Abstract

Relevance: Chronic rhinosinusitis (CRS) is a prevalent condition, affecting approximately 5-12% of the European population. It ranks among the top 10 diseases in the United States requiring significant direct and indirect costs, largely due to its high recurrence rate, especially in the phenotype with nasal polyps. Studies indicate that the rate of revision surgeries for CRS with nasal polyposis can reach 20-50%. Hence, there is a need for prognostic models based on the analysis of various factors influencing the disease course and the need for better disease management.

Objective: To investigate the course of CRS with nasal polyposis in Ukrainian patients and assess the risk factors for early recurrence of the disease.

Materials and methods: The study analysed all cases of CRS from 2019 to 2024. From a total of 584 disease histories, 42 were selected, which were divided into 3 groups according to the symptoms of the disease – with a controlled course, with a partially controlled course, and with an uncontrolled course. Medical history data were retrospectively collected from electronic medical records. Search criteria included age, article, complaints, examination, bad habits, allergic history, comorbidities, symptoms, disease course, history of previous surgical interventions, and general clinical blood tests.

Results: The majority of patients seeking surgical intervention for CRS with nasal polyposis had partially controlled disease (n=24). All age groups were similar across the study. Bilateral polyposis was a typical manifestation for both partially controlled and uncontrolled disease, observed in 79.2% and 100% of cases, respectively. History of previous surgeries for CRS showed twice the frequency of reoperations in the uncontrolled disease group compared to the partially controlled group. Significant differences were found between the groups in terms of comorbid conditions, associated diseases, and harmful habits, particularly in allergic rhinitis, nasal septum deviation, and smoking. Computed tomography (CT) parameters were consistently higher in the uncontrolled CRS group, although olfactory cleft obstruction scores showed similar results in the partially controlled group.

Conclusions: The findings emphasize the importance of identifying risk factors and monitoring patients with CRS with nasal polyposis to enhance surgical and conservative treatment strategies. Several factors influencing early recurrence in patients with uncontrolled CRS have been identified, including disease duration exceeding 7.5 years, concomitant allergic rhinitis, smoking, a Lund-Mackay score above 15, and serum blood eosinophilia exceeding 8.4%.

Keywords: rhinosinusitis, nasal polyposis, paranasal sinus CT, allergic rhinitis, FESS, revision surgery.