Efficacy of Full and Limited Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Nasal Polyps: A Randomised Controlled Trial
In brief
Full sinus surgery does not outperform limited surgery for nasal polyps
In a randomized trial of 94 patients with chronic rhinosinusitis and nasal polyps, both full and limited functional endoscopic sinus surgery reduced SNOT-22 scores by more than the minimal clinically important difference, but the improvement was similar between groups at 12 and 24 months. Secondary measures such as smell and polyp burden favored the full procedure, leaving the optimal extent of surgery still uncertain.
- Journal
- Allergy (Q1)
- Published
- 30 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- P Virkkula, S Hammarén-Malmi, A Laulajainen-Hongisto, M Lilja, J Wikstén, L Hafrén, et al.
- PMID
- 42530386
- DOI
- 10.1111/all.70438
Why clinicians should know about it
- Picked for Immunology and Allergy (top studies of the week, 2 August 2026).
Abstract
BACKGROUND: Despite adequate local treatment, chronic rhinosinusitis with nasal polyps (CRSwNP) may remain uncontrolled and necessitate endoscopic sinus surgery (ESS). It remains unclear what extent of ESS is most effective. This trial compares two common surgical approaches: full and limited functional ESS (FESS) in patients with CRSwNP. METHODS: AirGOs Operative is a randomised, controlled trial performed in two university hospitals. Patients with a total Sino-nasal-outcome-test (SNOT-22) score ≥ 30, bilateral nasal polyp score ≥ 4, modified Lund-Mackay radiological score ≥ 14, and previous surgery or systemic medication for CRSwNP were included. The primary outcome measure was the change in disease-specific health-related quality of life measure SNOT-22 between the baseline and 12- and 24-month follow-ups. FINDINGS: Between Oct 23, 2018 and Oct 12, 2022, 97 patients were recruited. The per protocol analysis included 47 patients in the full FESS group and 47 patients in the limited FESS group. At 12 months, the mean SNOT-22 score was 22.3 (SD 15.7) in the full FESS group and 31.5 (SD 18.8) in the limited FESS group yielding a mean difference of -9.2. At 24 months, the mean SNOT-22 scores were 25.3 (SD 16.9) and 27.8 (SD 21.6), respectively, with a mean difference of -2.5. However, the difference in change of total SNOT-22 scores between the groups was insignificant and did not exceed the minimal clinically important difference. Several secondary outcome measures, amongst which olfaction and polyp load, showed differences in improvement between the groups. INTERPRETATION: Full and limited FESS are both effective in improving HRQoL in patients with CRSwNP within 24 months. Decrease in total SNOT-22 scores exceeded the minimal clinically meaningful difference in both groups, but this difference was not met between the groups at 12 or 24 months. Postoperative differences between the groups in secondary outcomes may represent better inflammatory control after full FESS. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03704415. Registered on the 8th October 2018.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.