Efficacy of Targeted Medical Therapy in Chronic Rhinosinusitis, and Predictors of Failure

Abstract

Background No standardized medical therapy for chronic rhinosinusitis (CRS) is universally accepted. Success of medical therapy is reportedly 50% to 88%, but studies differ in inclusion criteria, medications, duration of therapy, and defining “success.” The objectives of this study were to determine efficacy of a standardized targeted medical therapy (TMT) regimen in CRS and to analyze factors associated with failure of therapy. Methods Retrospective analysis of prospectively collected data was performed. CRS was diagnosed based on CRS Taskforce guidelines. TMT was defined as a minimum 4-week treatment with oral antibiotics, oral steroids, topical nasal steroids, topical nasal decongestant rotation, and saline nasal douching. “Failure” was defined as relapse/persistence of signs/symptoms or need for surgery. One hundred forty-five patients that received TMT, with a minimum 2-month follow-up, were identified. The results of therapy were reviewed to determine efficacy and analyze factors associated with failure. Results Seventy-four patients (51.03%) were successfully treated. Failures included 26 patients (17.8%) with only partial improvement and 45 (31.03%) who underwent surgery. Only history of facial pressure/pain (p = 0.049), presence of mucosal inflammation (p = 0.013), and higher endoscopic severity grade (p = 0.011) were associated with failure of TMT. Conclusions TMT was unequivocally successful in 51% of patients. Failures included 31% who underwent surgery and 18% with partial benefit. Surgery was avoided in 69%. Facial pressure/pain, mucosal inflammation, and higher endoscopic severity grade were associated with failure of medical therapy.