Adherence to follow-up examinations is crucial for early identification of recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP).
Patients undergoing functional endoscopic sinus surgery (FESS) to treat chronic rhinosinusitis with nasal polyps (CRSwNP) may experience a recurrence of symptoms. After undergoing FESS, follow-up exams are crucial to identify recurrence early for timely treatment, study says published in American Journal of Otolaryngology.
Treatment-refractory patients may receive FESS, a minimally invasive procedure; however, recurrence can be 60% or more: research has found the 5-year recurrence rate to be 30.29% and the 10-year recurrence rate to be 66.06%. In this study, the researchers analyzed the recurrence of CRSwNP after FESS.
CRSwNP is a type 2 inflammatory disease of the nasal and paranasal sinuses that is treated with intranasal and systemic corticosteroids, biologic agents, and FESS in patients who are refractory to therapy.
“Post-FESS clinical examinations are essential for physicians to assess the results of the intervention, manage post-procedure complications, identify recurrences early, and tailor medical treatment,” they explained. “These exams also give patients the opportunity to discuss symptoms and their impact on quality of life.”
A total of 60 patients who underwent FESS were included. They had a mean follow-up of 9.88 years (range 3 to 22 years). The mean age of the included patients was 57 years (range 23 to 74 years). Almost half (48.3%) also had allergies and 36.7% asthma.
A quarter of the patients adhered to regular clinical examinations and regular treatment with nasal steroids. The majority (78.3%) perform daily nasal washes with isotonic saline solution.
“This low adherence to follow-up examinations and nasal steroids was probably due to surgeons not giving patients enough information and, more importantly, fear of potential steroid side effects,” the authors speculated.
More than half (56.7%) of the patients had recurrence of CRSwNP at their last follow-up, and a total of 91 recurrences were recorded after FESS. Of the 91 recurrences, 54.9% of the cases were treated with medical treatment and 45.1% were treated with revision endoscopic sinus surgery. There was a mean of 0.14 recurrences per year per subject.
At the last follow-up visit, 45.0% of patients complained of nasal obstruction and 51.7% of hyposmia, or a reduced ability to detect odors. The researchers found no statistically significant differences in nasal symptoms between patients who had recurrence and those who did not; however, patients who relapsed had a tendency to greater nasal obstruction.
There was no significant correlation between recurrence at follow-up and age, gender, allergy, asthma, and NSAID-exacerbated respiratory disease.
In the patients who had a recurrence, 12 had grade 1 nasal polyps, 11 had grade 2, three had grade 3, five had grade 4, two had grade 5, and one patient had grade 6.
The researchers also found that patients who underwent regular fiberoptic evaluations and prompt treatment when a small recurrence was identified had a lower chance of recurrence at their last follow-up exam.
“Since small relapses have few or no symptoms, adherence to follow-up examinations with nasal fiberoptic endoscopy is crucial to identify recurrence early after surgery and treat it promptly with medical therapy,” the authors concluded. “This is emerging as an even more important issue after the introduction of biological agents into clinical practice.”