CLINICAL VERSUS SURGICAL APPROACHES IN THE MANAGEMENT OF CHRONIC RHINOSINUSITIS: A SYSTEMATIC REVIEW

Introduction: Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition that significantly impairs quality of life and often requires long-term therapy. Medical management—comprising intranasal corticosteroids, saline irrigation, antibiotics, and biologics—serves as first-line therapy, yet many patients remain symptomatic. Surgical intervention via endoscopic sinus surgery (ESS) aims to restore ventilation, drainage, and facilitate ongoing topical therapy. The balance between prolonged medical therapy and early surgical intervention remains controversial. Objective: The primary objective is to compare clinical and surgical strategies in CRS management, evaluating efficacy, safety, and long-term outcomes. Secondary objectives include assessing subgroups (e.g., with nasal polyps vs without), recurrence rates, quality-of-life gains, complication profiles, and cost/benefit considerations. Methods: A systematic search of PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP was conducted for studies published from 2020 to 2025 (extended to ten years if fewer than ten eligible). Eligible works included randomized trials, controlled observational and cohort studies comparing medical and surgical treatment in adult CRS. Results and Discussion: ESS plus medical therapy generally achieved greater improvements in symptom scores (e.g. SNOT-22), endoscopic findings, and reduced medication use versus continued medical therapy alone. Subgroup analyses suggest greater benefit among patients with nasal polyposis, eosinophilic type disease, or refractory baseline quality-of-life scores. Recurrence rates and revision surgery remain substantial, particularly in long-term follow-up. Complication rates were low and comparable across strategies in most studies. Heterogeneity in definitions, surgical extent, and follow-up limits pooled inference; evidence certainty ranged from low to moderate. Conclusion: Surgical intervention, especially when combined with optimal medical therapy, provides superior symptom relief and mucosal outcomes in appropriately selected CRS patients. Medical therapy remains essential, especially in milder disease or as adjunctive maintenance. Decision-making should integrate disease subtype, patient risk, and expected long-term outcomes. Future trials with standardized metrics, longer follow-up, and head-to-head comparisons are needed to optimize timing and extent of surgery. Descriptors: Rhinosinusitis, Sinus Surgery, Drug Therapy, Quality of Life