Factors Affecting the Control of Chronic Rhinosinusitis With Nasal Polyps: A Comparison in Patients With or Without NERD

Author:

Lilja Markus Jukka12ORCID,Koskinen Anni12,Virkkula Paula12ORCID,Vento Seija Inkeri1,Myller Jyri3,Hammarén-Malmi Sari1,Laulajainen-Hongisto Anu12ORCID,Hytönen Maija1,Mäkitie Antti1,Numminen Jura4,Sillanpää Saara4,Raitiola Hannu4,Rautiainen Markus4,Toppila-Salmi Sanna Katriina25ORCID

Affiliation:

1. Department of Otorhinolaryngology---Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

2. Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

3. Department of Otorhinolaryngology, Päijät-Häme Central Hospital, Lahti, Finland

4. Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland

5. Haartman Institute, University of Helsinki, Helsinki, Finland

Abstract

Objectives The aim was to compare the control of chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), in patients with/without nonsteroidal anti-inflammatory drug exacerbated respiratory disease (NERD). Study Desing: A retrospective hospital-based sample of CRSwNP patients with/without NERD with follow-up. Setting Tertiary rhinology centers. Methods Electronic patient record data from 116 CRSwNP patients (46 with NERD and 70 without NERD) undergoing ESS during 2001–17 were studied. Mean follow-up time was 9.9 years (range 1.1–15.3). Endpoints reflecting uncontrolled CRSwNP were revision ESS, and need for rescue/advanced therapy (e.g. antibiotics, oral corticosteroids and/or biological therapy) during follow-up. NERD was variable of interest and gender, age, asthma, allergic rhinitis (AR), smoking, Lund-Mackay (LM) score of sinus computed tomography scans previous ESS and baseline total ethmoidectomy were used as covariates. Results Twenty-one (49.7%) NERD patients and 18 (25.7%) non-NERD patients underwent revision ESS within a mean ± SD of 4.3 ± 2.8 and 3.7 ± 2.6 years, respectively (p = .013, by Logrank test). In Cox´s regression models, NERD, female gender, young age, asthma, AR, previous ESS, and lack of total ethmoidectomy were associated with revision-ESS. In adjusted model, only the total ethmoidectomy predicted revision-free survival. In adjusted logistic regression model, there was an insignificant trend that NERD and LM score were associated with the need for rescue/advanced therapy in the follow-up. Conclusions Patients with NERD had higher risk of uncontrolled CRSwNP than patient group without NERD, as measured by revision ESS and/or need for rescue/advanced therapy in the follow-up. In addition, baseline total ethmoidectomy was associated with revision-free survival.

Funder

Suomen Lääketieteen Säätiö

Yrjö Jahnssonin Säätiö

The Finnish Association of Otorhinolaryngology and Head and Neck Surgery

Suomalainen Lääkäriseura Duodecim

Sigrid Juséliuksen Säätiö

Paulon Säätiö

the Tampere Tuberculosis Foundation

the Finnish Society of Allergology and Immunology

State funding for university-level health research

Väinö ja Laina Kiven Säätiö

Jane ja Aatos Erkon Säätiö

the Finnish Cultural Foundation

Publisher

SAGE Publications

Subject

Otorhinolaryngology,Immunology and Allergy

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