Extensive endoscopic sinus surgery: does this reduce the revision rate for nasal polyposis?

Nasal polyps treated either medically or surgically have a high recurrence rate. It is hypothesised that the performance of an extensive endoscopic sinus surgery (EESS), involving complete removal of nasal polyps along with full ethmoid clearance, will decrease the recurrence rate and therefore be an advantage to the patient. This study is a retrospective review of 149 patients who underwent EESS in a district general hospital. Surgical revision rates and perioperative complication data were recorded. A comparison was made with patients enlisted with the UK National Comparative Audit who underwent polyp disease removal limited to the anterior ethmoid cavity. A further measure regarding quality of life was derived from sinonasal outcome test 22 (SNOT-22). At 36 months after surgery, five patients from the extensive surgery group had undergone a revision procedure, which was significantly less than the National Audit figure (4.0 vs. 12.3% P = <0.006). The perioperative adverse complication rate was similar (7.4 vs. 6.6% P = <0.774). There is a large improvement in SNOT-22 scores from the pre-operative period (mean 39) to the post-operative period (mean 8). This study provides some evidence that extensive sinus surgery performed by an experienced rhinologist can lead to a lower revision rate without compromising patient safety. If a further prospective study confirms this hypothesis then this may provide a basis for change.