Comparative outcomes of nasalisation vs functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyposis: a 10-year retrospective study.

OBJECTIVE: To compare outcomes of functional endoscopic sinus surgery (FESS) and nasalisation (radical ethmoidectomy) in chronic rhinosinusitis with nasal polyposis (CRSwNP), and to identify subgroups benefiting most from nasalisation. METHODS: We retrospectively analysed 480 surgeries (374 FESS, 106 nasalisation) from 2012 to 2022. Nasalisation patients had more severe baseline disease than FESS patients (mean Nasal Obstruction Symptom Evaluation [NOSE] score: 76.88 ± 6.18 vs 73.55 ± 7.25; mean Visual Analogue Scale [VAS] olfaction score: 6.53 ± 1.1 vs 8.8 ± 1.15; mean Lildholdt score: 2.09 ± 0.76 vs 1.57 ± 0.83; all p < 0.001). Subjective (NOSE, VAS) and objective (Lildholdt) scores were recorded preoperatively and at one, 3, 6, 12, and 24 months postoperatively. RESULTS: Despite worse baseline status, nasalisation showed greater improvements in subjective and objective measures, and was particularly effective in diffuse extensive polyposis. Paired t-tests confirmed significant postoperative enhancements (all p < 0.001; Cohen's d > 0.8). At 24 months, nasalisation showed superior outcomes: NOSE (24.5 ± 5.5 vs 41 ± 6), VAS olfaction (1.95 ± 1.05 vs 3.95 ± 1.15) (both p < 0.001); Lildholdt scores were similar (0.5 ± 0.6 vs 0.53 ± 0.65; p = 0.68). CONCLUSIONS: The preliminary results of this retrospective study showed that nasalisation in more severe cases of CRSwNP yielded better long-term clinical outcomes. These results motivate for further investigation through a prospective study that will include comprehensive olfactory testing, quality of life measures, and a more complete methodology with refined variables to address the limitations of the current data set.