Chronic rhinosinusitis with nasal polyps: predictive factors for recurrence and revision surgery

Pedro Salvador; Catarina Lombo; Francisco Moreira da Silva; Rui Fonseca

doi:10.18203/issn.2454-5929.ijohns20205054

Authors

Pedro Salvador Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal http://orcid.org/0000-0002-7762-3615
Catarina Lombo Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
Francisco Moreira da Silva Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
Rui Fonseca Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20205054

Keywords:

Endoscopic sinus surgery, Nasal polyps, Predictive factors, Recurrence, Revision surgery

Abstract

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition which may have a significant impact on quality of life. Endoscopic sinus surgery (ESS) is indicated for patients refractory to maximal medical treatment and presents high recurrence and revision surgery rates. Aim of the study was to evaluate ESS outcome in CRSwNP management and to assess independent predictive factors for recurrence and revision surgery.

Methods: Retrospective medical chart review of patients who underwent ESS for recalcitrant CRSwNP, from January 2013 to December 2017, with a minimum follow-up time of 12 months.

Results: This study enrolled 132 patients, 62.1% of whom were males, with a mean age of 43.4±11.5 years. Asthma was the most common comorbidity (39.4%, n=52) and aspirin exacerbated respiratory disease (AERD) was present in 9.8% (n=12) of the study population. We found a recurrence rate of 34.1% (n=45) and 9% (n=12) of patients required revision surgery. Multivariate analysis identified as independent variables of recurrence (95% CI): a history of asthma (OR=8.81, CI 3.87-20.03; p<0.001) and a severe Lund-Mackay score (17-24) (OR=5.85, CI 2.73-12.51; p=0.001). Revision surgery was related to a severe endoscopic Lund-Kennedy score at presentation (OR=4.05, CI 1.91-8.01, p=0.001).

Conclusions: CRSwNP presents a high tendency to recur after ESS. Asthma, severe sinus opacification and severe endoscopic score are poor prognostic factors that hallmark a more aggressive disease. A more extensive surgical procedure and/or middle turbinate resection with a rigorous postoperative compliance should be considered to improve long term results.

Metrics

Metrics Loading ...

References

Fokkens WJ, Lund VJ, Mullol J. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:291-8.

Mendelsohn D, Jeremic G, Wright ED, Rotenberg BW. Revision rates after endoscopic sinus surgery: a recurrence analysis. Ann Otol Rhinol Laryngol. 2011;120(3):162-6.

Wu AW, Ting JY, Platt MP, Tierney HT, Metson R. Factors affecting time to revision sinus surgery for nasal polyps: a 25-year experience. Laryngoscope. 2014;124(1):29-33.

Hox V, Bobic S, Callebaux I, Jorissen M, Hellings PW. Nasal obstruction and smell impairment in nasal polyp disease: correlation between objective and subjective parameters. Rhinology. 2010;48(4):426-32.

Veloso TR, Cerejeira R, Farinha R, Buchwald C. Higher prevalence of nasal polyposis among textile workers: an endoscopic based and controlled study. Rhinology. 2018;56(2):99-105.

Tsuzuki K, Hashimoto K, Okazaki K, Nishikawa H, Sakagami M. Predictors of disease progression after endoscopic sinus surgery in patients with chronic rhinosinusitis. J Laryngol Otol. 2019;133(8):678-84.

Johansson L, Akerlund A, Holmberg K, Melén I, Stierna P, Bende M. Evaluation of methods for endoscopic staging of nasal polyposis. Acta Otolaryngol. 2000;120(1):72-6.

Lund VJ, Mackay IS. Staging in rhinosinusitus. Rhinology. 1993;31(4):183-4.

Bassiouni A, Wormald PJ. Role of frontal sinus surgery in nasal polyp recurrence. Laryngoscope. 2013;123(1):36-41.

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

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.

Klossek JM, Neukirch F, Pribil C. Prevalence of nasal polyposis in France: a cross-sectional, case-control study. Allergy. 2005;60(2):233-7.

Stevens WW, Schleimer RP. Aspirin-exacerbated respiratory disease as an endotype of chronic rhinosinusitis. Immunol Allergy Clin North Am. 2016;36(4):669-80.

Kountakis SE, Bradley DT. Effect of asthma on sinus computed tomography grade and symptom scores in patients undergoing revision functional endoscopic sinus surgery. Am J Rhinol. 2003;17(4):215-9.

Pearlman AN, Chandra RK, Chang D. Relationships between severity of chronic rhinosinusitis and nasal polyposis, asthma, and atopy. Am J Rhinol Allergy. 2009;23(2):145-8.

Stevens WW, Schleimer RP, Kern RC. Chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract. 2016;4(4):565-72.

Stevens WW, Peters AT, Hirsch AG. Clinical characteristics of patients with chronic rhinosinusitis with nasal polyps, asthma, and aspirin-exacerbated respiratory disease. J Allergy Clin Immunol Pract. 2017;5(4):1061-1070.e3.

Grgić MV, Ćupić H, Kalogjera L, Baudoin T. Surgical treatment for nasal polyposis: predictors of outcome. Eur Arch Otorhinolaryngol. 2015;272(12):3735-43.

Mortuaire G, Gengler I, Balden M, Capron M, Lefèvre G. Impact of allergy on phenotypic and endotypic profiles of nasal polyposis. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(3):159-62.

Kim JY, Han YE, Seo Y. Revisiting the Clinical Scoring System for the prognosis of chronic rhinosinusitis with nasal polyps. Yonsei Med J. 2019;60(6):578-584.

Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis: Focus on nasal polyposis. J Allergy Clin Immunol. 2015;136(6):1431-1440.

Masterson L, Tanweer F, Bueser T, Leong P. Extensive endoscopic sinus surgery: does this reduce the revision rate for nasal polyposis? Eur Arch Otorhinolaryngol. 2010;267(10):1557-61.

Jankowski R, Pigret D, Decroocq F, Blum A, Gillet P. Comparison of radical (nasalisation) and functional ethmoidectomy in patients with severe sinonasal polyposis a retrospective study. Rev Laryngol Otol Rhinol. 2006;127(3):131-40.

Marchioni D, Ciufelli AM, Mattioli F. Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis. Acta Otolaryngol. 2008;128(9):1019-26.

Hudon MA, Wright ED, Pellerin FE, Bussieres M. Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized controlled trial. J Otolaryngol Head Neck Surg. 2018;47(1):67.