2016 Section 5 Green Book

Baguley et al.

FIGURE 2. Pretreatment CT scores within patient groups. CT = computed tomography.

Clinical progress subsequent to post-MMT visit Median follow-up after the post-MMT visit for all patients was 6.3 months (IQR 17) with case files last being reviewed at 24 months (IQR 19). Follow-up differed across groups, being shortest for those with “resolved CRS” ( p = 0.006). Most of these 12 patients were discharged with advice to represent should symptoms recur. No known CRS recur- rence has occurred in a minimum of 11 months since the post-MMT visit for this group. Of the 43 patients considered surgical candidates, 84% had endoscopic sinus surgery (ESS) scheduled, with others opting for further medical treatment. Symptomatic patients with normal CT scans (n = 10) were further assessed as required and treated for alternate diagnoses as described above. One underwent ESS for mu- cus recirculation. The fate of patients with radiological mucosal disease but symptom control after 1 course of MMT All “asymptomatic CRS” patients were followed at 3- or 6-month intervals and offered topical steroid sprays and saline irrigations. Nine of 21 patients (43%) suf- fered symptom relapse between 3 and 23 months (me- dian 6, IQR 4.4 months) post-MMT and 6 (29%)

The presence of purulent secretions and hence antibi- otic prescription did not differ significantly between groups ( χ 2 2.42, p = 0.49). Subgroup analysis for patients with and without polyps The groups of patients with and without polyps had dif- ferent baseline characteristics. Although age, gender, and asthma/allergy history were not statistically different ( p = 0.80, 0.11, 0.08, 0.28, respectively) the CRSwP group had higher pretreatment CT scores (14.4 vs 8.7, p < 0.01), higher rates of previous surgery (29% vs 6%, p = 0.053), and were less likely to receive antibiotics (for purulent nasal secretions; 41% vs 64%, p = 0.04). Post-MMT mean NSS differed as expected given that groups were assigned based on patient-reported symp- tomatic progress ( p = 0.002) (Table 1). These scores were the same however among “symptomatic CRS” patients, whether there was radiological disease or not (mean NSS 1.9, 1.9, p = 0.98). Similarly for patients who reported good symptom control, the mean NSS were similar whether radiologic disease persisted or not ( p = 0.37, Fig. 3). Factors at post-MMT assessment determining response

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