Impact of Sinus CT Severity Score on the Outcomes of Endoscopic Sinus Surgery in Eosinophilic CRSwNP.

Abstract

Background: Eosinophilic chronic rhinosinusitis with nasal polyps (eos-CRSwNP), especially those with diffuse disease as indicated by CT scans, has high recurrence rate and low control rate after endoscopic sinus surgery (ESS). Most of them are difficult to treat.

Objective: This study sought to identify if eos-CRSwNP patients were to undergo surgery earlier, while the disease is still limited on CT, they might achieve better postoperative outcomes.

Methods: This study enrolled eos-CRSwNP patients with different degree of sinus involvement who underwent primary ESS and compared the surgical outcomes of the patients exhibiting mild sinus involvement with those displaying severe sinus involvement. The demographic data, preoperative disease severity, and surgery outcomes at 1 year postoperatively were collected. CRS control status was the primary endpoint to evaluate the outcomes.

Results: This study included 118 patients with at least one-year follow-up. The overall uncontrolled rate was 33.1% at 1 year postoperatively. The best cut-off value for CT Lund-Mackay (L-M) score was 13 to predict the uncontrolled status (AUC = 0.67). Then, patients were divided into the mild group (L-M < 13, n = 70) and the severe group (L-M ≥ 13, n = 48) according to L-M score. The follow-up data indicated that 24.3% of patients (17/70) in the mild group and 45.8% of patients (22/48) in the severe group were uncontrolled (p = 0.015). Postoperative endoscopic score in the mild group was significantly better than those in the severe group (p = 0.002).

Conclusion: ESS performed on eos-CRSwNP patients with mild sinus involvement have better postoperative outcomes at 1 year than patients with severe sinus involvement.

Levels of evidence: Level 3 Laryngoscope, 2024.