Combined corticosteroid therapy enhances outcomes of endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps: a prospective cohort study

To compare the efficacy and safety of nasal endoscopic surgery combined with pharmacological therapy versus surgery alone for chronic rhinosinusitis with nasal polyps (CRSwNP). In this prospective cohort study, 94 CRSwNP patients were randomized into two groups: a drug combination group (surgery + budesonide suspension, n=47) and a surgery-alone group (n=47). Outcomes were assessed at 1, 3, 6, 9, 12, and 18 months postoperatively, including Lund-Kennedy scores, SNOT-22 (with subdomain analysis), inflammatory biomarkers (blood/tissue eosinophils, IL-4, IL-5, IgE), nasal ventilation parameters (NMCA, DCAN), mucociliary clearance rate, and olfactory function scores. Compared with surgery alone, the combination group showed significantly lower Lund-Kennedy scores at 6 months (P=0.036), 12 months (P<0.010), and 18 months (P<0.010). SNOT-22 subdomain analysis revealed greater improvements in nasal symptoms at postoperative 3 months (P<0.010) and sleep dysfunction at postoperative 1 month (3.12±0.58 vs. 3.73±0.63, P=0.007). The recurrence rate was significantly lower in the combination group (2.13% vs. 8.51%, P<0.010). Inflammatory biomarkers showed greater suppression in the combination group, including a 41.3% reduction in IL-5 at postoperative 12 months (P<0.010) and a sustained decrease in peripheral blood eosinophil percentage at postoperative 18 months (P<0.010). Nasal ventilation improved at postoperative 12 months (NMCA, P<0.010). Mucociliary clearance was significantly enhanced in the combination group at postoperative 12 months (5.210±0.360 vs. 4.812±0.334 mm/min, P<0.011). Olfactory function scores were significantly better at 6 months (P<0.012) and 12 months (P<0.010). Compared to surgery alone, combining corticosteroids with surgery more effectively suppresses type-2 inflammation, improves multidimensional symptom control (particularly nasal and sleep domains), enhances nasal function, and reduces recurrence. This combination strategy offers a more comprehensive strategy for CRSwNP management.