Abstract
BACKGROUND: Patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD) or aspirin-exacerbated respiratory disease are prone to rapid recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), often resulting in persistent symptoms and reduced quality of life. OBJECTIVE: We sought to determine patient-reported timing and associated symptoms of CRSwNP recurrence after ESS, as well as to assess whether current disease burden differs by prior recurrence timing. METHODS: We analyzed data from 325 participants in our NSAID-ERD registry who reported a history of prior ESS. At registry enrollment, patients were asked to recall the time to recurrence of CRSwNP following their most recent ESS (≥2 years before enrollment). At enrollment, participants also completed the 22-Item Sino-Nasal Outcome Test (SNOT-22) and Asthma Control Test (ACT) questionnaires, reflecting current sinonasal and asthma disease burden. In a separate follow-up survey, a larger cohort of participants were asked to report the symptoms that they experienced with CRSwNP recurrence. RESULTS: The median patient-reported time to post-ESS CRSwNP recurrence was 6 months, with 51.1% reporting recurrence in 6 months or less, 18.2% reporting recurrence in 6 to 12 months, 15.4% reporting recurrence in 12 to 24 months, and 15.4% reporting no recurrence at 24 months. The most common symptoms reported with CRSwNP recurrence were nasal congestion (91.3%) and hyposmia/anosmia (86.6%). At registry enrollment, those with fast recurrence (≤6 months) had higher total SNOT-22 scores (52.4 ± 23.6 vs 39.7 ± 20.3 [P < .0001]) and lower ACT scores (18.2 ± 5.7 vs 20 ± 4.9 [P < .01]) than those with slow or no recurrence (>6 months). Scores in all SNOT-22 domains were higher in patients who reported fast recurrence. CONCLUSIONS: Post-ESS CRSwNP recurrence in patients with NSAID-ERD was most often signaled by worsening nasal congestion and loss of smell. Patients with fast CRSwNP recurrence later exhibited greater overall respiratory disease burden.