Revision endoscopic sinus surgery rates by chronic rhinosinusitis subtype

Area of Science:

• Otolaryngology
• Surgical Outcomes
• Chronic Rhinosinusitis Research

Background:

• Revision surgery rates after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) vary widely.
• Understanding outcomes across different CRS subtypes is crucial for optimizing treatment.

Purpose of the Study:

• To investigate the outcomes of ESS in various subtypes of CRS.
• To analyze revision surgery rates based on specific CRS classifications.

Main Methods:

• Retrospective review of 424 adult CRS patients who underwent ESS between 2010 and 2015.
• Outcomes were analyzed by CRS subtypes, including CRS with nasal polyps (CRSwNP) and CRS without polyps (CRSsNP).
• Specific subtypes analyzed included aspirin-exacerbated respiratory disease (AERD), allergic fungal sinusitis (AFS), immunodeficiency, granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA).

Main Results:

• All CRS subtypes showed significant improvement in postoperative Sino-Nasal Outcome Test (SNOT-22) scores.
• The overall revision ESS rate was 4% (3.5% for CRSwNP).
• Revision rates varied by subtype: AERD (2%), AFS (2%), immunodeficiency (14%), GPA (40%), and EGPA (0%).

Conclusions:

• ESS provides clinically meaningful improvements for all CRS subtypes.
• Patients with immunodeficiency and GPA experienced higher revision surgery rates, warranting further investigation.
• Tailored surgical and medical strategies based on CRS subtype improve outcomes, particularly for AERD, AFS, and EGPA.