Healthcare (Commonwealth Union) – A large clinical study led by researchers at the University College London (UCL), in collaboration with the University of East Anglia and Guy’s and St Thomas’ NHS Foundation Trust, has found that sinus surgery is more effective than antibiotics for treating chronic rhinosinusitis.
Chronic rhinosinusitis (CRS), which is generally referred to as sinusitis, is a continuous condition that has an impact on roughly one in ten adults in the UK. It causes symptoms that include a blocked or runny nose, smell loss, facial pressure or pain, fatigue, and can worsen breathing difficulties like asthma. While it generally feels like a severe cold, it can continue for months or even years.
The trial, which randomly assigned patients to sinus surgery, long-term antibiotic treatment, or a placebo, involved over 500 participants from across the country. All participants also continued using nasal steroids and saline rinses, which are known to provide some relief.
The study appeared in The Lancet, demonstrated that patients who underwent surgery experienced enhanced improvement in symptoms, with benefits still evident six months later. Researchers of the study stated that, 87% of those who had surgery had shown a better quality of life half a year after the procedure.
A 12-week treatment using low-dose antibiotics did not prove effective, as results showed no meaningful difference between patients who received the antibiotics and those given a placebo.
The research forms part of the MACRO programme, a joint effort led by UCL (the trial sponsor) alongside the University of East Anglia (UEA), Guy’s and St Thomas’ NHS Foundation Trust, the University of Southampton, the University of Oxford, UCLH, and Imperial College London. Funding for the programme comes from the National Institute for Health and Care Research.
Professor Carl Philpott of UEA’s Norwich Medical School, a Chief Investigator on the MACRO trial, indicated that chronic rhinosinusitis leads to inflammation and swelling of the sinuses—the air-filled spaces within the nose and head. He further indicated that this widespread condition prevents mucus from draining properly, resulting in severe nasal congestion, difficulty breathing through the nose, and is the leading cause of smell loss across the population.
“What we found is that surgery was effective at reducing symptoms six months on, while taking the course of antibiotics seemed to make little difference. Until now, there was no evidence in the form of a trial that showed sinus surgery works better than medical treatment and access to sinus surgery has been restricted in some parts of the UK in recent years. This could be a real game-changer for sufferers worldwide.
“We hope our findings will help reduce the length of time for patients to get treatment. Streamlining clinical pathways will help reduce unnecessary visits and consultations, and save on healthcare resources.”
In the study, every participant was given nasal steroid sprays and saline rinses as part of routine treatment, along with their randomly assigned option of sinus surgery, antibiotics, or placebo tablets. They were monitored at three and six months, during which researchers carried out nasal and sinus examinations, measured airflow, and performed smell tests. These assessments were used to determine how well each treatment worked in terms of symptom relief, quality of life, and potential side effects.
Professor Claire Hopkins (Guy’s Hospital, London), one of the Chief Investigators of the MACRO trial, indicated that despite the fact that sinus surgery is a common procedure in the NHS, doubts about how effective it truly is have meant that access has often been limited. She further pointed out that the findings of the MACRO trial show the clear improvements in quality of life that many patients achieve after surgery, and should provide both patients and their GPs with greater confidence in considering surgery for chronic rhinosinusitis and they hope these results will help improve care for adults with this condition within the NHS and beyond.
