Chronic rhinosinusitis is a heterogeneous inflammatory disorder involving the mucosa of the nose and paranasal sinuses. It is clinically characterized by the persistence of two or more sinonasal symptoms for at least 12 weeks, one of which should be nasal obstruction or nasal discharge, with or without facial pain or pressure and reduction or loss of smell. Contemporary definitions additionally require objective evidence of sinonasal inflammation on nasal endoscopy or computed tomography. This combined clinical and objective approach helps distinguish chronic rhinosinusitis from allergic rhinitis, recurrent acute rhinosinusitis and non-rhinogenic facial pain.[1–3]

The reported burden of chronic rhinosinusitis differs considerably among countries and study populations because of variations in case definition, diagnostic method, access to specialist evaluation and environmental exposure. A recent global systematic review confirmed marked geographical variation in incidence and prevalence.[4] Studies relying only on symptom questionnaires tend to produce higher estimates than those requiring both symptoms and objective findings. Epidemiological analyses using stricter guideline-based criteria have generally suggested a true population prevalence below 5%, although substantially broader ranges have been reported across Asian populations.[5,6]

Chronic rhinosinusitis has traditionally been divided into disease with nasal polyps and disease without nasal polyps. However, current understanding recognizes that these phenotypes include multiple inflammatory endotypes with different immunological pathways, comorbidities, recurrence risks and treatment responses. Type 2 inflammation is prominent in many patients with nasal polyps, asthma or aspirin-exacerbated respiratory disease, whereas non-type 2 and mixed inflammatory patterns are more frequently encountered in some Asian populations. These differences emphasize the need to interpret local clinical and outcome data within their geographical and demographic setting.[7,8]

Patients may present with nasal obstruction, mucous or mucopurulent discharge, postnasal drainage, facial pressure, headache, sneezing, cough and olfactory dysfunction. Sleep disturbance, fatigue, reduced productivity and emotional symptoms may further impair daily functioning. Disease burden may therefore be inadequately represented by examination or radiological findings alone. The 22-item Sino-Nasal Outcome Test is a validated patient-reported instrument that measures rhinological, ear and facial, sleep, functional and emotional effects of sinonasal disease. It has become one of the most widely used measures of response to medical and surgical treatment.[9]

Nasal endoscopy assists in identifying mucosal oedema, polyps, purulent discharge, crusting and anatomical abnormalities. Computed tomography demonstrates the extent and distribution of sinus opacification and is particularly important when surgery is being considered. The Lund–Kennedy endoscopic and Lund–Mackay computed-tomography systems provide standardized methods of documenting objective disease; however, imaging severity should be interpreted together with symptoms and quality-of-life impairment rather than used alone to determine treatment need or predict outcome.[10]

Initial treatment commonly includes saline nasal irrigation, intranasal corticosteroids, management of allergy and relevant comorbidities, and selected use of systemic medication according to disease phenotype and clinical findings. The updated 2025 adult-sinusitis guideline emphasizes objective confirmation of chronic rhinosinusitis and recommends saline irrigation, topical intranasal corticosteroids or both for symptomatic relief. Antibacterial treatment should not be routinely used in the absence of clinical evidence supporting bacterial infection.[3]

Endoscopic sinus surgery is considered for appropriately selected adults whose anticipated benefit from surgery exceeds that expected from continued nonsurgical treatment. The 2025 surgical-management guideline advises individualized assessment based on symptoms, quality of life, disease characteristics and previous therapy rather than requiring a uniform medication regimen before surgery. It also recommends appropriate preoperative CT imaging, realistic counselling regarding the chronic and potentially recurrent nature of the disease, and postoperative assessment between three and 12 months using symptoms, quality-of-life measures and nasal endoscopy.[11]

Despite advances in chronic-rhinosinusitis management, locally applicable evidence describing patient presentation, treatment selection and outcomes remains limited in many centres. Most published studies focus either on clinical characteristics or on surgical outcomes alone, with fewer prospective studies evaluating the entire pathway from initial medical therapy to subsequent surgery and follow-up.

The present study was therefore undertaken to evaluate the demographic and clinical profile, presenting symptoms, examination and radiological findings, treatment patterns and six-month management outcomes of adults with chronic rhinosinusitis. Changes in symptom severity were assessed throughout the cohort, while disease-specific quality of life and postoperative endoscopic outcomes were evaluated among surgically treated patients.

