Endoscopic Sinus Surgery for Type-2 CRS wNP: An Endotype-Based Retrospective Study

Area of Science:

• Otolaryngology
• Surgical Innovation
• Immunology

Background:

• Nasal polyps often involve type 2 inflammation and frequently recur after surgery.
• Current endoscopic sinus surgery (ESS) techniques aim to spare mucosa, but recurrence remains a challenge.

Purpose of the Study:

• To evaluate the efficacy of a novel 'reboot approach' for surgical removal of nasal polyps.
• To compare polyp recurrence rates between the reboot approach and traditional mucosa-sparing ESS in patients with type 2 inflammation.

Main Methods:

• A retrospective case-control study involving 50 patients with type 2 chronic rhinosinusitis with nasal polyps (CRSwNP).
• Patients underwent either classical non-reboot ESS, partial reboot approach, or complete reboot approach.
• Polyp recurrence over a 2-year follow-up was the primary outcome measure.

Main Results:

• All patients exhibited type 2 inflammation.
• Recurrence rates were 45% (classical), 17% (partial reboot), and 8% (full reboot).
• The reboot approach showed significantly lower recurrence rates compared to the classical method (P=0.02).

Conclusions:

• The reboot approach, involving complete removal of diseased paranasal sinus mucosa, significantly reduces nasal polyp recurrence.
• This technique offers improved long-term outcomes for type 2 inflammatory CRSwNP compared to mucosa-sparing methods.