109 / 236
Baguley et al.
FIGURE 2.
Pretreatment CT scores within patient groups. CT
=
computed tomography.
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).
Factors at post-MMT assessment determining
response
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).
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%)
International Forum of Allergy & Rhinology, Vol. 4, No. 7, July 2014
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