Skip to main content

Advertisement

SpringerLink
Log in

Evidence-based Surgery for Chronic Rhinosinusitis with and without Nasal Polyps

  • RHINOSINUSITIS (J MULLOL, SECTION EDITOR)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Meta-analysis of both large outcome studies as well as cohort studies support the safety and efficacy of Endoscopic Sinus Surgery for Chronic Rhinosinusitis. The efficacy of endoscopic sinus surgery is demonstrated in the improvement of both disease-specific and generic QOL as well as objective measures. However, this must be interpreted together with a well-recognized long-term 15–20 % revision rate, seen more often in patients with ASA trias and cystic fibrosis as well as osteitis and previous surgery. The effect of surgery is higher in managing nasal obstruction (effect size 1.7) and less so hyposmia (effect size 0.8). Allergy has an additive role on the symptomatology of CRS; however, its role if any on the outcome of ESS for CRS is unclear. The concurrent presence of aspiring sensitivity and asthma is associated with increased disease burden and more revision surgeries. Improved phenotyping of CRS may lead in the future to better tailoring of surgical treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2. [Internet]. 2011. Available from: http://www.cebm.net/index.aspx?o=5653

  2. Smith GCS, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ. 2003;327(7429):1459–61.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Khalil H, Nunez DA. Functional endoscopic sinus surgery for chronic rhinosinusitis. In: The Cochrane Collaboration, Khalil H, editors. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2006 [cited 2011 Apr 19]. Available from: http://doi.wiley.com/10.1002/14651858.CD004458.pub2

  4. Fairley J. Correlation of nasal symptoms with objective findings and surgical outcome measurement [thesis]. [London]; 1993.

  5. Hartog B, van Benthem PP, Prins LC, Hordijk GJ. Efficacy of sinus irrigation versus sinus irrigation followed by functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol. 1997;106(9):759–66.

    PubMed  CAS  Google Scholar 

  6. Ragab SM, Lund VJ, Scadding G. Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. Laryngoscope. 2004;114(5):923–30.

    Article  PubMed  Google Scholar 

  7. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012 Mar;(23):3 p preceding table of contents, 1–298.

  8. Blomqvist EH, Lundblad L, Anggård A, Haraldsson PO, Stjärne P. A randomized controlled study evaluating medical treatment versus surgical treatment in addition to medical treatment of nasal polyposis. J Allergy Clin Immunol. 2001;107(2):224–8.

    Article  PubMed  CAS  Google Scholar 

  9. Lildholdt T, Rundcrantz H, Bende M, Larsen K. Glucocorticoid treatment for nasal polyps. The use of topical budesonide powder, intramuscular betamethasone, and surgical treatment. Arch Otolaryngol Head Neck Surg. 1997;123(6):595–600.

    Article  PubMed  CAS  Google Scholar 

  10. Lildholdt T, Fogstrup J, Gammelgaard N, Kortholm B, Ulsoe C. Surgical versus medical treatment of nasal polyps. Acta Otolaryngol. 1988;105(1–2):140–3.

    Article  PubMed  CAS  Google Scholar 

  11. Lildholdt T. Surgical versus medical treatment of nasal polyps. Rhinol Suppl. 1989;8:31–3.

    PubMed  CAS  Google Scholar 

  12. Blomqvist EH, Lundblad L, Bergstedt H, Stjärne P. A randomized prospective study comparing medical and medical-surgical treatment of nasal polyposis by CT. Acta Otolaryngol. 2009;129(5):545–9.

    Article  PubMed  CAS  Google Scholar 

  13. Alobid I, Benítez P, Bernal-Sprekelsen M, Roca J, Alonso J, Picado C, et al. Nasal polyposis and its impact on quality of life: comparison between the effects of medical and surgical treatments. Allergy. 2005;60(4):452–8.

    Article  PubMed  CAS  Google Scholar 

  14. Georgalas C, Fokkens WJ. Rhinology and Skull Base Surgery: From the Lab to the Operating Room-an International Approach. Thieme Medical Publishers, Incorporated; 2013. 916 p.

  15. Dalziel K, Stein K, Round A, Garside R, Royle P. Endoscopic sinus surgery for the excision of nasal polyps: A systematic review of safety and effectiveness. Am J Rhinol. 2006;20(5):506–19.

    Article  PubMed  Google Scholar 

  16. Hopkins C, Browne JP, Slack R, Lund V, Topham J, Reeves B, et al. The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Clin Otolaryngol. 2006;31(5):390–8.

    Article  PubMed  CAS  Google Scholar 

  17. Hopkins C, Slack R, Lund V, Brown P, Copley L, Browne J. Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope. 2009;119(12):2459–65.

    Article  PubMed  Google Scholar 

  18. Smith TL, Kern RC, Palmer JN, Schlosser RJ, Chandra RK, Chiu AG, et al. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study. Int Forum Allergy Rhinol. 2011;1(4):235–41.

