Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disorder characterised by variable disease severity, extensive sinonasal involvement and a risk of postoperative recurrence. Contemporary endoscopic sinus surgery incorporates individualised surgical extent, image guidance in selected cases and continued postoperative medical treatment. Methods: This prospective observational study included 123 patients with symptomatic nasal polyposis undergoing functional endoscopic sinus surgery (FESS). Patients underwent standardised clinical assessment, nasal endoscopy, computed tomography of the paranasal sinuses scored using the Lund–Mackay system, serum total IgE estimation and nasal eosinophil assessment. The extent of surgery, use of image guidance and selected postoperative antifungal treatment were documented. Patients were followed clinically and endoscopically for up to 12 months, and postoperative recurrence and revision surgery were recorded. Recurrence was defined by clinically significant polyp reappearance, persistent or recurrent polyposis on endoscopy, or radiological recurrence accompanied by corresponding clinical or endoscopic disease. Paired preoperative and postoperative scores were compared using the paired t-test. Categorical comparisons used the twosided Fisher exact test; unadjusted odds ratios (OR) are reported with Wald 95% confidence intervals (CI). Results: The cohort comprised 91 males (74.0%) and 32 females (26.0%). Severe or very severe clinical disease was present in 76 patients (61.8%). Anterior ethmoid involvement was the commonest CT finding (105; 85.4%), followed by ostiomeatal complex obstruction (101; 82.1%) and maxillary sinus involvement (92; 74.8%). Image-guided surgery was used in 52 patients (42.3%), while extended or extensive procedures were performed in 35 (28.5%). Mean clinical severity score decreased from 11.8 ± 2.8 preoperatively to 4.1 ± 2.1 postoperatively (p < 0.001). Recurrence occurred in 17 patients (13.8%), while 106 (86.2%) remained recurrence-free. Nine patients (7.3%) required revision surgery. Previous sinonasal surgery (OR 7.42, 95% CI 2.46–22.37; p < 0.001) and a Lund–Mackay score ≥ 15 (OR 5.81, 95% CI 1.89–17.87; p =0.002) were associated with recurrence. Conclusion: In this prospective observational cohort of 123 patients with CRSwNP, advanced endoscopic sinus surgery was associated with substantial clinical improvement and satisfactory postoperative disease control, with recurrence in 13.8% over follow-up of up to 12 months. Previous sinonasal surgery and higher baseline radiological disease burden were the factors most strongly associated with recurrence. Because only 17 recurrence events occurred, these associations are exploratory and require confirmation in larger cohorts.
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