Treatment outcomes in chronic rhinosinusitis

This thesis evaluates the burden and optimal management of patients with chronic rhinosinusitis (CRS), and in particular the medical and surgical treatment options.
Chronic rhinosinusitis is a prevalent disease with a 12.8% prevalence in the general population when only symptoms are taken into account, and 3% when symptoms are combined with significant abnormalities at imaging (CT scan of the sinuses with a Lund-Mackay score ≥4). The high prevalence of CRS results in a significant societal burden and high costs, primarily from lost productivity and work absenteeism.
In a randomised, controlled, multicentre trial involving 238 patients in 15 centres in the Netherlands, endoscopic sinus surgery combined with medical therapy resulted in a significantly larger improvement of disease-specific health-related quality of life, compared to medical therapy alone. Furthermore, the addition of ESS had a steroid-sparing effect.
A systematic review on beneficial and harmful effects of systemic corticosteroids showed a risk of significant adverse events on both the short-term and long-term. Furthermore, the thesis contains a Cochrane Systematic Review on aspirin treatment after desensitization in patients with CRS and NSAID-exacerbated respiratory disease showing significant improvements in disease-specific health-related quality of life and asthma control. Aspirin treatment after desensitization is considered a cheap treatment alternative to revision surgery and/or systemic corticosteroids but carries a risk of adverse events that may lead to frequent discontinuation.