    Article  PubMed  Google Scholar 

  19. Wynn R, Har-El G. Recurrence rates after endoscopic sinus surgery for massive sinus polyposis. Laryngoscope. 2004;114(5):811–3.

    Article  PubMed  Google Scholar 

  20. Dietz de Loos DAE, Hopkins C, Fokkens WJ. Symptoms in chronic rhinosinusitis with and without nasal polyps. Laryngoscope. 2013 Jan;123(1):57–63.

  21. Fokkens WJ. Patient-centered treatment goals. Rhinology. 2013;51(3):193–4.

    PubMed  CAS  Google Scholar 

  22. Chester AC, Antisdel JL, Sindwani R. Symptom-specific outcomes of endoscopic sinus surgery: a systematic review. Otolaryngol Head Neck Surg. 2009;140(5):633–9.

    Article  PubMed  Google Scholar 

  23. Briner HR, Jones N, Simmen D. Olfaction after endoscopic sinus surgery: long-term results. Rhinology. 2012;50(2):178–84.

    PubMed  CAS  Google Scholar 

  24. Croy I, Hummel T, Pade A, Pade J. Quality of life following nasal surgery. Laryngoscope. 2010;120(4):826–31.

    Article  PubMed  Google Scholar 

  25. Smith TL, Mendolia-Loffredo S, Loehrl TA, Sparapani R, Laud PW, Nattinger AB. Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. 2005;115(12):2199–205.

    Article  PubMed  Google Scholar 

  26. Deal RT, Kountakis SE. Significance of nasal polyps in chronic rhinosinusitis: symptoms and surgical outcomes. Laryngoscope. 2004;114(11):1932–5.

    Article  PubMed  Google Scholar 

  27. Javer AR, Genoway KA. Patient quality of life improvements with and without computer assistance in sinus surgery: outcomes study. J Otolaryngol. 2006;35(6):373–9.

    Article  PubMed  Google Scholar 

  28. Marks SC, Shamsa F. Evaluation of prognostic factors in endoscopic sinus surgery. Am J Rhinol. 1997;11(3):187–91.

    Article  PubMed  CAS  Google Scholar 

  29. Nishioka GJ, Cook PR, Davis WE, McKinsey JP. Immunotherapy in patients undergoing functional endoscopic sinus surgery. Otolaryngol Head Neck Surg. 1994;110(4):406–12.

    PubMed  CAS  Google Scholar 

  30. Tran KN, Beule AG, Singal D, Wormald P-J. Frontal ostium restenosis after the endoscopic modified Lothrop procedure. Laryngoscope. 2007;117(8):1457–62.

    Article  PubMed  Google Scholar 

  31. Chan Y, Melroy CT, Kuhn CA, Kuhn FL, Daniel WT, Kuhn FA. Long-term frontal sinus patency after endoscopic frontal sinusotomy. Laryngoscope. 2009;119(6):1229–32.

    Article  PubMed  Google Scholar 

  32. Robinson S, Douglas R, Wormald P-J. The relationship between atopy and chronic rhinosinusitis. Am J Rhinol. 2006;20(6):625–8.

    Article  PubMed  Google Scholar 

  33. Ebbens FA, Toppila-Salmi S, de Groot EJJ, Renkonen J, Renkonen R, van Drunen CM, et al. Predictors of post-operative response to treatment: a double blind placebo controlled study in chronic rhinosinusitis patients. Rhinology. 2011;49(4):413–9.

    PubMed  CAS  Google Scholar 

  34. Hellings PW, Fokkens WJ, Akdis C, Bachert C, Cingi C, Dietz de Loos D, et al. Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today? Allergy. 2013 Jan;68(1):1–7

  35. Kim HY, Dhong H-J, Chung SK, Chung Y-J, Kim M-G. Clinical characteristics of chronic rhinosinusitis with asthma. Auris Nasus Larynx. 2006;33(4):403–8.

    Article  PubMed  Google Scholar 

  36. Kennedy DW. Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope. 1992;102(12 Pt 2 Suppl 57):1–18.

    PubMed  CAS  Google Scholar 

  37. Wang P-C, Chu C-C, Liang S-C, Tai C-J. Outcome predictors for endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2002;126(2):154–9.

    Article  PubMed  Google Scholar 

  38. Dejima K, Hama T, Miyazaki M, Yasuda S, Fukushima K, Oshima A, et al. A clinical study of endoscopic sinus surgery for sinusitis in patients with bronchial asthma. Int Arch Allergy Immunol. 2005;138(2):97–104.

    Article  PubMed  Google Scholar 

  39. Batra PS, Kern RC, Tripathi A, Conley DB, Ditto AM, Haines 3rd GK, et al. Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and asthma. Laryngoscope. 2003;113(10):1703–6.

