TOPLINE

Both full and limited functional endoscopic sinus surgery (FESS) substantially improved quality of life (QOL) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), with no clinically meaningful differences between the approaches.

METHODOLOGY

• Researchers conducted a randomized controlled trial at two university hospitals in Finland, enrolling patients with severe CRSwNP who required surgical intervention between 2018 and 2022.
• Overall, 97 patients (mean age, 47 years; 56% men) were included, all of whom had uncontrolled disease despite adequate medical therapy with fluticasone drops (400 µg once or twice daily) and nasal lavages (for at least 3 months).
• Patients were randomly assigned to undergo either full FESS under general anesthesia — which required more time, equipment, and expertise — or limited FESS, preferably performed under local anesthesia.
• The primary outcome was the change in the health-related QOL (HRQOL) score assessed with the help of the Sino-Nasal Outcome Test from before surgery to 12 and 24 months after surgery; secondary outcomes included recovery from anosmia, the nasal polyp score, peak nasal inspiratory flow, tissue eosinophilia, oral corticosteroid use, disease control, and revision surgery.

TAKEAWAY

• Both the full and limited FESS groups showed significant reductions in mean total HRQOL scores at 12 and 24 months, with each achieving the minimal clinically important difference of 8.9. The mean differences between the groups at 12 months and 24 months were -9.2 and -2.5, respectively; neither difference met the minimal clinically important difference.
• Recovery from anosmia was significantly better after full FESS at 12 months (P < .001) but not at 24 months, with mean score differences between groups of 2.7 points at 12 months and 0.8 points at 24 months.
• Nasal polyp scores decreased to a significantly greater extent after full FESS at 12 months (P = .003) and 24 months (P = .019), with mean differences between groups of -1.3 and -0.7, respectively.
• Oral corticosteroid use decreased similarly in both groups during the 24-month follow-up vs the preoperative year (P < .001 for both groups).

IN PRACTICE

“Our findings show that patients experience meaningful HRQOL improvement from both approaches. Limited FESS surgery can be performed under local anesthesia, enabling treatment also in cases where general anesthesia carries more risk,” the authors of the study wrote.

SOURCE

Paula Virkkula, MD, with Helsinki University Hospital and the University of Helsinki in Helsinki, Finland, was the corresponding author of the study, which was published online on July 30 in Allergy.

LIMITATIONS

Masking was not possible due to differences in anesthesia between groups and the legally mandated release of complete records to patients. The findings of the study may not be generalizable to patients excluded from the trial, such as those excluded due to language barriers. The 24-month follow-up was considered too short to fully evaluate the risk for revision surgery or long-term outcomes.

DISCLOSURES

The study was supported by grants from several Finnish foundations (including the Tampere Tuberculosis Foundation, Finnish ORL-HNS Foundation, and Paulo Foundation) and state health research funding. Several authors, including the corresponding author, reported receiving consultancy, lecture, or advisory fees from multiple pharmaceutical companies outside the submitted work. Detailed disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.