Surgical interventions for chronic rhinosinusitis with nasal polyps

Background

Benign nasal polyps are abnormal tissue growths inside the nasal passages and sinuses, often on both sides of the nose. They can cause a wide array of symptoms including blocked nose, poor sense of smell that can lead to a loss of taste, runny nose and nasal congestion. Sinuses are air-filled cavities in the bones of the face, which are in continuity with the nasal passages. The first-line treatment for nasal polyps is usually medical therapy in the form of steroids - as sprays (topically) or by mouth (orally). In patients where this treatment has failed to relieve the symptoms, the polyps can be removed surgically. These surgical procedures are often not curative and patients may need to continue medical therapy or undergo further surgeries. A number of well-established surgical techniques can be used to remove polyps. What has not been established is whether removing the nasal polyps and clearing out the sinuses offers any advantage in the control of the disease when compared to simply removing the polyps and leaving the sinuses unchanged. We sought evidence in the literature to establish whether there was any difference in patients who underwent nasal polyp removal alone versus those who had nasal polyps removed as well as opening up of the sinuses.

Study characteristics

No trials met our inclusion criteria. We did identify six controlled trials (five of which were randomised) in which some but not all of our inclusion criteria were met, but we had to exclude these studies from the review.

Key results

No trials met our inclusion criteria.

Quality of evidence

At present, we cannot comment on whether taking nasal polyps out alone or also opening up the sinuses at the same time is a better treatment for patients with this disease. There is a need for high-quality randomised controlled trials to answer this question. This evidence is current to February 2014.

Authors' conclusions: 

We are unable to reach any conclusions as to whether isolated nasal polypectomy or more extensive sinus surgery is a superior surgical treatment modality for chronic rhinosinusitis with nasal polyps. There is a need for high-quality randomised controlled trials to assess whether additional sinus surgery confers any benefit when compared to nasal polypectomy performed in isolation.

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Background: 

Surgical treatment of chronic rhinosinusitis with nasal polyps is an established treatment for medically resistant nasal polyp disease. Whether a nasal polypectomy with additional sinus dissection offers any advantage over an isolated nasal polypectomy has not been systematically reviewed.

Objectives: 

To assess the effectiveness of simple polyp surgery versus more extensive surgical clearance in chronic rhinosinusitis with nasal polyps.

Search strategy: 

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 1); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 February 2014.

Selection criteria: 

Randomised and quasi-randomised controlled trials in patients over 16 with chronic rhinosinusitis with nasal polyps, who have failed a course of medical management and who have not previously undergone any previous surgical intervention for their nasal disease. Studies compared nasal polypectomy with more extensive sinus clearance in this patient cohort.

Data collection and analysis: 

We used the standard methodological procedures expected by The Cochrane Collaboration.

Main results: 

We identified no trials which met our inclusion criteria. Six controlled trials (five randomised) met some but not all of the inclusion criteria and were therefore excluded from the review.

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