Skip to main content Accessibility help

Effectiveness of extensive sinus surgery with post-operative medical management for chronic rhinosinusitis

  • A J Wood (a1), L Zhou (a2), S Wilkinson (a1) and R G Douglas (a1)



To prospectively assess treatment outcomes of chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery and post-operative medical treatment over a prolonged follow-up period.


Patients undergoing functional endoscopic sinus surgery in the tertiary referral practice of a single surgeon were studied prospectively. Symptoms were scored by patients pre-operatively and over a minimum follow-up period of 12 months.


The study comprised 200 non-consecutive patients. The median pre-operative symptom score was 16 (out of a maximum of 25) (95 per cent confidence interval = 15 to 17). Symptom scores reduced to a median of 7 (95 per cent confidence interval = 6 to 8) after 12 months of follow up (p < 0.0001). The median symptom score improved for all symptoms and across all patient subgroups.


Extensive functional endoscopic sinus surgery offers significant and durable symptom improvement in patients with chronic rhinosinusitis refractory to medical treatment. This improvement extends to all patient subgroups. Prolonged medical therapy is recommended after functional endoscopic sinus surgery.


Corresponding author

Address for correspondence: Dr Richard Douglas, Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand Fax: +64 9 377 9656 E-mail:


Hide All
1 Stammberger, H, Posawetz, W. Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 1990;247:6376
2 Fokkens, WJ, Lund, VJ, Mullol, J, Bacchert, C, Alobid, I, Baroody, F et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 2012;50:112
3 Hastan, D, Bokkens, WJ, Bachert, C, Newson, RB, Bislimovska, J, Bockelbrink, A et al. Chronic rhinosinusitis in Europe--an underestimated disease. A GA(2)LEN study. Allergy 2011;66:1216–23
4 Young, LC, Stow, NW, Zhou, L, Douglas, RG. Efficacy of medical therapy in treatment of chronic rhinosinusitis. Allergy Rhinol (Providence) 2012;3:e812
5 Bhattacharyya, N, Orlandi, RR, Grebner, J, Martinson, M. Cost burden of chronic rhinosinusitis: a claims-based study. Otolaryngol Head Neck Surg 2011;144:440–5
6 Damm, M, Quante, G, Jungehuelsing, M, Stennert, E. Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis. Laryngoscope 2002;112:310–15
7 Hopkins, C, Slack, R, Lund, V, Brown, P, Copley, L, Browne, J. Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope 2009;119:2459–65
8 Kern, RC, Conley, DB, Walsh, W, Chandra, R, Kato, A, Tripathi-Peters, A et al. Perspectives on the etiology of chronic rhinosinusitis: an immune barrier hypothesis. Am J Rhinol 2008;22:549–59
9 Wabnitz, DA, Nair, S, Wormald, PJ. Correlation between preoperative symptom scores, quality-of-life questionnaires, and staging with computed tomography in patients with chronic rhinosinusitis. Am J Rhinol 2005;19:91–6
10 Georgalas, C, Cornet, M, Adriaensen, G, Reinartz, S, Holland, C, Prokopakis, S et al. Evidence-based surgery for chronic rhinosinusitis with and without nasal polyps. Curr Allergy Asthma Rep 2014;14:427
11 Welch, KC, Stankiewicz, JA. A contemporary review of endoscopic sinus surgery: techniques, tools, and outcomes. Laryngoscope 2009;119:2258–68
12 Lund, VJ, Holmstrom, M, Scadding, GK. Functional endoscopic sinus surgery in the management of chronic rhinosinusitis. An objective assessment. J Laryngol Otol 1991;105:832–5
13 Litvack, JR, Mace, J, Smith, TL. Does olfactory function improve after endoscopic sinus surgery? Otolaryngol Head Neck Surg 2009;140:312–19
