Endoscopic Sinus Surgery for Recurrent Acute Rhinosinusitis

Importance: Recurrent acute rhinosinusitis (RARS) decreases quality of life. The effects of endoscopic sinus surgery (ESS) in RARS are understudied. Objective: To compare the quality of life between patients with RARS who had surgery and medical treatment vs medical treatment alone. Design, Setting, and Participants: This is an open-label randomized clinical trial with 2 parallel groups with a 6-month follow-up. Patients referred to Oulu University Hospital Otolaryngology Clinic between May 2020 and June 2024 were recruited to participate in the trial. Inclusion criteria were adults with physician-diagnosed RARS episodes occurring at least 3 times during the past 6 months, 4 times during the past year, or twice per year for 3 consecutive years. Conservative treatment had been insufficient for symptom relief. Data collection and analyses were planned before commencing recruitment. Data collection was performed from May 2020 to December 2024, and analysis from January 2025 to January 2026. Interventions: The operative group received ESS and medical treatment, and the conservative group received medical treatment alone. Main Outcomes and Measures: The main outcome was the difference between groups in mean SinoNasal Outcome Test 22 (SNOT-22) score change from baseline to a 6-month follow-up. The SNOT-22 questionnaire measures rhinosinusitis-related quality of life. Sinonasal symptoms, number of health care visits, antibiotic courses, absences from work or study, and the adverse effects of operative treatment were also studied. Results: A total of 59 patients (mean [SD] age, 40 [14] years; 52 women [88%]) were recruited, 30 in the operative and 29 in the conservative group. Intention-to-treat analysis of the primary outcomes was performed. The mean SNOT-22 score change from baseline to 6 months was greater after ESS compared to medical treatment only (difference, 22.41 points (95% CI, 13.67-31.10 points). Per-protocol analyses of secondary outcomes supported the primary findings for the most part. Only 4 patients received intervention for an operative complication (3 infections, 1 synechia with septal perforation). Conclusions and Relevance: In this randomized clinical trial, ESS improved patient-related outcomes at a 6-month follow-up in adults with RARS. Conservative treatment had no clinically meaningful effect. These results suggest that ESS is an effective treatment without major problems. Trial Registration: ClinicalTrials.gov Identifier: NCT04241016.