Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial

Laryngoscope. 2004 May;114(5):923-30. doi: 10.1097/00005537-200405000-00027.

Abstract

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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Androstadienes / therapeutic use*
  • Anti-Inflammatory Agents / therapeutic use*
  • Endoscopy / methods
  • Female
  • Fluticasone
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nitric Oxide / metabolism
  • Prospective Studies
  • Quality of Life
  • Rhinitis / diagnosis
  • Rhinitis / drug therapy*
  • Rhinitis / surgery*
  • Rhinometry, Acoustic / methods
  • Sinusitis / diagnosis
  • Sinusitis / drug therapy*
  • Sinusitis / surgery*

Substances

  • Androstadienes
  • Anti-Inflammatory Agents
  • Nitric Oxide
  • Fluticasone