14 Briner, HR, Jones, N, Simmen, D. Olfaction after endoscopic sinus surgery: long-term results. Rhinology 2012;50:178–84
15 Rizk, H. Role of aspirin desensitization in the management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2011;19:210–17
16 Rudmik, L, Soler, ZM, Orlandi, RR, Stewart, MG, Bhattacharyya, N, Kennedy, DW et al. Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2011;1:417–30
17 Lund, VJ. Low priority procedures--a uniquely British concept. Rhinology 2011;49:1
18 Wood, AJ, Douglas, RG. Pathogenesis and treatment of chronic rhinosinusitis. Postgrad Med J 2010;86:359–64
19 Naidoo, Y, Tan, N, Signal, D, Wormald, PJ. Chronic rhinosinusitis assessment using the Adelaide Disease Severity Score. J Laryngol Otol 2013;127(suppl 2):S24–8
20 Chester, AC, Antisdel, JL, Sindwani, R. Symptom-specific outcomes of endoscopic sinus surgery: a systematic review. Otolaryngol Head Neck Surg 2009;140:633–9
21 Soler, ZM, Smith, TL. Quality-of-life outcomes after endoscopic sinus surgery: how long is long enough? Otolaryngol Head Neck Surg 2010;143:621–5
22 Smith, TL, Litvack, JR, Hwang, PH, Loehrl, TA, Mace, JC, Fong, KJ et al. Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg 2010;142:5563
23 Clinger, JD, Mace, JC, Smith, TL. Quality-of-life outcomes following multiple revision endoscopic sinus surgery. Int Forum Allergy Rhinol 2012;2:444–52
24 Elmorsy, SM, Khafagy, YQ. Does asthma and aspirin hypersensitivity affect the outcome of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps. J Aller Ther 2011;S5:2
25 Kim, JE, Kountakis, SE. The prevalence of Samter's triad in patients undergoing functional endoscopic sinus surgery. Ear Nose Throat J 2007;86:396–9
26 Fokkens, W, Lund, V, Mullol, J. EPOS 2007: European position paper on rhinosinusitis and nasal polyps. Rhinology 2007;45:1139
27 Jain, R, Stow, N, Douglas, R. Comparison of anatomical abnormalities in patients with limited and diffuse chronic rhinosinusitis. Int Forum Allergy Rhinol 2012;3:493–6
28 Lund, VJ, Mackay, IS. Staging in rhinosinusitus. Rhinology 1993;31:183–4
29 Thomas, WW 3rd, Harvey, RJ, Rudmik, L, Hwang, PH, Schlosser, RJ. Distribution of topical agents to the paranasal sinuses: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2013;3:691703
30 Liang, KL, Su, MC, Tseng, HC, Jiang, RS. Impact of pulsatile nasal irrigation on the prognosis of functional endoscopic sinus surgery. J Otolaryngol Head Neck Surg 2008;37:148–53
31 Kalish, L, Snidvongs, K, Sivasubramaniam, R, Cope, D, Harvey, RJ. Topical steroids for nasal polyps. Cochrane Database Syst Rev 2012;(12):CD006549
32 Rudmik, LJ, Mace, J, Smith, T. Low-stage computed tomography chronic rhinosinusitis: what is the role of endoscopic sinus surgery? Laryngoscope 2011;121:417–21
33 DeConde, AS, Mace, JC, Alt, JA, Soler, ZM, Orlandi, RR, Smith, TL. Investigation of change in cardinal symptoms of chronic rhinosinusitis after surgical or ongoing medical management. Int Forum Allergy Rhinol 2014;5:3645
34 Siedek, V, Pilzweger, E, Betz, C, Berghaus, A, Leunig, A. Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients. Eur Arch Otorhinolaryngol 2013;270:141–8
35 Soler, ZM, Rudmik, L, Hwang, PH, Mace, JC, Schlosser, RJ, Smith, TL. Patient-centered decision making in the treatment of chronic rhinosinusitis. Laryngoscope 2013;123:2341–6
36 Liu, JJ, Davis, GE. The significance of response shift in sinus surgery outcomes. Int Forum Allergy Rhinol 2015;5:55–9



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed