(1212) Endoscopic Sinus Surgery Under Biologics: Retrospective Case Review Questionnaire From the Perspective of Canadian Rhinologists

Introduction: Endoscopic sinus surgery (ESS) is a crucial treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), and the impact of biologics on postsurgical complications and outcomes is not well documented. Surgeons would benefit from more information on how biologics affect the performance and recovery from ESS to enhance patient management.

Methods: Chronic rhinosinusitis with nasal polyposis (CRSwNP), linked to Th2 inflammation, presents with symptoms like congestion, obstruction, post-nasal drip, and reduced smell. Treatments include intranasal and oral corticosteroids, and endoscopic sinus surgery (ESS). Health Canada's recent approval of biologic therapies has revolutionized CRSwNP management, enhancing long-term outcomes. Over 4 months, a survey was conducted among Canadian ENT specialists in rhinology, exploring perioperative aspects (surgical comfort, bleeding, purulence) and postoperative factors (patient impressions, pain, smell, crust formation, purulence, edema, nasal dryness).

Results: In total, 18 Canadian rhinologists responded to the questionnaire, and 15/18 reported having had ESS while their patient was taking biologics. Surgeons considered surgical difficulty as “same” or “less” in 87% of cases on biologics, with 93% reporting “same” or “less” intraoperative bleeding and 100% “same” or “less” intraoperative purulence.

The postoperative course for patients on biologics was considered to be “improved” in 12/15 (80%) rhinologists and “no different” in 2/15 (13%) . Sense of smell was reported as “improved” in 60% and unchanged in 40%. No unfavorable effect was noted for post operative outcomes of crusting, purulence, pain, oedema, or dryness.

Conclusions: Results from this pan-Canadian survey of rhinologists suggest that endoscopic sinus surgery (ESS) can be safely performed in patients under biologic agents. Limited information is available due to the novelty of this practice, and not all Canadian rhinologists' data could be obtained. These findings hint at the possibility that combining ESS with biologic therapies may be superior to ESS alone, warranting further investigation.