Evaluation of the surgical treatment of nasal polyposis. II: Influence of a non-specific bronchial hyperresponsiveness

Otitis media with effusion in nasal polyposis and outcomes following surgery: A longitudinal observational study

OBJECTIVE

In patients with nasal polyposis (NP), otitis media with effusion (OME) seems to be a marker of severity of the inflammatory process occurring in those patients. The aim was to assess whether OME could represent a marker of resistance to the surgical treatment of NP.

DESIGN

Longitudinal observational cohort study including patients between January 1991 and January 2017. Mean follow-up was 7.4 years.

SETTING

Tertiary-care hospital centre.

PARTICIPANTS

Patients with NP who underwent surgery (radical bilateral sphenoethmoidectomy).

MAIN OUTCOME MEASURES

Four outcomes reflecting resistance to the surgical treatment: a clinical score of rhinologic symptoms, the mean number of systemic corticosteroids treatment per year, the recurrence rate of polyps and the rate of reoperation.

RESULTS

A total of 266 patients were included (63.9% of men, mean age 48 years). In multivariate linear mixed-effects regression, when compared to patients without OME, patients with OME presented a similar clinical score of symptoms (coefficient 0.09, 95% confidence interval (CI) -0.25 to 0.06, P-value = 0.24) and a borderline higher mean number of systemic corticosteroids treatments per year (coefficient 0.11, 95% CI 0.003-0.23, P-value = 0.04). In multivariate Cox regression analyses, patients with OME had a similar reoperation rate than patients without OME (hazard ratio (HR) 0.29, 95% CI 0.06-1.50) and a similar recurrence rate of polyps (HR 0.59, 95% CI 0.23-1.53).

CONCLUSION

In patients with NP, OME is not a marker of surgical resistance. Those patients should be managed similarly than patients without, and similar outcomes following surgery should be expected.

Meticulous endoscopic sinus surgery to prevent recurrence of massive nasal polyposis

OBJECTIVE

To evaluate the effect of meticulous endoscopic surgery, including opening of all involved sinus cells, on the subsequent symptoms and endoscopic findings of patients with massive nasal polyposis.

STUDY DESIGN AND METHOD

One hundred patients with massive nasal polyposis resistant to medical treatment were selected. We documented each patient's demographic data, associated diseases, endoscopic findings, Lund-Mackay score and Sino-Nasal Outcome Test 22 (SNOT22) symptom score. All patients were followed up for at least two years to evaluate any recurrence.

RESULTS

Of the 100 patients, 20 per cent had a history of asthma and 27 per cent had undergone previous surgery. All underwent endoscopic sinus surgery. After two years of follow up, 8 per cent had recurrence requiring surgery. Recurrence was significantly associated with a history of asthma (p < 0.001) and the histopathological presence of eosinophilia (p = 0.014).

CONCLUSION

Meticulous endoscopic opening of all involved sinus cells can be a safe and effective means of controlling massive nasal polyposis, with an acceptable recurrence rate.

Eosinophil infiltration of nasal polyps in patients with nasal polyposis: role in clinical evolution after medical and surgical treatment

Objective:

In patients with severe nasal polyposis resistant to strict medical treatment, surgery is indicated, but no prognostic factors for surgery efficacy have yet been determined. Some authors suggest that eosinophilic infiltration of nasal polyps could indicate a risk of surgical ineffectiveness.

Methods:

Surgical plus medical treatment was evaluated over a mean follow-up period of 64 months. One hundred and forty-four subjects were separated into two groups: those with eosinophilic infiltration of >50 per cent (n = 73); and those with ≤50 per cent infiltration (n = 71).

Results:

Combined surgery and corticosteroid therapy was effective in the treatment of severe nasal polyposis. No significant difference was found between the two groups in terms of control of nasal obstruction and sense of smell loss. However, a significant difference was found in terms of control of posterior rhinorrhoea (p = 0.01).

Conclusion:

Eosinophilic infiltration influences the outcome of nasal polyposis surgery, mainly regarding control of posterior rhinorrhoea. It could be considered as a risk factor for surgery in patients with nasal polyposis.