Long-term outcomes of functional endoscopic sinus surgery with selective vidian neurectomy for chronic rhinosinusitis with nasal polyps combined with allergic rhinitis and asthma.

BACKGROUND

Patients with allergic rhinitis (AR), chronic rhinosinusitis (CRS) with nasal polyps (ARwCRSwNP), and asthma often exhibit high recurrence rates after functional endoscopic sinus surgery (FESS), sometimes requiring revision surgery. This study evaluated the long-term outcomes of combining FESS with selective vidian neurectomy in patients with ARwCRSwNP and asthma.

METHODS

Fifty-six ARwCRSwNP patients, including 27 with asthma, were divided into two groups: one received FESS with selective vidian neurectomy (group A), and the other underwent FESS alone (group B or control). Disease severity, control, and outcomes were evaluated using the Visual Analog Scale (VAS), the 22-item Sino-Nasal Outcome Test (SNOT-22), and the Lund-Kennedy score for nasal endoscopy. To assess factors influencing disease severity and treatment outcomes, we recorded allergy assessments (for mites, mold, and pollens), preoperative blood eosinophilia, and tissue eosinophil levels from histopathological examination following endoscopic surgery.

RESULTS

After three years, patients from both groups showed significant improvements in symptoms and quality of life compared to the preoperative period (p < 0.01). CRS patients with high tissue eosinophilic inflammation exhibited reduced disease control compared to those with controlled or partly controlled disease (p < 0.05). Patients in group A had better outcomes for nasal itching and sneezing compared to group B. While overall CRS control was similar between the two groups, group A demonstrated better CRS control among asthma patients (p < 0.05).

CONCLUSION

Combining FESS with selective vidian neurectomy effectively improves nasal symptoms in ARwCRSwNP patients and represents a beneficial treatment option for those with comorbid asthma.