Asthma and antibiotic use increase the likelihood of revision sinus surgery

Asthma and antibiotic use increase the likelihood of revision sinus surgery

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

Nasal polyps are benign mucosal projections that, in severe cases, can completely block the nostrils. Nasal polyps often develop in association with prolonged sinus infection, resulting in chronic rhinosinusitis with nasal polyps.

Chronic rhinoceros hornitis with nasal polyps is treated with corticosteroids administered nasally and, as the disease progresses, corticosteroids administered orally. If these treatments are not sufficient, polyps can be surgically removed via sinus surgery. After the procedure, chronic rhinoceros hornitis with nasal polyps is generally manageable, a small percentage of patients require revision surgery due to recurrence of the symptom and polyp growth.

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 people. The age of the patients ranged from 42 to 65 years, with 72% being male. The follow-up lasted until the end of 2019.

During follow-up, 15.9% of patients required at least one revision surgery. The likelihood of sinus revision, including nasal polyp removal, increased if the patient had asthma or was on antibiotics at the time of their first surgery. When the average patient was defined as a 55-year-old man, the probability of revision surgery within three years was 11% without asthma or antibiotic use, which increased to 23% with neither asthma nor antibiotics and 23% with both.

Revision surgery was more common in younger patients. The more extensive the initial surgery, the higher the likelihood of revision surgery. Patients who frequently required oral corticosteroids prior to their initial surgery were also more likely to undergo repeat revision surgeries.

The results suggest 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 treated despite repeated courses of antibiotics, oral corticosteroids, and sinus surgery. “

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 courses of antibiotics and oral corticosteroids should be taken into account when considering surgery.

“Patients should also be informed that the severe form of the disease may return after surgery and this must be made before a decision about surgery,” adds Professor Salmi.

The study was published inClinical and translational allergyand carried out in collaboration with pharmaceutical company AstraZeneca, research services company Medaffcon and Tampere University.

Sources: