Long‐Term Outcomes of Optimized Surgery and Medication in Chronic Rhinosinusitis With Nasal Polyps

ABSTRACT Objective Chronic Rhinosinusitis With Nasal Polyps (CRSwNP) is predominantly associated with type 2 inflammation (85.4%) and significant disease severity. This study aims to investigate the overall control status of CRSwNP patients one to seven years after endoscopic sinus surgery (ESS) and identify the real‐world factors influencing these outcomes. Methods The study included 427 adult patients diagnosed with primary diffuse CRSwNP who underwent bilateral ESS performed by a senior, well‐trained surgeon between 2017 and 2022. Among them, 315 patients completed follow‐ups in January 2024. Data collected included demographic information, comorbidities, symptom questionnaires (VAS, TNSS, SNOT‐22), blood test results, nasal endoscopic scores, and Lund‐Mackay CT scores. The clinical control status was assessed postoperatively using EPOS 2020 criteria. Ordinal logistic regression was used to analyze the factors influencing postoperative control status. Results The median follow‐up period was 34 months. The most pronounced symptom is a decline in olfactory function (VAS 8, IQR: 4–10), followed by nasal obstruction (VAS 7, IQR: 5–9) before surgery. Generally, postoperative outcomes showed that 54.6% of patients achieved controlled status, 30.2% were partly controlled, and 15.2% remained uncontrolled. A high blood eosinophil ratio (> 4.75%), worse smell VAS scores (> 9.5), and higher Lund‐Mackay CT scores (> 14.5) were associated with poorer control status, whereas medication adherence significantly improved postoperative outcomes. Conclusions Proper surgical techniques combined with good medication adherence play a crucial role in improving postoperative outcomes for CRSwNP patients, including those with type 2 inflammation. Level of Evidence 4.