Impact of Early Versus Delayed Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps

Radhika Duggal; Trisha Shang; David R Hoying; David Kaelber; Mohamad R Chaaban

doi:10.1002/ohn.70131

Impact of Early Versus Delayed Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps

Otolaryngol Head Neck Surg. 2026 Jan 19. doi: 10.1002/ohn.70131. Online ahead of print.

Authors

Radhika Duggal^{1

2}, Trisha Shang³, David R Hoying³, David Kaelber⁴, Mohamad R Chaaban²

Affiliations

¹ Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
² Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA.
³ Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
⁴ Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA.

PMID: 41553024
DOI: 10.1002/ohn.70131

Abstract

Objective: Previous studies have suggested a benefit to early functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS). With the approval of T2 biologics for CRS with nasal polyps (CRSwNP), it is important to re-evaluate FESS timing in relation to T2 biologic utilization. In this study, we aimed to understand the impact of FESS timing on CRSwNP disease control.

Study design: Retrospective database study.

Setting: Patients diagnosed with CRSwNP in the TriNetX platform.

Methods: The TriNetX platform was queried to identify adult patients with one or more encounter diagnoses of CRSwNP. Among this cohort, we identified subgroups of individuals who underwent early (within 1 year) or delayed (1-2, 2-3, 3-4, 4-5, or >5 years after initial encounter) FESS, based on CPT codes. Pertinent outcomes, including the need for revision FESS and first-time T2 biologic prescription, were compared.

Results: After 1:1 propensity matching, we included a range of 264 to 1419 patients in each cohort. When followed for 2 and 5 years postoperatively, the delayed FESS (>5 years) cohort had 96% and 83% greater odds of new T2 biologic prescription (OR 1.96, 95% CI 1.40-2.73 and OR 1.83, 95% CI 1.40-2.40), but had no significant difference in the odds of revision FESS (2 year OR 1.03, 95% CI 0.73-1.47 and 5 year OR 1.23, 95% CI 0.93-1.63).

Conclusions: Our findings demonstrate that the delayed FESS cohort had a higher T2 biologic prescription rate. Additional investigations are necessary to determine if this is due to the recent introduction of T2 biologics or a consequence of heightened disease severity necessitating long-term biologic use when surgery is delayed.

Keywords: biologic therapy; chronic rhinosinusitis; chronic rhinosinusitis with nasal polyps; disease control; dupilumab; functional endoscopic sinus surgery; mepolizumab; nasal polyps; omalizumab; surgical timing.