A recent study has found that patients with asthma or those on antibiotics during their initial sinus surgery are more likely to require revision sinus surgery, including the removal of nasal polyps. The study, which focused on individuals with chronic rhinosinusitis with nasal polyps (CRSwNP) who had undergone endoscopic sinus surgery (ESS), offers new insights into factors that affect the likelihood of requiring additional surgical procedures.
Nasal polyps, benign growths in the mucosal lining of the nasal passages, can cause significant obstruction and discomfort, particularly when they develop as part of chronic rhinosinusitis. This condition is commonly treated with corticosteroids administered nasally or orally. When these treatments are not effective, surgery to remove the polyps may be necessary. While most patients experience relief after sinus surgery, a small proportion require revision surgery due to symptoms recurring or polyps regrowing.
The study, which analyzed data from Finnish adults who underwent ESS between January 2012 and December 2018, included 3,506 individuals aged 42 to 65, with 72% of them being male. The patients were followed until the end of 2019. Among these patients, 15.9% required at least one revision surgery.
The results highlighted key factors associated with an increased likelihood of revision surgery. Patients with asthma or those who were on antibiotics at the time of their initial surgery showed a higher probability of requiring further surgical intervention. For instance, in the case of a 55-year-old male patient, the chance of needing revision surgery within three years was 11% without asthma or antibiotic use. However, this likelihood increased to 16% with either asthma or antibiotic use, and up to 23% when both factors were present.
Age, however, was not a significant predictor for the need for revision surgery. Interestingly, revision surgeries were more common among younger patients. The extent of the initial surgery also played a role, with more extensive procedures correlating with a higher probability of needing a follow-up operation. Additionally, patients who had frequently required oral corticosteroids prior to their initial surgery were more likely to undergo repeated revision surgeries.
Professor Sanna Toppila-Salmi, the lead author from the University of Eastern Finland, noted that chronic rhinosinusitis with nasal polyps is often associated with asthma. She suggested that patients with a severe form of the disease might benefit from additional treatments, such as biologics, especially if their condition cannot be managed with repeated antibiotics, oral corticosteroids, and surgeries.
The study emphasizes the importance of considering a patient’s asthma status, use of antibiotics, and the frequency of oral corticosteroid courses when deciding whether to proceed with sinus surgery. Patients should also be informed about the potential for recurrence of the severe form of the disease following surgery, enabling them to make more informed decisions regarding their treatment options.
This study, published in Clinical and Translational Allergy, was conducted in collaboration with pharmaceutical company AstraZeneca, research service provider Medaffcon, and Tampere University.
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