Endoscopic sinus surgery improves quality of life compared with clarithromycin and placebo in chronic rhinosinusitis

1. Patients in the endoscopic sinus surgery group reported lower SNOT-22 scores at 6 months, suggesting improved quality-of-life metrics.

2. Serious adverse events were comparable across all groups with no fatalities reported.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Chronic rhinosinusitis is typically treated with endoscopic sinus surgery or prolonged antibiotics, but there is limited evidence guiding the best approach. This has led to wide variation in practice patterns. This randomized controlled trial aimed to compare the effectiveness of endoscopic sinus surgery, long-term clarithromycin, and placebo in adults with chronic rhinosinusitis. The primary outcome of this study was disease-specific quality of life measured by Sino-Nasal Outcome Test quality-of-life questionnaire (SNOT-22) scores at 6 months, while key secondary outcome was safety. According to study results, endoscopic sinus surgery significantly improved SNOT-22 scores compared with clarithromycin and placebo and there were no differences between clarithromycin versus placebo. Although this study was well done, it was limited by long-term follow-up data.

Click to read the study in The Lancet

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In-depth [randomized controlled trial]: From Nov 1, 2018, to Oct 13, 2023, 1948 patients were recruited from 20 secondary and tertiary care sites in the UK. Included were patients ≥ 18 years with symptomatic chronic rhinosinusitis refractory to medical therapy. Altogether, 514 patients (172 in clarithromycin, 171 in placebo, and 171 in endoscopic sinus surgery) were included in the final analysis. The primary outcome of SNOT-22 scores at 6 months was lower with surgery than both clarithromycin (adjusted mean difference -18.13, p<0.0001) and placebo (-20.44, p<0.0001), though clarithromycin did not differ significantly from placebo (-3.11, p=0.17). The secondary outcome of serious adverse events demonstrated that these were comparable across all groups, with no fatal events reported. Findings from this study suggest that endoscopic sinus surgery improves quality of life for patients with chronic rhinosinusitis.

Image: PD

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