A well written prospective study, which demonstrates that patients who require endoscopic sinus surgery, should be operated on without long delay since this achieves better and more sustained outcomes. There were 1493 patients undergoing primary nasal surgery who had completed a SNOT-22 identified from the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis. They were divided into three groups depending on how long their symptoms had been present for; up to a year, a year to five or more than five years. Postoperative SNOT-22 scores were also recorded over the following five years; of course the amount of data collected deteriorated with time. It was found that all patients reported a decrease in their SNOT-22 scores, however, even after correcting for patients with asthma, those in the early cohort demonstrated a significantly lower SNOT-22 both before and after surgery and also managed to maintain a low score over the five year follow up period. The prevalence of CRS is 11% and is a significant disease burden, those with symptoms should be treated promptly with medical management and those failures should receive early surgery, preferably within a year of onset of symptoms. This would seem to produce the best and most sustainable outcomes over this five year follow up period.
