This is a good study design, sufficiently powered, comparing medical management to balloon sinus dilatation. All patients had failed medical management and were thoroughly assessed preoperatively with Lund-Mackay score confirming abnormal CT findings, SNOT 20 index score, chronic sinusitis score (CSS), rhinosinusitis disability index (RSDI) and Lund-Kennedy endoscopy score. Adult patients were recruited over a two-year period, from multiple centres and response to either treatment pathway was assessed. Concurrent surgery was permitted, e.g. ethmoidectomy, polypectomy, septoplasty or turbinate reduction, so it is difficult to attribute the results to the balloon dilatation alone. In addition, the patients self-selected their treatment pathway, which introduces some bias, although the authors tried to allow for this by evaluating the results against the respective baselines for each group. Overall, this paper provides convincing evidence that for patients with confirmed chronic sinusitis who have failed medical therapy, either balloon dilatation alone, or balloon dilatation in conjunction with further sinus surgery offers a superior reduction in symptoms. It would be nice to see a further study with randomisation of patients rather than self-selection, however the authors discuss the difficulties of this process in treating real patients.

Medical therapy versus sinus surgery by using balloon sinus dilatation technology: a prospective multi centre study.
Payne SC, Stolovitzky P, Mehendale N, et al.
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Joanna Stephens

United Lincolnshire Hospitals NHS Trust, UK.

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