    Article  PubMed  Google Scholar 

  40. Lund VJ, MacKay IS. Outcome assessment of endoscopic sinus surgery. J R Soc Med. 1994;87(2):70–2.

    PubMed Central  PubMed  CAS  Google Scholar 

  41. Rowe-Jones JM, Mackay IS. Endoscopic sinus surgery in the treatment of cystic fibrosis with nasal polyposis. Laryngoscope. 1996;106(12 Pt 1):1540–4.

    Article  PubMed  CAS  Google Scholar 

  42. Becker SS, de Alarcon A, Bomeli SR, Han JK, Gross CW. Risk factors for recurrent sinus surgery in cystic fibrosis: review of a decade of experience. Am J Rhinol. 2007;21(4):478–82.

    Article  PubMed  Google Scholar 

  43. Macdonald KI, Gipsman A, Magit A, Fandino M, Massoud E, Witterick IJ, et al. Endoscopic sinus surgery in patients with cystic fibrosis: a systematic review and meta-analysis of pulmonary function. Rhinology. 2012;50(4):360–9.

    PubMed  CAS  Google Scholar 

  44. Sil A, Mackay I, Rowe-Jones J. Assessment of predictive prognostic factors for functional endoscopic sinus surgery in a 5-year prospective outcome study. Am J Rhinol. 2007;21(3):289–96.

    Article  PubMed  Google Scholar 

  45. Stewart MG, Donovan DT, Parke Jr RB, Bautista MH. Does the severity of sinus computed tomography findings predict outcome in chronic sinusitis? Otolaryngol Head Neck Surg. 2000;123(1 Pt 1):81–4.

    Article  PubMed  CAS  Google Scholar 

  46. Smith TL, Litvack JR, Hwang PH, Loehrl TA, Mace JC, Fong KJ, et al. Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg. 2010;142(1):55–63.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Singhal D, Psaltis AJ, Foreman A, Wormald P-J. The impact of biofilms on outcomes after endoscopic sinus surgery. Am J Rhinol Allergy. 2010;24(3):169–74.

    Article  PubMed  Google Scholar 

  48. Khalid AN, Mace JC, Smith TL. Outcomes of sinus surgery in ambulatory patients with immune dysfunction. Am J Rhinol Allergy. 2010;24(3):230–3.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Georgalas C, Videler W, Freling N, Fokkens W. Global Osteitis Scoring Scale and chronic rhinosinusitis: a marker of revision surgery. Clin Otolaryngol. 2010;35(6):455–61.

    Article  PubMed  CAS  Google Scholar 

  50. Kim HY, Dhong H-J, Lee HJ, Chung Y-J, Yim YJ, Oh J-W, et al. Hyperostosis may affect prognosis after primary endoscopic sinus surgery for chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2006;135(1):94–9.

    Article  PubMed  Google Scholar 

  51. Videler WJM, Georgalas C, Menger DJ, Freling NJM, van Drunen CM, Fokkens WJ. Osteitic bone in recalcitrant chronic rhinosinusitis. Rhinology. 2011;49(2):139–47.

    PubMed  CAS  Google Scholar 

  52. Georgalas C. Osteitis and paranasal sinus inflammation: what we know and what we do not. Curr Opin Otolaryngol Head Neck Surg. 2013;21(1):45–9.

    Article  PubMed  Google Scholar 

  53. Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, et al. Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy. 2012;67(1):91–8.

    Article  PubMed  CAS  Google Scholar 

  54. Krzeski A, Galewicz A, Chmielewski R, Kisiel M. Influence of cigarette smoking on endoscopic sinus surgery long-term outcomes. Rhinology. 2011;49(5):577–82.

    PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Christos Georgalas, Marjolein Cornet, Gwijde Adriaensen, Susanne Reinartz, Carlijn Holland, Emmanuel Prokopakis, and Wytske Fokkens declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Academic Medical Centre, A2-228, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands

    Christos Georgalas, Marjolein Cornet, Gwijde Adriaensen, Susanne Reinartz, Carlijn Holland, Emmanuel Prokopakis & Wytske Fokkens

Authors
  1. Christos Georgalas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marjolein Cornet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gwijde Adriaensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susanne Reinartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlijn Holland
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emmanuel Prokopakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wytske Fokkens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christos Georgalas.

Additional information

This article is part of the Topical Collection on Rhinosinusitis

Rights and permissions

Reprints and permissions

About this article

Cite this article

Georgalas, C., Cornet, M., Adriaensen, G. et al. Evidence-based Surgery for Chronic Rhinosinusitis with and without Nasal Polyps. Curr Allergy Asthma Rep 14, 427 (2014). https://doi.org/10.1007/s11882-014-0427-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11882-014-0427-7

Keywords

Search

Navigation