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Evaluation of the Medical and Surgical Treatment Of Chronic Rhinosinusitis: A Prospective, Randomised, Controlled Trial
Author(s) -
Ragab Sameh M.,
Lund Valerie J.,
Scadding Glenis
Publication year - 2004
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200405000-00027
Subject(s) - medicine , chronic rhinosinusitis , medical therapy , randomized controlled trial , surgery , acoustic rhinometry , medical treatment , prospective cohort study , nasal polyps , refractory (planetary science) , sinusitis , nose , physics , astrobiology , medical emergency
Objectives: To conduct the first prospective, randomized, controlled trial evaluating and comparing the medical and surgical treatment of polypoid and nonpolypoid chronic rhinosinusitis (CRS). Materials and Methods: Ninety patients with CRS were equally randomized either to medical or surgical therapy. All patients underwent pre‐ and posttreatment assessments of visual analogue score (VAS), the Sinonasal Outcome Test‐20 (SNOT‐20), the Short Form 36 Health Survey (SF‐36), nitric oxide (NO), acoustic rhinometry, saccharine clearance time (SCT), and nasal endoscopy. Each patient had three assessments: before starting the treatment, after 6 months, and, finally, after 1 year. Results: Both the medical and surgical treatment of CRS significantly improved almost all the subjective and objective parameters of CRS ( P < .01), with no significant difference being found between the medical and surgical groups ( P > .05), except for the total nasal volume in CRS ( P < .01) and CRS without polyposis ( P < .01) groups, in which the surgical treatment demonstrated greater changes. Conclusion: CRS should be initially targeted with maximal medical therapy (e.g., a 3 month course of a macrolide antibiotic, douche, and topical steroid), with surgical treatment being reserved for cases refractory to medical therapy. The presence of nasal polyps is not a poor prognostic factor for the efficacy of CRS therapy, either surgical or medical.