Clinical evaluation of primary endoscopic frontal sinus surgery grade 6 (Draf III) in patients with moderate to severe eosinophilic chronic rhinosinusitis with polyps: a randomized study

Abstract Background Endoscopic sinus surgery (ESS) is an effective treatment for chronic rhinosinusitis (CRS) that does not respond to proper conventional treatment. The Draf 2A frontal sinusotomy is the most used procedure for this purpose and Draf III is classically reserved for revision cases. The aim of this study was to assess the impact of primary endoscopic frontal sinus surgeries grade 6 (Draf III) on the clinical results of individuals with moderate to severe eosinophilic CRS with Nasal Polyps (CRS w NP). Methods This double-blinded, pilot randomized, prospective, controlled, work included 50 individuals who had moderate to severe eosinophilic CRS w NP. These individuals were separated into two groups. Group A: 25 individuals underwent wide corridor paranasal sinus surgery including endoscopic frontal sinus surgery grade 6 (Draf III). Group B: 25 patients received wide corridor paranasal sinus surgery including endoscopic frontal sinus surgery grade 1–3 (Draf I or IIa). Results Rhinologic symptom score, extra-nasal rhinologic score, psychological dysfunction score, facial/ear symptoms, sleep score, and total of SNOT 22 were significantly lower in follow-up at 1 year than preoperative in group Draf III and group Draf I or IIa ( P value < 0.001) and were insignificantly different at preoperative among group A and group B while were significantly lower at 1 year in group A contrasted to group B ( P value < 0.05). There were no substantial variations observed among both groups in terms of age, sex, or total follow-up time. The number of corticosteroid courses needed and total dose of systemic corticosteroids through 1 year postoperatively were significantly lower in group A than in group B ( P value = 0.003 and 0.02, respectively). % of cohort exceeding minimal clinically important difference (MCID) improvement at 1 year was substantially greater in group A than group B ( P value = 0.039). Conclusion The use of endoscopic modified Lothrop procedure (EMLP) as a primary surgery for patients with moderate to severe eosinophilic CRSwNP improved outcomes in those patients. The technique is well-tolerated and has a low rate of complications. It also helps in effectively managing medical conditions for individuals with AERD.