A randomized controlled study evaluating medical treatment versus surgicaltreatment in addition to medical treatment of nasal polyposis

Background: Controlled prospective studies are needed to determine whether surgical treatment in fact has an effect additive to that of medical treatm ent of nasal polyposis. Objective: We sought to compare the effect of medical treatment versus comb ined surgical and medical treatment on olfaction, polyp score, and symptoms in nasal polyposis. Methods: Thirty-two patients with nasal polyposis and symmetrical nasal air ways were randomized to unilateral endoscopic sinus surgery after pretreatm ent with oral prednisolone for 10 days and local nasal budesonide bilateral ly for 1 month, Postoperatively, patients were given local nasal steroids ( budesonide). Patients were evaluated with nasal endoscopy, symptom scores, and olfactory thresholds, They were followed for 12 months. Results: The sense of smell was improved by the combination of local and or al steroids. Surgery had no additional effect, Symptom scores improved sign ificantly with medical treatment alone, but surgery had additional benefici al effects on nasal obstruction and secretion. After surgery, the polyp sco re decreased significantly on the operated side but remained the same on th e unoperated side. Twenty-five percent of the patients were willing to unde rgo an operation also on the unoperated side at the end of the study. Conclusions: Medical treatment seems to be sufficient to treat most symptom s of nasal polyposis. When hyposmia is the primary symptom, no additional b enefit seems to be gained from surgical treatment. If nasal obstruction is the main problem after steroid treatment, surgical treatment is indicated. Selection of those who will benefit from surgery should be based on the pat ient's symptoms and not on the examiner's polyp score.