Predictors of the Need for Additional Postoperative Treatment for Eosinophilic Chronic Rhinosinusitis

We retrospectively analysed the background and treatment effects of patients who improved with steroid treatment alone and those in whom steroids were ineffective and required dupilumab or revision functional endoscopic sinus surgery (FESS) for postoperative recurrence of eosinophilic chronic rhinosinusitis (ECRS). The objective of this study was to determine the factors influencing the effectiveness of steroid treatment and to evaluate the outcomes of alternative treatments, such as dupilumab or revision FESS.

Between April 2007 and July 2021, 118 adult patients with ECRS who underwent an initial FESS and required additional treatment (corticosteroids, dupilumab, or revision FESS) were included. Responders included 84 patients who required steroid treatment, and non-responders comprised 34 patients who required dupilumab or revision FESS for postoperative recurrence. Patient characteristics (age, sex, bronchial asthma, aspirin intolerance, period from onset to initial FESS), questionnaires (self-administered odour questionnaire and nasal symptoms questionnaire), and results of examinations (JESREC score, peripheral blood eosinophils, non-specific IgE level, mean olfactory detection and recognition thresholds, intravenous olfactory test, and CT score) were compared.

The period from onset to initial FESS was significantly longer in non-responders than that in responders (p < 0.001). In both groups, in questionnaires and detection and recognition thresholds in the standard olfactory test, significant improvements were observed after treatment (p < 0.05). However, no significant differences in the questionnaires and examinations were observed between the two groups after treatment.

Early therapeutic intervention is important because the period from onset to initial FESS affects the therapeutic effect of steroids on ECRS. Dupilumab or reoperation has been suggested to provide equivalent treatment outcomes even in patients who are resistant to steroids after surgery.