Evaluation of the medical and surgical management of chronic rhinosinusitis with polyposis

Abstract

Background: Chronic rhinosinusitis (CRS) is a group of disorders characterized by inflammation of the mucosa of the nose and paranasal sinuses of at least 12 consecutive weeks duration. Surgical intervention may be required if severe symptoms of obstruction and infection prove medical treatment to be ineffective. Little is known about the outcomes of patients electing to continue medical management or the comparative effectiveness of continued medical therapy with FESS. Methods: The study was conducted on 126 adult patients in the age group of 18-55 who fulfilled the CRS criteria with nasal polyposis. All patients were medically treated for the CRS, and observed after 3 weeks. In case the treatment was not effective; they were scheduled for FESS intervention and further observed after another 6 weeks. The improvement of the patients was measured by Visual analogue score, nasal endoscopy score and saccharine test. Results: Males between 41-50 were the most common patients with CRS. There was a significant improvement in the VAS score, nasal endoscopy score after 3 weeks of medical treatment. In 88% of patients the saccharine score was normal showing that this was not an effective measure for assessing the improvement. Conclusions: Medical treatment was found to be sufficient to treat most symptoms of CRS with nasal polyposis (grade 1 and 2). Surgery should only be done in refractory cases. Selection of those patients who will benefit from surgery should be based on the patient's symptoms and not on the examiner's polyp score. Quality of life is not proportional to polyp size (Upto grade 2).

Chronic rhinosinusitis: medical versus surgical management

“…Similarly, the study undertaken by Modgil also showed that patients who underwent only medical treatment and those who underwent combined medical and surgical treatments showed equal amounts of improvements. 8 Khalil et al in their review of large randomized control…”