Chronic rhinosinusitis with nasal polyps in the elderly

Background

To determine the influence of age on the long term results of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

Methods

In this study we sent all adult patients who received FESS because of CRSwNP between the year 2000 and 2005 in the AMC in Amsterdam a quality of life questionnaire in the year 2012. The Lund-Mackay score was calculated for each patient. We compared postoperative subjective improvement using the SNOT questionnaire. Two different age groups were analysed separately, group 1 (age 18-65) and group 2 (over 65 years).

Results

Response rate was 67% (151 out of 225). 104 patients were < 65 years old (group 1) and 47 patients > 65 years (group 2). The mean age at the time of questionnaire of the whole group was 56 years old (range 28-84). Mean follow-up time was 7 years (range 12 years).Of these patients 35% had a primary FESS and 65% revision surgery. There was no statistical difference in Lund-Mackay score between the two age groups. The mean postoperative total SNOT score in the whole group was 1.3. We found a tendency to significance with a lower score in the older age group compared to the younger patients (p=0.06) and in several separate SNOT domain scores we found a significant difference. The older patients scored significantly lower in the domains of ear- and head symptoms.

Conclusion

Our subjective postoperative outcomes show a significant difference in several SNOT domains and a tendency to significance in total SNOT score between the two different age groups. These results could be influenced by a natural decrease in symptoms over time in older patients. There is still not enough evidence for this thought and further research will be needed on this subject.