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.