Evaluation of Diffuse Type 2 Dominant or Eosinophilic Chronic Rhinosinusitis With Corticosteroid Irrigation After Surgical Neosinus Cavity Formation.

Importance eosinophilic chronic rhinosinusitis (e crs), contemporarily classified as diffuse type 2 dominant chronic rhinosinusitis (crs), is characterized by eosinophil-dominant mucosal inflammation.Contemporary management of e crs as an inflammatory airway condition is multimodal with corticosteroid irrigations after the surgical creation of a neosinus cavity.Objectives to assess long-term treatment outcomes in patients with primary diffuse type 2 crs or e crs receiving multimodal treatment.Design, setting, and participants a prospective cohort study of patients seen in a tertiary rhinology practice recruited from may 2010 to november 2018 was conducted.Follow-up duration was 12 months or more following endoscopic sinus surgery (ess) with a neosinus cavity formed.Data analysis was performed from august to november 2020.Consecutive adult (≥18 years) patients diagnosed with primary diffuse type 2 dominant crs or e crs based on the european position paper on rhinosinusitis and nasal polyps 2020 criteria were included.Type 2 inflammation was defined as more than 10 eosinophils per high-power field obtained from sinus mucosal biopsy and managed with neosinus cavity ess and ongoing corticosteroid irrigations.Exclusion criteria were less than 12 months of follow-up and secondary crs.Interventions endoscopic sinus surgery with complete removal of intersinus bony partitions to create a neosinus cavity.Nasal irrigation (240 m l) with betamethasone, 1 mg, or budesonide, 1 mg, daily for 3 to 6 months after ess and tapered to an as-needed basis (minimum, 2-3 per week).Main outcomes and measures poor control was defined as polyp recurrence (polyp growth in >1 sinus area on a single side), use of long-term systemic therapy (biologic therapy or ≥3 consecutive months of oral corticosteroids), and revision surgery involving polypectomy.The disease in patients with no poor control criteria was defined as well controlled, and the disease in those with 1 or more criteria was considered poorly controlled.Maintenance medical therapy use and patient-reported outcomes based on the 22-item sinonasal outcomes test for preoperative and last follow-up were collected.Results of the 222 participants recruited with primary diffuse type 2 dominant crs or e crs and minimum of year of follow-up, 126 were men (56.8%).Mean (sd) age was 54.8 (13.6) years, and median (sd) follow-up was 2.2 (2.2) years.Of the 222 patients, 195 (87.8%) had well-controlled disease, 16 (7.2%) had polyp recurrence, 7 (3.2%) continued to receive long-term oral corticosteroid therapy, 5 (2.3%) received biologic therapy, and 8 (3.6%) underwent a revision polypectomy.Clinically meaningful change on the 22-item sinonasal outcomes test and the nasal subdomain score was maintained at the last follow-up in 134 patients (67.0%).Poor disease control was not associated with poor adherence to irrigation use.Conclusions and relevance the findings of this cohort study suggest that long-term disease control and reduction in symptom burden in patients with primary diffuse type 2 crs or e crs might be achieved when managed as an inflammatory disorder.Maintenance corticosteroid irrigations in the population examined appeared to be successfully self-tapered to disease activity.

Journal: JAMA otolaryngology-- head & neck surgery (2021)
Publication types: Journal Article