Clinical outcomes after revision endoscopic sinus surgery

Objective: To determine if patients undergoing revision endoscopic sinus surgery (ESS) for chronic rhinosinusitis obtain significant symptomatic benefit from surgery. Design: Prospective controlled clinical trial. Methods: Adult patients undergoing revision ESS were evaluated preoperatively with a computed tomographic scan and the Rhinosinusitis Symptom Inventory. After the revision ESS, patients were reevaluated with the Rhinosinusitis Symptom Inventory. Data were analyzed for symptom score changes and effect sizes, changes in medication, and economic variables. Improvements in sinonasal symptom scores, medication use, and economic variables were compared with those of a contemporaneous control group of patients undergoing primary ESS and matched for age, sex, and Lund score. Results: The 21 patients (mean age, 44.8 years) who completed evaluation after revision ESS had a mean follow-up of 12.4 months. Mean preoperative Lund score was 12.6. Large effect sizes indicating significant symptom improvements were noted for nasal obstruction (effect size, -1.9), hyposmia (-0.9), and headache (-0.6), as well as nasal (-1.1) and total symptom domains (-0.9; P < .05 in all cases). Nasal steroid and nonsedating antihistamine use did not decrease significantly after ESS, but oral antibiotic use showed a downward trend (net change, -2.9 wk/y; P =. 23). Improvements in clinical symptoms were statistically similar to corresponding improvements in the matched cohort of patients undergoing primary ESS. Conclusions: The symptomatic relief that revision ESS can provide for patients with refractory chronic rhinosinusitis is similar to that following a primary ESS. However, many patients undergoing revision ESS require continued intense medical management of their chronic rhinosinusitis.