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Medical versus surgical management of chronic rhinosinusitis

September 20, 2016 by ASK DR BLOOM

Chronic rhinosinusitis is a recurring, persistent inflammation of the nasal and sinus mucosa lasting longer than 12 weeks that is known to cause significant physical symptoms and adversely impact quality of life and daily function. It is successfully treated medically in the majority of cases. However, in the United States 500,000 patients undergo endoscopic sinus surgery a year to treat it. A recent article from T. Smith etal enrolled 180 adult patients in a nonrandomized, multi-institional study comparing medical therapy to surgery for chronic rhinosinusitis patients who failed initial medical management. Prior to enrollment, all patients previously failed medical management defined as a minimum of 3 weeks of broad spectrum antibiotics and 3 weeks of topical steroid use. Clinical judgement and patient preference were used to determine if patients had continued medical therapy or underwent sinus surgery with patients electing for about half of each. Both groups experienced significant improvement over the next 6 months with 10% of the medical group electing to have surgery during this time period. The remaining 90% of medically treated patients seemed satisfied. However, patients who elected to undergo sinus surgery, had a significantly greater improvement in some quality of life measures, a reduction in antibiotic and systemic steroid use and fewer missed school/work days.

Reference: T Smith etal. Medical therapy vx surgery for chronic rhinosinusitis: a prospective multi-insitutional study. Inf Forum Allergy Rhinol. 2011; 1:235-241.

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