Asthma and antibiotic use increase the likelihood of revision sinus surgery

The probability of revision sinus surgery including the removal of nasal polyps is higher if the patient has asthma or is on antibiotics at the time of their initial surgery. However, higher age was not a predictor of revision surgery, according to a new study. The register-based population study explored the probability of revision surgery and factors associated with it in individuals with chronic rhinosinusitis with nasal polyps who had undergone endoscopic sinus surgery.

Nasal polyps are benign mucosal protrusions that can, in severe cases, block the nostrils entirely. Nasal polyps often develop in conjunction with a prolonged sinus infection, leading to chronic rhinosinusitis with nasal polyps.

Chronic rhinosinusitis with nasal polyps is treated with nasally administered corticosteroids and, as the diseases progresses, also with orally administered corticosteroids. If these treatments are insufficient, polyps can be surgically removed via sinus surgery. After the procedure, chronic rhinosinusitis with nasal polyps is generally manageable, but a small percentage of patients require revision surgery due to symptom recurrence and polyp regrowth.

The study included data on all Finnish adults with chronic rhinosinusitis with nasal polyps who underwent endoscopic sinus surgery between January 2012 and December 2018, comprising a total of 3,506 individuals. The patients' ages ranged from 42 to 65 years, with 72% being male. The follow-up continued until the end of 2019.

During the follow-up, 15.9% of patients required at least one revision surgery. The probability of revision sinus surgery including the removal of nasal polyps increased if the patient had asthma or was on antibiotics at the time of their initial surgery. When the average patient was defined as a 55-year-old male, the probability of revision surgery within three years was 11% without asthma or antibiotic use, increasing to 16% with either asthma or antibiotic use, and to 23% with both.

Revision surgeries were more common among younger patients. The more extensive the initial surgery, the higher the probability of revision surgery. Patients who had frequently required oral corticosteroids before their initial surgery were also more likely to undergo repeated revision surgeries.

The results indicate that severe chronic rhinosinusitis with nasal polyps is often associated with asthma. Patients with a severe form of the disease may benefit from additional treatments, such as biologics, if the disease cannot be managed despite repeated courses of antibiotics, oral corticosteroids, and sinus surgeries."

Professor Sanna Toppila-Salmi, University of Eastern Finland, lead author of the study

The study suggests that a patient's asthma status and the number of antibiotic and oral corticosteroid courses should be considered when contemplating surgery.

"Patients should also be informed of the fact that the severe form of the disease may recur post-surgery, and this needs to be done before any decision on surgery is made," Professor Salmi adds.

The study was published in Clinical and Translational Allergy and conducted in collaboration with the pharmaceutical company AstraZeneca, the research service company Medaffcon, and Tampere University.