Lili Wang, Minghui Zhou, Shanpeng Yuan, Yang Jiao, Luping Wang, Yunpeng Ba, Qingwen Zhu
In adults with postoperative difficult-to-treat CRSwNP, the intensified outpatient strategy was associated with earlier and more frequent recorded postoperative cavity epithelialization than conventional budesonide nasal spray. These findings indicate a strategy-level association and do not isolate component effects or establish comparative safety. The 12-week endpoint reflects early recorded epithelialization and does not establish durable disease control or recurrence prevention. Prospective component-controlled or factorial studies with follow-up of at least 12 months are needed.
BACKGROUND: Difficult-to-treat chronic rhinosinusitis with nasal polyps (CRSwNP) may remain uncontrolled after adequate endoscopic sinus surgery and guideline-directed postoperative therapy. Obstructive edematous or polypoid tissue in the operated sinus cavity may limit topical corticosteroid access and delay mucosal recovery. We evaluated whether an intensified outpatient strategy-targeted in-office endoscopic debridement followed by supine head-hanging budesonide instillation-was associated with earlier recorded postoperative cavity epithelialization.
METHODS: This single-center retrospective cohort included 102 adults treated from January 2020 to January 2025 and reassessed against EPOS 2020 difficult-to-treat criteria. Fifty-two patients received the intensified strategy, and 50 received conventional budesonide nasal spray; both groups received the same 7-day oral methylprednisolone course. The primary endpoint was recorded postoperative cavity epithelialization at 12 weeks. Secondary endpoints included 8-week epithelialization, time to first recorded epithelialization, symptom and Lund-Kennedy score improvement, exploratory adjusted association with 12-week epithelialization, and adverse events documented in records. Because the intensified strategy comprised multiple co-delivered components, the study evaluated the overall strategy, not individual components.
RESULTS: Epithelialization by week 8 was recorded in 43/52 (82.69%) intensified-strategy patients and 20/50 (40.00%) conventional-strategy patients (P < 0.001). Twelve-week epithelialization was recorded in 46/52 (88.46%) and 32/50 (64.00%) patients, respectively (risk difference, 24.46 percentage points; 95% CI, 8.57-40.35; risk ratio, 1.38; 95% CI, 1.10-1.74; P = 0.004). Median time to first recorded epithelialization was 4 versus 12 weeks (log-rank P < 0.001). Holm-adjusted comparisons favored the intensified strategy for symptom and endoscopic score improvements. In exploratory Firth regression, the intensified strategy remained associated with 12-week epithelialization (adjusted OR, 5.58; 95% CI, 1.87-16.68; P = 0.002). Serious adverse events were not documented, but safety assessment was retrospective and incomplete.
CONCLUSION: In adults with postoperative difficult-to-treat CRSwNP, the intensified outpatient strategy was associated with earlier and more frequent recorded postoperative cavity epithelialization than conventional budesonide nasal spray. These findings indicate a strategy-level association and do not isolate component effects or establish comparative safety. The 12-week endpoint reflects early recorded epithelialization and does not establish durable disease control or recurrence prevention. Prospective component-controlled or factorial studies with follow-up of at least 12 months are needed.