UK study finds sinus surgery more effective than antibiotics in treating chronic rhinosinusitis

Chronic or long-term sinusitis, also known as chronic rhinosinusitis, is an inflammatory condition of one or more sinuses that persists for more than 12 weeks. It is less common than acute sinusitis but appears to be getting more common in all age groups and it’s estimated to affect one in ten UK adults.

Now, a major clinical trial led by scientists at University College London along with academics at the University of East Anglia and Guy’s and St Thomas’ NHS Foundation Trust, has posited that sinus surgery is more effective than antibiotics at treating chronic rhinosinusitis.

What are chronic sinusitis symptoms?

If you have chronic sinusitis, you can expect to feel:

• Tenderness or pain, particularly around your nose, eyes, cheeks or forehead
• Thick yellow or green mucus from the nose
• Mucus down the back of the throat known as postnasal drip
• Stuffy congested nose making it hard to breathe
• Reduced sense of smell and taste

You may also feel:

• Aching in the teeth
• Headache, particularly a headache that makes your face hurt
• Cough
• Fatigue
• Ear pain
• Bad breath

Sinus surgery vs antibiotics

The UK team carried out a randomised controlled patient trial comparing sinus surgery with long-term use of antibiotics, as well as a placebo. Over 500 patients took part, all of them using nasal steroids and saline rinses as part of their usual care.

The trial found that surgery was effective at relieving sinusitis symptoms, and those participants who underwent surgery were still feeling better six months later. Published in The Lancet, the study revealed that 87% expressed that their quality of life had improved six months on.

However, those on a course of low-dose antibiotics for three months had a similar outcome to those prescribed a placebo. All participants were assessed at three and six months, where researchers examined their nose and sinuses, took airflow readings and conducted smell tests, as well as gauged the improvement to their quality of life.

The study is part of the MACRO programme, involving a collaborative group of researchers from UCL (the trial’s sponsor), the University of East Anglia (UEA), Guy’s and St Thomas’ NHS Foundation Trust, the University of Southampton, the University of Oxford, UCLH, and Imperial College London. The programme is funded by the National Institute for Health and Care Research.

Part of Mr Annakan Navaratnam’s NHS practice is at University College London Hospital (UCLH) which was involved in recruiting hospitals for the trial.

“This study demonstrates that sinus surgery works better than antibiotic treatment for the management of chronic sinusitis and this could be a real game-changer for sufferers of the disease. The trial has influenced national guidance that I have written in my role as National Clinical Advisor for the Getting it Right First Time programme. It is also vital that the surgery is comprehensive in order for the patients to get the best outcome.

“Operations carried out in the trial were performed or supervised by Consultant Rhinologists (a specialist ENT surgeon), like me, who specialise in treating diseases of the nose and sinuses. I often review patients with severe chronic rhinosinusitis who have received care by non-specialist surgeons that is not up to date with current guidance or falls short of the nationally recommended treatment. It is important that those with severe or recurrent disease are managed by Rhinologists with specialist knowledge and experience so that the correct treatment and extent of surgery is delivered.

“I’ve created a video on the endoscopic sinus surgery to give patients further information about the operation that can be watched here.”

 

For more advice on rhinosinusitis and your treatment options, call +44 (0)203 627 2918 to arrange a consultation with Mr Annakan Navaratnam.