Although most otolaryngologists would agree that surgery improves the outcomes of patients with CRS when medical treatment has failed, both Cochrane reviews state that there is no proof of improved efficacy of surgery over medicine – however, that was after excluding a number of valid studies that did not reach the criteria for level I evidence. The authors looked specifically for evidence available after 2005 and appropriate medical treatment (AMT) was defined as at least three weeks of antibiotics and topical steroids. Analysis was done using the free RevMan software and the fixed-effects model, looking at six studies (selected from 971 manuscripts). All of these studies satisfied high-quality criteria, and were prospective crossover or randomised control trials.
The authors found a significant reduction both in days off work as well as in endoscopy scores and, most importantly, in most outcome measures with surgery. Importantly, sinus surgery was the most cost-effective solution for patients who have failed medical treatment.
