Long-Term Outcomes of Optimized Surgery and Medication in Chronic Rhinosinusitis With Nasal Polyps

Abstract

Objective: Chronic Rhinosinusitis With Nasal Polyps (CRSwNP) is predominantly associated with type 2 inflammation (85.4%) and significant disease severity. This study aims to investigate the overall control status of CRSwNP patients one to seven years after endoscopic sinus surgery (ESS) and identify the real-world factors influencing these outcomes. Methods: The study included 427 adult patients diagnosed with primary diffuse CRSwNP who underwent bilateral ESS performed by a senior, well-trained surgeon between 2017 and 2022. Among them, 315 patients completed follow-ups in January 2024. Data collected included demographic information, comorbidities, symptom questionnaires (VAS, TNSS, SNOT-22), blood test results, nasal endoscopic scores, and Lund-Mackay CT scores. The clinical control status was assessed postoperatively using EPOS 2020 criteria. Ordinal logistic regression was used to analyze the factors influencing postoperative control status. Results: The median follow-up period was 34 months. The most pronounced symptom is a decline in olfactory function (VAS 8, IQR: 4–10), followed by nasal obstruction (VAS 7, IQR: 5–9) before surgery. Generally, postoperative outcomes showed that 54.6% of patients achieved controlled status, 30.2% were partly controlled, and 15.2% remained uncontrolled. A high blood eosinophil ratio (> 4.75%), worse smell VAS scores (> 9.5), and higher Lund-Mackay CT scores (> 14.5) were associated with poorer control status, whereas medication adherence significantly improved postoperative outcomes. Conclusions: Proper surgical techniques combined with good medication adherence play a crucial role in improving postoperative outcomes for CRSwNP patients, including those with type 2 inflammation. Level of Evidence: 4.