To compare the outcomes of full and limited functional endoscopic sinus surgery (FESS) in patients with uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP).
Approach:
Study Design: An open-label, randomized controlled trial (AirGOs Operative) conducted at two tertiary centers in Finland.
Participants: 97 patients aged 18 to 65 with severe, uncontrolled CRSwNP were randomized between October 2018 and October 2022.
Interventions: Full FESS involved extensive sinus surgery under general anesthesia, while limited FESS included less invasive procedures, often under local anesthesia.
Primary Outcome: Change in the 22-item Sino-Nasal Outcome Test (SNOT-22) scores at 12 and 24 months.
Key Findings:
Both full and limited FESS showed clinically meaningful improvements in SNOT-22 scores over 24 months.
The difference in improvement between the two groups did not reach the minimal clinically important difference.
Full FESS resulted in greater recovery from anosmia and lower nasal polyp scores compared to limited FESS.
Limitations:
Masking was not possible, potentially influencing reported outcomes.
Findings primarily applicable to patients with moderate to severe eosinophilic CRSwNP.
Short follow-up period of 24 months may not capture all treatment considerations.
Conclusion:
Full FESS was associated with greater recovery from anosmia and lower polyp burden, particularly in the first postoperative year.
Higher annual oral corticosteroid exposure was associated with greater odds of systemic adverse events, with avascular bone necrosis and pneumonia showing dose-dependent associations with cumulative dose and osteoporosis associated with longer annual exposure duration.
Amoxicillin-clavulanate was not linked to lower treatment failure but was associated with a slightly higher risk of secondary infections compared with amoxicillin in adults with uncomplicated acute sinusitis.