AIM

To evaluate the clinical profile, management patterns and short-term treatment outcomes of chronic rhinosinusitis among adult patients attending a tertiary-care centre.

OBJECTIVES

1. To describe the demographic characteristics, presenting symptoms, clinical findings, etiological factors and radiological features of adults diagnosed with chronic rhinosinusitis.
2. To assess the response to medical and surgical management at three and six months using clinical improvement, symptom-severity scores, SNOT-22 scores and postoperative endoscopic findings.

Study Design and Setting This prospective observational study was conducted in the Department of Otorhinolaryngology at Osmania Medical College over a period of Six months, from January 2026 to June 2026. Adult patients attending the otorhinolaryngology outpatient department with clinically diagnosed chronic rhinosinusitis, with or without nasal polyposis, were screened for eligibility. Patients satisfying the study criteria were enrolled consecutively and followed for six months after initiation of treatment. Study Population A total of 1000 adult patients attended the study centre during the six months study period. Among them, 200 patients diagnosed with chronic rhinosinusitis were included in the study. All eligible patients were recruited consecutively until the required study sample was obtained. Inclusion Criteria Patients satisfying the following criteria were included: 1. Age 18 years or older. 2. Clinical features suggestive of chronic rhinosinusitis. 3. Persistence of sinonasal symptoms for at least 12 weeks. 4. Chronic rhinosinusitis with or without nasal polyposis. 5. Diagnosis supported by clinical examination, nasal endoscopy or radiological findings, where indicated. 6. Willingness to undergo the prescribed treatment and attend scheduled follow-up visits. 7. Provision of written informed consent. Exclusion Criteria Patients with any of the following were excluded: 1. Acute rhinosinusitis of less than 12 weeks’ duration. 2. Sinonasal malignancy. 3. Significant facial trauma or congenital sinonasal abnormality. 4. Previous major sinonasal surgery during the recent period before recruitment. 5. Incomplete clinical or follow-up information. 6. Patients unwilling to participate or unable to complete the six-month follow-up. 7. Severe systemic illness preventing standard evaluation or treatment. Clinical Evaluation A detailed clinical history was obtained from every participant using a predesigned case-record form. The demographic details recorded included age, sex, relevant occupation, duration of symptoms, relevant comorbidities, and allergic history. The presenting symptoms assessed included nasal discharge, nasal obstruction, excessive sneezing, itching of the ear, nose, or throat, ear pain, headache, cough, anosmia, hyposmia, epistaxis, fever, facial pain or pressure, facial congestion, halitosis, fatigue, and dental pain. As more than one symptom could be present in the same patient, symptom percentages were calculated independently and were not expected to total 100%. Otorhinolaryngological Examination All patients underwent a complete ear, nose, and throat examination. Anterior rhinoscopy was performed to assess inferior turbinate engorgement, nasal mucosal oedema, nasal discharge, septal abnormalities, nasal polyps, and other visible intranasal abnormalities. Diagnostic nasal endoscopy was performed in selected patients with persistent symptoms, suspected nasal polyposis, inconclusive anterior-rhinoscopy findings, or when surgical intervention was being considered. Endoscopic findings included nasal polyps, mucosal oedema, purulent or mucous discharge, crusting, scarring, and synechiae. Radiological Assessment Plain radiographs of the paranasal sinuses were obtained when clinically indicated. The radiological features documented included maxillary antral mucosal thickening, haziness or opacification of the paranasal sinuses, air–fluid levels, inferior turbinate enlargement, and other sinus abnormalities. Computed tomography of the paranasal sinuses was performed in patients with persistent symptoms, suspected complications, nasal polyposis, or those being evaluated for surgical treatment. Computed-tomography findings were reviewed to determine the extent and distribution of sinonasal disease and were used for surgical planning. Etiological and Microbiological Assessment Probable allergic involvement was identified from a compatible history of recurrent sneezing, nasal itching, watery rhinorrhoea, turbinate hypertrophy and related examination findings. Microbiological or fungal investigations were performed only when clinically indicated. Nasal or sinus secretions were collected aseptically and processed according to institutional laboratory protocols. Medical and Surgical Management All patients initially received individualized medical treatment based on their clinical presentation. Therapy included saline nasal irrigation, intranasal corticosteroids, oral antihistamines, analgesics, antibiotics when bacterial infection was suspected, short courses of systemic corticosteroids in selected patients, and treatment of associated allergy or comorbid conditions. Adherence and clinical response were reviewed during follow-up. Response to medical treatment was assessed at approximately three months and classified as marked improvement, partial improvement or no meaningful improvement. Patients with persistent symptoms despite adequate medical therapy underwent repeat clinical and radiological evaluation for surgery. Surgical treatment was offered to selected patients with refractory symptoms, nasal polyposis, significant anatomical obstruction or relevant radiological abnormalities. Procedures included bilateral inferior meatal antrostomy, functional endoscopic sinus surgery, intranasal polypectomy, inferior turbinectomy and other appropriate sinonasal procedures. The operative approach was selected according to clinical findings, disease extent and surgeon assessment. Follow-up and Clinical Outcome Assessment Patients were followed at baseline, three months and six months after initiation of treatment or surgical intervention. At each visit, symptom improvement, persistence, recurrence, additional treatment requirements and complications were documented. Six-month outcomes were categorized as marked improvement, partial improvement, persistent symptoms or recurrence after initial improvement. Marked or partial improvement was considered a favourable outcome. Visual Analogue Scale Assessment The severity of nasal obstruction, nasal discharge, sneezing, facial pain or pressure, headache and reduced sense of smell was assessed using a 10-point visual analogue scale, where 0 represented no symptoms and 10 represented the worst imaginable severity. Scores were recorded at baseline, three months and six months. SNOT-22 Assessment Disease-specific quality of life among surgically treated patients was assessed using the 22-item Sino-Nasal Outcome Test. Each item was scored from 0 to 5, producing a total score ranging from 0 to 110, with higher scores indicating greater symptom burden. SNOT-22 scores were recorded before surgery and at three and six months postoperatively, and changes from the preoperative value were calculated. Postoperative Endoscopic Assessment Patients who underwent surgery were evaluated by diagnostic nasal endoscopy during follow-up. Assessment included sinus-ostial patency, mucosal oedema, nasal or sinus discharge, residual or recurrent polyps, crusting, scarring or synechiae and postoperative infection. The Lund–Kennedy endoscopic score was recorded before surgery and at six months. Postoperative complications, additional interventions and revision surgery were also documented. Outcome Measures The primary outcome was the proportion of patients achieving a favourable clinical response at six months following medical or surgical management. Secondary outcomes included demographic and clinical characteristics, presenting symptoms, clinical and radiological findings, probable etiological factors, response to initial medical treatment, requirement for surgery, changes in visual analogue scale scores, postoperative SNOT-22 and Lund–Kennedy scores, complications and need for revision surgery. Statistical Analysis Data were entered into Microsoft Excel and analysed using IBM SPSS Statistics, version. Categorical variables were expressed as frequencies and percentages. Continuous variables were presented as mean ± standard deviation or median with interquartile range, depending on their distribution.A p-value of less than 0.05 was considered statistically significant.

During the 2-year study period, 12,346 adult patients attended the study centre. Of these, 200 patients were diagnosed with chronic rhinosinusitis, giving a hospital-based prevalence of 1.62%. The average number of newly diagnosed cases was approximately 100 per year. All 200 patients completed the scheduled 6-month follow-up and were included in the final analysis.

There were 99 males (49.5%) and 101 females (50.5%), giving a male-to-female ratio of approximately 1:1.02. The participants ranged in age from 18 to 80 years, with a mean age of 36.42 ± 12.18 years. Most patients, 129 (64.5%), were between 18 and 39 years of age.

Table 1. Age distribution of patients with chronic rhinosinusitis

Patients aged 18–29 years constituted the largest age group, accounting for 33.5% of the study population, followed by those aged 30–39 years at 31.0%. Only 4.5% of patients were aged 60 years or older.

The duration of symptoms ranged from 4 to 28 weeks. All patients presented with more than one symptom. Nasal discharge was the most frequent complaint, followed by nasal obstruction, excessive sneezing and itching involving the ear, nose or throat.

Table 2. Presenting symptoms among patients with chronic rhinosinusitis

Percentages exceed 100% because individual patients presented with multiple symptoms.

Nasal discharge was reported by 168 patients (84.0%), nasal obstruction by 145 (72.5%), excessive sneezing by 121 (60.5%) and itching of the ear, nose or throat by 119 (59.5%). Dental pain and fatigue were the least frequently reported symptoms.

Anterior rhinoscopy revealed engorgement of the inferior turbinates in 186 patients (93.0%). Maxillary antral mucosal thickening was the commonest radiological abnormality. Allergy was identified as the probable etiological factor in 129 patients (64.5%).

Table 3. Clinical, etiological and investigative findings

Diagnostic nasal endoscopy was performed in 12 patients (6.0%), particularly in those with persistent symptoms or suspected nasal polyposis. Six patients (3.0%) underwent computed tomography of the paranasal sinuses for detailed assessment and surgical planning. Fungal organisms were identified in two patients (1.0%).

All 200 patients initially received medical treatment. At the end of the study, 185 patients (92.5%) had been managed with medical treatment alone, whereas 15 patients (7.5%) underwent surgery because of persistent symptoms despite adequate medical therapy.

Table 4. Final management modality

Among the 15 surgically treated patients, bilateral inferior meatal antrostomy was the most frequently performed procedure, followed by functional endoscopic sinus surgery.

Table 5. Surgical procedures performed

Bilateral inferior meatal antrostomy accounted for 46.67% of the procedures, while functional endoscopic sinus surgery accounted for 40.0%.

Response to Initial Medical Management

Treatment response was initially assessed after approximately 12 weeks of medical therapy. Marked symptomatic improvement was observed in 120 patients (60.0%), while 50 patients (25.0%) demonstrated partial improvement. Thirty patients (15.0%) showed no meaningful improvement.

Table 6. Response following initial medical management

Of the 30 patients who showed an inadequate initial response, 15 underwent surgical treatment. The remaining 15 patients continued intensified medical management because surgery was either not clinically indicated or was not accepted by the patient.

Six-Month Management Outcomes

At 6 months, marked improvement was observed in 132 of the 185 medically managed patients (71.4%) and in 12 of the 15 surgically treated patients (80.0%). Partial improvement was observed in 39 medically managed patients and two surgically treated patients.

Table 7. Six-month clinical outcomes according to treatment modality

A favourable outcome, defined as marked or partial improvement, was achieved in 171 medically managed patients (92.4%) and 14 surgically managed patients (93.3%). The difference in favourable-outcome rates between the two management groups was not statistically significant (p=1.000, Fisher’s exact test).

Overall, 185 patients (92.5%) achieved marked or partial improvement by the end of the 6-month follow-up.

Change in Symptom-Severity Scores

Symptom severity was assessed using a 10-point visual analogue scale, where a higher score represented greater symptom severity. Analysis was performed among patients who reported each symptom at baseline.

Table 8. Change in symptom-severity scores following treatment

There was a statistically significant reduction in all assessed symptom-severity scores at three and six months compared with baseline. The greatest absolute improvements were observed for nasal obstruction and nasal discharge.

Although symptom scores remained substantially lower at six months than at baseline, mild residual symptoms were observed in some patients, particularly those with reduced sense of smell and recurrent allergic symptoms.

Quality-of-Life Outcome Following Surgery

The Sino-Nasal Outcome Test-22 was administered to the 15 patients who underwent surgery. The mean preoperative SNOT-22 score was 49.80 ± 17.20. This decreased to 19.60 ± 9.40 at three months and 22.30 ± 10.10 at six months.

Table 9. Change in total SNOT-22 score among surgically treated patients

The mean SNOT-22 score improved by 30.20 points at three months and by 27.50 points at six months compared with the preoperative value. Although there was a slight increase between the three- and six-month assessments, the six-month score remained significantly lower than the preoperative score.

Postoperative Endoscopic Outcomes

Among surgically managed patients, the mean Lund–Kennedy endoscopic score decreased significantly from 7.47 ± 2.67 before surgery to 1.93 ± 1.16 at six months.

Table 10A. Change in Lund–Kennedy nasal endoscopy score

The reduction in the mean endoscopic score indicated significant postoperative improvement in mucosal oedema, discharge and polyp-related findings.

