Ibrahim K. Aljabr
Objective: This investigation aimed to evaluate and contrast outcomes of endoscopic sinus surgery and biologic treatment with respect to sinonasal symptom burden, health-related quality of life, and polyp recurrence in patients with relapsing CRSwNP. Study Design: Retrospective observational studyPlace and Duration of Study: This study was conducted at the Otorhinolaryngology and Head and Neck Surgery Division at a tertiary referral hospital in Alahsa City spanning July 2022 to July 2025. Methods: One hundred and twenty adult CRSwNP patients were enrolled and allocated to two treatment arms: Arm A (n=60) received functional endoscopic sinus surgery (FESS), while Arm B (n=60) was managed with biologic agents (dupilumab or mepolizumab). Treatment response was quantified through SNOT-22 scoring, health-related quality of life instruments, and polyp recurrence documentation across a minimum observation window of 6–12 months. Results: SNOT-22 scores declined meaningfully in both treatment arms; however, the magnitude of reduction was substantially greater in the biologic arm at the six-month assessment (22.1 ± 7.5 versus 28.6 ± 8.2; p<0.01). Patient- reported quality of life gains favored the biologic arm (72% vs. 55%; p=0.03). Polyp recurrence was markedly less frequent among biologic-treated patients (10%) relative to those who underwent surgery (30%; p<0.01). While surgery conferred more rapid early relief, biologics yielded superior durable disease suppression. Conclusion: Biologic treatment demonstrated advantages in sustained symptom suppression, enhanced quality of life, and lower recurrence rates when measured against surgical management alone in CRSwNP patients. Surgery nonetheless retains clear utility as a strategy for prompt symptomatic relief. Clinical decision-making should adopt an individualized framework tailored to patient profile and disease characteristics.