Value of a concomitant functional endoscopic paranasal sinus surgery in CRSwNP patients with partial response under antibody therapy.

Introduction  Biologicals, which have been available since 2019 for the treatment of CRSwNP patients with severe disease, fortunately lead to a significant improvement in symptoms and quality of life in the majority of patients – with a limited side effect profile at the same time. Some patients, however, show a stagnant manifestation of symptoms with continued relevant complaints and persistent nasal polyps after an initial moderate improvement during this therapy. This group of patients could benefit from functional endoscopic sinus surgery (FESS) with continuation of antibody therapy to maintain the postoperative condition.

Methods The patients were examined before and after the initiation of antibody therapy as well as after FESS by using smell test, SNOT-22, visual analogue scale and nasal polyp score as well as monitoring the total IgE and the differential blood count. In addition, the tissue samples obtained during surgery were analysed by histopathological staining for increased tissue eosinophilia.

Results In the examined patients, a clear improvement of the clinical symptoms was observed after FESS, even in the long term. Both the SNOT-22 and the VAS showed a significant reduction in symptom severity after surgical therapy.

Conclusion Our findings indicate that in patients with insufficient improvement of symptoms under antibody therapy and persistent nasal polyps, a significant and long-term improvement can be achieved by an additional FESS. Therefore, a combination of antibody therapy and surgical intervention should be considered for this group of patients in the future.

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Artikel online veröffentlicht:
12. Mai 2023