Comparison to other studies
Our IP cohort has a better preoperative HRQoL compared to the preoperative HRQoL of the chronic rhinosinusitis (CRS) patients from our recently published study.14 The CRS patients had a mean EES-Q score of 37 (only median scores are published); in this population the mean preoperative score was 20. The biggest difference was in the physical domain, followed by the social domain. Our IP cohort does have a worse HRQoL than the healthy individuals of that same study (20 vs 14, respectively). The EES-Q score of the IP cohort one year postoperatively is similar to the EES-Q score of healthy individuals, suggesting that HRQoL will return to normal. Van Samkar and Georgalas support this outcome by showing that the SNOT-22 score after removal of an IP at follow-up (median 6 years) is similar as in healthy individuals.8 Whether the social domain was influential in their outcome is not known because the SNOT-22 cannot differentiate between these, unlike the EES-Q. In addition, they had no preoperative data and their population was rather small (n=37). Deckard et al. included 18 IP in their analysis on HRQoL after endoscopic treatment of sinonasal neoplasms (n=71) and concluded that patients with benign tumours have a better HRQoL outcome than patients with malignant tumours.6 Harrow et al. reported similar results in their study including IP patients (n=19), who accounted for only 20% of their total population (benign and malignant).7 Both performed no subanalysis on IP alone.
Preoperatively, patients of the different ASA groups score similar. However, the postoperative HRQoL is better in patients with a higher ASA score. We hypothesize that this can be explained by the fact that chronically diseased patients are known to accommodate to their illness, which results in better HRQoL measures.15 Moreover, the group with the high preoperative EES-Q score show the biggest improvement in HRQoL postoperative compared to the other groups. This is in line with CRS studies where patients with a higher preoperative SNOT-22 score show a greater improvement postoperative compared to patients with a lower preoperative SNOT-22 score.16-18
The existing body of literature presents divergent findings regarding the benefits of postoperative antibiotics after endoscopic endonasal sinus (EES) surgery for sinusitis. While certain studies demonstrate positive outcomes associated with their use,19-21other studies do not report significant advantages.22, 23 Systematic reviews on this topic therefore do not provide a comprehensive recommendation.24, 25 In our cohort, antibiotics were administered for the treatment of postobstructive sinusitis, i.e. secondary sinusitis. Notably, the forementioned studies do not differentiate between primary and secondary sinusitis, although this distinction could potentially influence the outcome. To the best of our knowledge, there are no existing studies investigating the use of postoperative antibiotics specifically for secondary CRS. Our hypothesis is that if antibiotics contribute to improved long-term HRQoL, it may be attributed to enhanced healing of the sinonasal mucosa. Further research is necessary to explore this in greater detail.