Table 10B. Postoperative clinical and endoscopic findings

Percentages do not total 100% because patients could have more than one postoperative finding.

Patent sinus ostia were observed in 13 patients (86.7%), and 12 patients (80.0%) had no evidence of purulent discharge at six months. Postoperative crusting occurred in three patients, while two developed minor synechiae or scarring. No patient required revision surgery during the follow-up period.

Figure 1. Age Distribution of Patients with Chronic Rhinosinusitis

Figure 2. Major Presenting Symptoms of Chronic Rhinosinusitis

Figure 3. Six-Month Clinical Outcomes by Treatment Modality

Figure 4. Change in Mean SNOT-22 Score After Surgical Treatment

The present prospective observational study evaluated 200 adults with chronic rhinosinusitis over a two-year period. The main findings were a hospital-based disease proportion of 1.62%, a nearly equal sex distribution, concentration of cases among younger adults, and predominance of nasal discharge, nasal obstruction, sneezing and itching. Most patients were managed medically, while 7.5% required surgery following an inadequate initial response. At six months, 92.5% had marked or partial clinical improvement. Significant reductions were also recorded in symptom-severity scores, while the surgical subgroup demonstrated substantial improvement in SNOT-22 and Lund–Kennedy endoscopic scores. Disease frequency and demographic profile The observed proportion of 1.62% was lower than many symptom-based community estimates reported in international studies. This difference is understandable because the denominator in the present study consisted of all adults attending the study centre rather than a systematically sampled community population. It should therefore be described as a hospital-based proportion and not extrapolated as community prevalence. Recent epidemiological evidence has shown that reported frequency varies markedly according to diagnostic criteria, study methodology and geographical region, with estimates falling when both symptoms and objective evidence are required.[4–6] The mean age was 36.42 years, and approximately two-thirds of patients were aged 18–39 years. This finding indicates that chronic rhinosinusitis substantially affects economically productive adults in the study population. The nearly equal numbers of men and women suggest that there was no strong sex predominance. However, because the study was hospital based, the observed age and sex distributions may have been influenced by local healthcare-seeking behaviour and referral patterns. Presenting symptoms and clinical findings Nasal discharge was the most frequent symptom, followed by nasal obstruction, excessive sneezing and itching. Nasal obstruction, nasal discharge and altered smell have also been identified as important patient-centred outcomes in contemporary chronic-rhinosinusitis research.[12] The high frequency of sneezing, itching and turbinate engorgement suggests substantial coexistence of allergic upper-airway symptoms in the study population. Nevertheless, the designation of allergy as a probable cause in 64.5% should be interpreted cautiously unless supported by standardized allergy testing, because symptom history and turbinate appearance alone cannot establish sensitization or prove causality. Inferior-turbinate engorgement was observed in 93.0% of patients, and maxillary antral mucosal thickening was the commonest radiological finding. Fungal organisms were identified in only 1.0%. The low fungal proportion is compatible with fungal disease representing a specific subgroup rather than the dominant cause of chronic rhinosinusitis. Future studies should distinguish colonization, fungal ball, allergic fungal rhinosinusitis and invasive fungal disease because they have different diagnostic and therapeutic implications. Response to medical management All patients initially received medical treatment. At approximately three months, 60.0% had marked improvement and 25.0% had partial improvement, whereas 15.0% showed no meaningful response. These findings reinforce the importance of appropriate nonsurgical treatment as the initial strategy for most adults. The ReOpen1 and ReOpen2 randomized trials demonstrated that enhanced topical delivery of fluticasone improved cardinal symptoms, CT opacification and exacerbation-related outcomes in patients with chronic rhinosinusitis, including patients without nasal polyps.[13] A pooled analysis subsequently found improvements among both surgery-naïve patients and those with previous sinus surgery, indicating that effective topical therapy may retain a role across different stages of disease management.[14] Although the exact drug-delivery method used in the present study was different, the direction of improvement supports the principle that appropriately delivered anti-inflammatory treatment can produce clinically relevant benefit. At six months, 171 of 185 patients managed medically had marked or partial improvement. This favourable rate should be interpreted within the context of a selected outpatient cohort, the outcome definitions used and the absence of an untreated comparator. Dejaco et al. prospectively evaluated several treatment pathways among patients with disease refractory to maximal medical therapy and found improvement across standardized medical and surgical approaches, although improvement was generally greater after surgery in appropriately selected patients.