Endoscopic Sinus Surgery for Type‐2 CRS wNP: An Endotype‐Based Retrospective Study

Objectives

Nasal polyps are often characterized by type 2 inflammation and disease recurrence. We developed a new surgical technique, referred to as reboot approach, which aims to maximally remove all sinus mucosa and allow healthy re‐epithelialization from the preserved nasal mucosa. We here review type 2 endotype chronic rhinosinusitis with nasal polyps (CRSwNP) patients who underwent classical mucosa‐sparing endoscopic sinus surgery (ESS) or the reboot approach.

Methods

Retrospective case‐control study of 50 consecutive CRSwNP patients who underwent endoscopic sinus surgery between 2015 and 2017, either as a classical non‐reboot ESS (n = 20); a partial reboot approach removing the mucosa of the ethmoidal, sphenoidal, and maxillary sinuses (n = 18); or a complete reboot approach including Draf III and removal of all frontal sinus mucosa (n = 12). Polyp recurrence over the follow‐up period of 2 years served as the primary outcome.

Results

All patients demonstrated a type 2 inflammation of the mucosal tissue harvested during surgery. In the classical approach group (n = 20), nine patients relapsed within 2 years (45%); in the partial reboot group, three out of 18 patients (17%) relapsed; and in the full reboot group one out of 12 patients (8%) relapsed. The relapse rates were significantly different between the non‐reboot and the reboot groups (P = 0.02) but also between all treatment groups (P = 0.038).

Conclusion

Complete removal of diseased mucosa from the paranasal sinuses (reboot approach) significantly reduces the recurrence of nasal polyps for 30 months postoperatively compared to the current mucosa‐sparing approach in type 2 inflammatory CRSwNP.

Level of Evidence

3b. Laryngoscope, 2019

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