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We are all familiar with patients suffering extensive nasal polyps who relapse all to soon after careful and thorough endoscopic sinus surgery (ESS). This paper looks to answer whether we can predict which patients will do well, and which less so, with preoperative nasal cytology to determine type and load of inflammation. Secondary objectives were to assess the prognostic value of Lund-Mackay score (LMS), blood eosinophilia, allergy and intolerance to NSAIDs in predicting poor postoperative disease control at one year. The authors looked at 80 patients with chronic rhinosinusitis with nasal polyposis (CRSwNP), all of whom were treated with nasal corticosteroids for one year after ESS, and they all received standardised surgery of fronto-ethmoido-sphenoidotomy. They were assessed at regular intervals post-surgery and response to surgery assessed with LMS, SNOT-22, VAS scores. Cytology results were most interesting, with patients with a mixed pattern (neutrophils AND eosinophils) on swabbing demonstrating the worst disease preoperatively, and eosinophilia-dominated patients the next worst affected. Therefore, good disease control at 12 months was highest in patients with a neutrophilia pattern. High LMS, eosinophilia, allergy, asthma and Samter’s triad all predicted a poorer outcome. I think this is a useful study, as nasal cytology (although not widely used currently) is a cheap and easily available investigation which can help to guide postoperative medical management for higher risk patients. Perhaps we should consider incorporating this into the routine management of patients with recalcitrant CRSwNP?

Predictors of Disease Control After Endoscopic Sinus Surgery Plus Long-Term Local Corticosteroids in CRSwNP.
De Corso E, Settimi S, Tricarico L, et al.
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Joanna Stephens

United Lincolnshire Hospitals NHS Trust, UK.

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