Chronic rhinosinusitis with polyposis is a type 2 inflammation with risks of recurrence and need for revision operations. This is known to depend on the endotype and phenotype factors. This is a retrospective study of 212 patients. Of these, 112 did not require revision surgery and 100 did. The existence of risk factors was compared in the two groups and the observations were as follows: in the group of patients requiring revision surgery, there was a higher existence of history of smoking, asthma, aspirin hyper-sensitivity, eosinophilia, presence of mucins, positive prick test and fungal sinusitis. The symptoms that seemed to favour revision were olfactory dysfunction and nasal discharge but not facial pain, post-nasal drip. Interestingly, in this study, the use of intranasal and systemic steroids, pre, intra and postoperatively favoured the need of revision surgery, as did a longer follow-up period. Patients undergoing FESS at a younger age needed revision more than older patients. Factors such as Global Osteitis Scoring Scale and Lund-Mackay score did not seem to vary in the two groups. It is therefore concluded that clinical and radiological phenotypes can be used to predict recurrence and need for revision surgery.
Factor favouring the need for revision FESS in chronic sinusitis with polyps – a multivariate analysis including phenotypes
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