In a homegrown multicenter study, of which results in The Lancet Respiratory Medicine published, endoscopic sinus surgery plus medication has been shown for the first time to be more effective than medication alone in patients with chronic rhinosinusitis with nasal polyps.
A 2014 Cochrane review found the available evidence to be of very low quality. Therefore, no solid conclusions could be drawn about the role of sinus surgery. The advice was to conduct a high quality randomized controlled trial.
This open-label, pragmatic, randomized, controlled study was conducted in 3 third-line centers and 12 second-line centers in Almere, Amstelveen, Amsterdam, Blaricum, The Hague, Deventer, Haarlem, Hoofddorp, Hoorn, Leiderdorp and Rotterdam. The operation was performed according to local practice, although anterior ethmoidectomy was mandatory. The medication could include, but was not limited to, nasal corticosteroids, nasal rinses, corticosteroids, or antibiotics.
After 12 months, data from 206 participants were analyzed for the primary endpoint. At that time, the mean Sinonasal Outcome Test 22 (SNOT-22) score, a validated measure of quality of life, was 27.9 in the surgery plus medication group and 31.1 in the medication group. The incidence of adverse events (AEs) was comparable between the two groups. The most common AEs were mild epistaxis and gastrointestinal distress.
Sinus surgery plus medication was more effective than medication alone in patients with chronic rhinosinusitis with nasal polyps, but the minimal clinically relevant difference was not achieved.
Long-term data is needed to determine whether the effect persists. The current results form a basis for the further development of evidence-based guidelines.
Bron:
Lourijsen ES, Reitsma S, Vleming M, et al. Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: a multicentre, randomised, controlled trial. Lancet Respir Med. 2022;10:337-46.