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

OBJECTIVES: To compare the efficacy and safety of nasal endoscopic surgery combined with pharmacological therapy versus surgery alone for chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: 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. RESULTS: 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). CONCLUSION: 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.