Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps: Clinical Outcome and Predictive Factors of Recurrence

Abstract

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly prevalent disease of the nasal cavity and paranasal sinus, but its exact etiology is still unclear and remains a difficult-to-treat condition.

Hypothesis

Endoscopic sinus surgery (ESS) is an effective treatment for medically recalcitrant CRSwNP. There are independent variables that can predict surgical outcomes in patients with CRSwNP.

Objectives

To evaluate ESS efficacy in CRSwNP treatment and to establish prognostic factors for disease recurrence.

Methods

Eighty-five patients with CRSwNP submitted to ESS, and a minimum follow-up of 9 months was selected. Patient demographics, occupational organic exposure (e.g., cotton, fuel gas, wood dust) and inorganic dust exposure (e.g., bleach, metals, cement), comorbidities, previous nasal surgeries, pre- and postoperative symptoms, ear, nose and throat examination findings, computed tomography results, and medical and surgical treatment information were collected from medical records. Statistical analysis was performed.

Results

All rhinologic symptoms improved after surgery, in a statistically significant way, with the best recovery rate for nasal obstruction and the worst for hyposmia. The major and minor complications rates were 1.2 and 15.3%, respectively. Disease recurrence occurred in 31% of the patient, but only 7% required surgical reintervention. Multivariate logistic regression analysis identified occupational dust exposure (p = 0.001) and non-immunoglobulin E (IgE) mediated asthma (p = 0.012) as independent predictive variables in CRSwNP recurrence, unlike the other tested variables: age, sex, IgE-mediated asthma, allergic rhinitis, smoking habits, nasal polyps endoscopic grade, Lund-Mackay score, and postoperative topical corticoid use. The adjusted logistic model presented a good discriminatory capacity with a receiver operating characteristic area under the curve of 0.82 (95% confidence interval, 0.73-0.91; p < 0.001).

Conclusion

ESS proved to be an effective treatment in CRSwNP but with a considerable rate of recurrence. These results indicated an important correlation of occupational dust exposure and non-IgE-mediated asthma with disease recurrence.