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From June 1986 until January 1988, 165 patients underwent endoscopic paranasal sinus surgery, and the results were evaluated. Surgery was performed for a variety of different indications, and 69% of the patients had had prior nasal surgery. Preoperative findings on nasal endoscopy and tomography are discussed. The subjective result, or the patient's opinion of the operation, was considered good in 51%, moderate in 22%, and poor in 27% of patients. Postoperative nasal endoscopy showed a good result for 63% and a poor result for 37% of the sides operated on. These subjective and objective results are correlated to the surgical indications. Minor complications were seen in 1.8% of the patients.

BackgroundChronic rhinosinusitis with nasal polyps is a chronic disease frequently seen in otorhinolaryngological practice. Along with its chronic disease burden it creates high societal costs. Therapy consists of long-term use of medication and, if insufficient, endoscopic sinus surgery. No consensus exists on the right timing and extent of disease that warrants surgery. Furthermore, there is lack of clinical knowledge about the benefit of surgery over medication only. The current trial evaluates the clinical effectiveness and cost-effectiveness of endoscopic sinus surgery in addition to drug treatment versus medication exclusively in the adult patient group with nasal polyps.MethodsA prospective, multicentre, superiority, randomised controlled (PolypESS) trial in 238 patients aged 18 years or older selected for primary or revision endoscopic sinus surgery by the otorhinolaryngologist was designed. Patients will be randomised to either endoscopic sinus surgery in addition to medication or medical therapy only. Relevant data will be collected prior to randomisation, at baseline and 3, 6, 12, 18 and 24 months after start of treatment. Complete follow-up will be 24 months. Primary outcome is disease-specific Health-related Quality of Life quantified by the SNOT-22 after 12-month follow-up. Secondary outcomes are generic Health-related Quality of Life, cost-effectiveness, objective signs of disease and adverse effects of treatment. Subgroup analyses will be performed to verify whether treatment effects differ among patient phenotypes.DiscussionThe PolypESS trial will investigate tailored care in adult patients with chronic rhinosinusitis with nasal polyps and will result in improved clinical pathways to help to determine in which circumstances to perform surgery.Trial registrationDutch Trial Register, NTR4978. Registered on 27 November 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1728-z) contains supplementary material, which is available to authorized users.

Endoscopic sinus surgery (ESS) for nasal polyps was performed on 105 patients, who had a total of 134 operations, on 263 sides. Most patients (84%) had been previously operated on because of recurrent nasal polyps. The subjective results were good in 86% after one or more operations, with a median follow-up of almost 2 years. The objective results, as assessed by nasal endoscopy, show no recurrence in this group in 61%. Preoperative and postoperative lung function was tested in 30 patients with chronic obstructive pulmonary disease (COPD). An improvement was noted in 64%, in 23% the lung function was unchanged, and in 13% it had decreased. A relationship was noted between IgE-mediated allergy and the recurrence of nasal polyps. Patients with an IgE-mediated allergy had significantly more recurrences (50%). The complication rate was 4.3% of the 263 operated sides.