Sinus surgery is more effective than antibiotics at treating chronic rhinosinusitis, according to a major clinical trial led by UCL along with academics at the University of East Anglia and Guy’s and St Thomas’ NHS Foundation Trust.
Chronic rhinosinusitis (CRS), or sinusitis, is a long-term condition affecting one in 10 UK adults. Symptoms include a blocked and runny nose, loss of smell, facial pain, tiredness and worsening of breathing problems, such as asthma. It’s often similar to the symptoms of a bad cold, but it can last for months or even years.
The team carried out a randomised controlled patient trial comparing sinus surgery with long-term use of antibiotics, and a placebo.
More than 500 patients took part from around the UK, and all of them used nasal steroids and saline rinses as part of their usual care – both of which have been shown to help the condition.
The researchers found that surgery was effective at relieving sinusitis symptoms, and trial participants were still feeling better six months later, according to the findings published in The Lancet. Of those who underwent surgery, 87% said their quality of life had improved six months on.
A three-month course of low dose antibiotics was not found to be helpful as there was no significant difference in outcomes between those on antibiotics and those in the placebo arm of the trial.
The study is part of the MACRO programme, involving a collaborative group of researchers from UCL (the trial’s sponsor), 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. The programme is funded by the National Institute for Health and Care Research.
Study co-author Professor Anne Schilder (UCL Ear Institute), director of the NIHR UCLH BRC Hearing Health Theme, who is leading the project at UCL, said: “Here we have provided robust evidence that surgery is an effective means to treat chronic rhinosinusitis when local treatments have failed, which should be welcome news to the large numbers of people with the condition.
“The MACRO trial has shown the value of research collaboration, across specialties and organisations. It was the first NIHR programme grant for our specialty, recognising the need for better evidence for the management of common ENT conditions and the strength of our collaborative team. The commitment of our investigators, research nurses and of course our patient participants across 20 UK sites made it into a success.”
Jim Boardman, MACRO patient representative, said: “I’ve lived under a cloud for years with CRS, as have many others I’ve met with the same condition. There’s a persistent headache and blocked nose along with the loss of sense of smell, which removes a whole dimension of everyday experience and enjoyment. A clear path to successful treatment will be welcomed by all CRS sufferers.”
The researchers are now continuing their research to assess the cost-effectiveness of sinus surgery, while also continuing to follow up trial participants over longer periods of time to see how long the benefits last.
