MEDICAL VERSUS SURGICAL TREATMENT OF NASAL POLYPS

Nasal Polyps

Abstract

Objective: To compare medical versus surgical treatment of nasal polyps in terms of frequency of success and recurrence.
Study Design: Randomized controlled trial.
Place and Duration of Study: This study was conducted at the department of ear nose throat (ENT), Combined Military Hospital (CMH) Peshawar over 2 years’ period, from Jan 2000 to Dec 2002.
Material and Methods: During this period, 80 patients were diagnosed of nasal polyps. These patients were randomly divided into two treatment groups. Patients in group-A received medical treatment in the form of intra-nasal steroids while patients in group-B received surgical treatment depending upon the extent of disease. Outcome variables were frequency of successful resolution of nasal polyps after 1 month of treatment and frequency of recurrence upon 1 year follow-up.
Results: The age of the patients ranged from 15 years to 40 years with a mean of 26.13 ± 2.5 years. There were 49 (61.25%) male and 31 (38.75%) female patients in the study group giving a male to female ratio of 1.6:1. There was no significant difference between the two study groups in terms of gender (p=0.818) distribution. Bilateralintranasal polypectomy was the most frequently performed procedure (70.0%) followed by intranasal ethmoidectomy (12.5%), external ethmoidectomy (10.0%) and functional endoscopic sinus surgery (7.5%). The frequency of successful treatment was significantly higher with surgery (100% vs. 52.50%; p<0.001) as compared to intra-nasal steroids at 1 month follow-up. However, over the long-term follow-up, the frequency of recurrence was significantly lower with intra-nasal steroids (4.8% vs. 30.0%; p=0.022) as compared to surgery. There was no complication in the patients treated with intra-nasal steroids. While crusting (15.0%) followed by infection (10.0%) were among the few complications observed in the surgical group-B.
Conclusion: Though associated with significantly lower frequency of successful treatment, intranasal steroids were associated with significantly lower frequency of recurrence as compared to surgery. Moreover, their use was not associated with any complication as experienced with surgery. Due to these benefits and non-invasiveness, intra-nasal steroids become first line treatment of choice. It can be advocated on the basis of the present study, that patients with nasal polyps should receive a course of intra-nasal steroids and surgery should only be reserved for refractory cases.