Surgical interventions for chronic rhinosinusitis with nasal polyps

Sharma, Rishi; Lakhani, Raj; Rimmer, Joanne; Hopkins, Claire

doi:10.1002/14651858.cd006990.pub2

Cited by 55 publications

(54 citation statements)

References 55 publications

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“…1125 Although ESS has become the mainstay for achieving these aims, it is notable that strong evidence for the superiority of ESS over simple polypectomy is lacking. 7,1126 Moreover, for CRSwNP specifically (as opposed to CRS overall), there is a similar lack of high-level evidence for the superiority of surgery over medical therapy for nasal polyposis. 1127 To be clear, evidence can be extrapolated from some studies, especially lower levels of evidence, to support the superiority of surgery in CRSwNP.…”

Section: Ixe Aecrs: Complicationsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

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554

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Ixe Aecrs: Complicationsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

Self Cite

554

888

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“…Chronic rhinosinusitis with nasal polyposis (CRSwNP) is one of the two major phenotypes of chronic rhinosinusitis (CRS) and is defined by the presence of nasal polyps in the middle meatus . Studies have shown that CRSwNP negatively affects quality of life and is a common problem worldwide, with prevalence estimates of 0.2%‐4% . While surgery provides significant benefit in symptomatology and respiratory health, as many as 40% of the patients with CRSwNP may develop recurrent polyposis within 12 months postoperatively .…”

Section: Introductionmentioning

confidence: 99%

“…1 Studies have shown that CRSwNP negatively affects quality of life and is a common problem worldwide, with prevalence estimates of 0.2%-4%. 2,3 While surgery provides significant benefit in symptomatology and respiratory health, 4,5 as many as 40% of the patients with CRSwNP may develop recurrent polyposis within 12 months postoperatively. 6,7 Clinical factors such as asthma prevalence, as well as aspirinexacerbated respiratory disease (AERD), appear to be associated with higher recurrence rates of nasal polyps.…”

mentioning

confidence: 99%

Histopathological characteristics of surgical tissue from primary vs recurrent chronic rhinosinusitis with nasal polyposis patients

Donnell

Marino

Zarka

et al. 2020

Laryngoscope Investig Oto

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Objective The histopathological characteristics of primary vs recurrent nasal polyps in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have not been studied comprehensively. Identification of these features may be helpful for prognostication, postoperative management, and consideration of novel eosinophil‐targeting biologic therapy. This study investigates the histopathological differences in primary vs recurrent CRSwNP tissue. Methods Patients undergoing endoscopic sinus surgery for CRSwNP were included if all 13 histopathological and mucin characteristics on a standardized report were available. Histopathology parameters were compared in surgical tissue and mucin from primary vs recurrent CRSwNP. Results Complete structured histopathology reports were available for 96 patients (39 primary polyps and 57 recurrent polyps). Compared to primary polyp tissue, recurrent CRSwNP mucin was significantly more likely to feature eosinophil aggregates (57.9% vs 35.9%; P = .047). Tissue eosinophilia (using a threshold >10 per high power field [HPF]) was not significantly different in primary and recurrent CRSwNP tissue. Other histopathologic parameters and clinical characteristics were similar. Conclusion Eosinophil aggregates on histopathology are significantly more likely to be present in recurrent CRSwNP. In the limited series, tissue eosinophilia (>10 per HPF) was not significantly different in primary and recurrent CRSwNP. Therefore, in addition to the study of tissue eosinophilia levels, Rhinologic surgeons should also direct attention to CRSwNP mucin. Mucin eosinophilic aggregates are an independent marker of severe inflammation that is associated more likely with recurrent vs primary polyposis. Further study of this marker may help determine its role of choice of postoperative medical therapies, including anti‐eosinophilic biologics. Level of Evidence 4

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“…In a recently published Cochrane review considering the effectiveness of different surgical interventions for CRSwNP, Sharma et al [35] evaluated trials where patients were randomised to different surgical procedures. After an initial search identified 3014 records, only 6 met the criteria above, and these were all excluded due to risk of bias and other limitations.…”

Section: Nasal Polypectomy Alone Versus Adjunctive Endoscopic Sinus Smentioning

confidence: 99%

Surgical Versus Medical Interventions in CRS and Nasal Polyps: Comparative Evidence Between Medical and Surgical Efficacy

Dessouky

Hopkins

2015

Curr Allergy Asthma Rep

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CRS with nasal polyps (CRSwNP) is a subgroup of CRS, where polyps can be visualised in the middle meatus. In the general population, the prevalence is estimated to lie between 0.2 and 4 %. Up to 15 % of patients with asthma have nasal polyps and up to 45 % of patients with nasal polyps have asthma. The management of CRSwNP involves primary medical management, with surgery normally reserved for recalcitrant cases. Surgical techniques for CRSwNP range from simple polypectomy and endoscopic sinus surgery (ESS) to radical nasalisation with removal of the middle turbinates. We have reviewed the comparative literature regarding medical and surgical interventions in CRSwNP, with emphasis on outcomes, complications, cost-effectiveness and on the timing of surgery. Similar outcomes are reported for medical and surgical management, but there is sufficient evidence to support the role of surgery once symptoms have failed to adequately respond. There is insufficient evidence to define the optimal timing and extent of surgery.

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Surgical interventions for chronic rhinosinusitis with nasal polyps

Cited by 55 publications

References 55 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Histopathological characteristics of surgical tissue from primary vs recurrent chronic rhinosinusitis with nasal polyposis patients

Surgical Versus Medical Interventions in CRS and Nasal Polyps: Comparative Evidence Between Medical and Surgical Efficacy

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