Toward Better Outcomes: Avoid revision surgeries in chronic rhinosinusitis patients

“From my perspective, the patient needs to be educated about the disease process,” Dr. Citardi said. “They need to understand that this is chronic and they are likely to require ongoing medical management even after a good surgical outcome.”

For Dr. Kern, it is imperative that otolaryngologists properly educate patients on their expectations of surgery. For example, he said, patients with severe polyposis, allergic fungal sinusitis, or cystic fibrosis are at high risk of needing additional, sometimes multiple, surgeries and need to be aware of this.

For some patients who are allergic to aspirin, treatment in which they gradually become tolerant to aspirin through a process called aspirin desensitization has been shown to reduce the sinus inflammation in their sinuses.

According to John Bosso, MD, chief of Allergy/Immunology, director of the Aspirin Desensitization Program at Nyack Hospital in Nyack, N.Y. and one of the few experts in the country trained in this highly specialized therapy, about 40 percent of patients with nasal polyps and asthma have aspirin-exacerbated respiratory disease (AERD) and could potentially benefit from aspirin desensitization. Identifying these patients prior to surgery would reduce the need for revision surgery, he said.

Dr. Citardi, who has referred patients for aspirin desensitization, thinks aspirin desensitization plays a definite role in treating select patients. “Aspirin desensitization seems to prevent patients from worsening,” he said, “although I don’t think that it makes the pre-existing inflammatory sinus disease better.”

Overall, recognizing patients with AERD highlights an important message for all otolaryngologists who, along with their patients, are often stymied by the lack of improvement following surgical treatment. When patients continue to not do well, “physicians need to step back and reconsider the assumptions that have been implicit in the entire treatment course before that point,” Dr. Citardi said. ENTtoday

Mary Beth Nierengarten is a medical writer based in St. Paul, Minn.

IMAGE SOURCES: PHOTOS PHANIE/PHOTO RESEARCHERS, INC.