CRS) through meta-analysis.
• To identify factors influencing surgical outcomes and revision rates in CRS patients.
• To explore the impact of comorbidities on ESS effectiveness.

Main Methods:

• Meta-analysis of large outcome studies and cohort studies.
• Assessment of disease-specific and generic Quality of Life (QOL) measures.
• Analysis of objective outcome measures and complication rates.

Main Results:

• ESS demonstrates significant efficacy in improving QOL and objective measures for CRS.
• A long-term revision rate of 15-20% is observed, higher in patients with ASA triad, cystic fibrosis, osteitis, or prior surgery.
• Nasal obstruction shows a higher effect size (1.7) compared to hyposmia (0.8).
• The role of allergy in ESS outcomes for CRS remains unclear.
• Aspirin sensitivity and asthma are linked to increased disease burden and revision surgeries.

Conclusions:

• ESS is a safe and effective treatment for CRS, with demonstrable improvements in patient-reported and objective outcomes.
• Patient selection and understanding of risk factors, such as comorbidities and previous interventions, are critical for optimizing surgical success and minimizing revision rates.
• Further research into CRS phenotyping may enable more personalized surgical treatment strategies.