[23] The findings emphasize that treatment response is not uniform and that ongoing medical management remains beneficial for some patients even after an incomplete initial response. Surgical treatment and overall clinical outcome Fifteen patients underwent surgery after inadequate improvement with medical treatment. Bilateral inferior meatal antrostomy and functional endoscopic sinus surgery were the most frequently documented procedures. At six months, 14 of 15 operated patients had marked or partial improvement. The 93.3% favourable outcome in the surgical group was numerically similar to the 92.4% rate in the medically managed group. This must not be interpreted as evidence of equivalent efficacy. Treatment was not randomized, the groups had markedly unequal sample sizes, and surgery was reserved for patients with persistent or anatomically significant disease. The comparison is affected by confounding by indication and inadequate statistical power. The results are better interpreted as showing that appropriate escalation to surgery produced improvement in most selected patients who had not responded adequately to initial medical therapy. SNOT-22 outcomes Mean SNOT-22 score decreased from 49.80 preoperatively to 19.60 at three months, representing a 30.20-point improvement. At six months, the mean score was 22.30, corresponding to a sustained 27.50-point improvement from baseline. Both reductions were considerably greater than the established minimum clinically important difference for the instrument.[9] Keshari et al. reported substantial postoperative symptom improvement following endoscopic sinus surgery, with total symptom scores decreasing from 49.01 ± 14.83 before surgery to 21.91 ± 8.88 during early follow-up.[15] Prithviraj et al. similarly reported a decrease in mean SNOT-22 score from 60.10 ± 9.74 to 28.13 ± 8.03 three months after surgery in patients with concurrent chronic rhinosinusitis and laryngopharyngeal reflux.[16] These findings are consistent with the magnitude and direction of improvement observed in the present surgical subgroup. Chapurin et al. prospectively evaluated 115 surgical patients and found improvement in patient-reported and objective measures across all evaluated inflammatory endotype clusters. The type 2 inflammatory cluster demonstrated a mean six-month SNOT-22 improvement of 28.3 points, closely resembling the 27.5-point improvement observed in the present study.[17] This supports the clinical benefit of surgery across heterogeneous inflammatory profiles, although the small surgical sample in the present study prevented meaningful endotype analysis. A recent prospective cohort from Rawalpindi also demonstrated substantial postoperative SNOT-22 improvement among 50 patients undergoing functional endoscopic sinus surgery.[22] The systematic review and meta-analysis by Soler et al. found significant postoperative SNOT-22 improvement across published studies, confirming that disease-specific quality of life is one of the most consistently improved outcomes after endoscopic sinus surgery.[24] The slight increase in mean SNOT-22 score between three and six months in the present study may reflect residual inflammation, recurrence of allergic symptoms, inconsistent postoperative topical therapy or normal variability within a very small sample. Importantly, the score at six months remained substantially better than the preoperative value. Longer follow-up is needed to determine whether this represents temporary fluctuation or the beginning of progressive symptom recurrence. Endoscopic and postoperative findings The mean Lund–Kennedy score decreased from 7.47 before surgery to 1.93 at six months, demonstrating objective improvement in sinonasal inflammation. Patent sinus ostia were observed in 86.7%, while 80.0% had no purulent discharge. Crusting, minor scarring or synechiae and residual polyp disease were observed in a small number of patients, and no revision surgery was required during six months of follow-up. Chapurin et al. also demonstrated improvement in postoperative Lund–Kennedy endoscopic scores across different inflammatory endotypes.[17] Martin-Jimenez et al. found significant clinical improvement after both limited and expanded endoscopic sinus surgery in patients with nasal polyps, with greater SNOT-22 improvement and fewer revisions in the expanded-surgery group during longer follow-up.[18] These observations indicate that both patient-reported and objective endoscopic measures should be documented because improvement in one does not necessarily guarantee parallel improvement in the other. Symptom-specific improvement Significant reductions were recorded in VAS scores for nasal obstruction, nasal discharge, sneezing, facial pain or pressure, headache and impaired smell. Nasal obstruction and discharge demonstrated the largest absolute improvement. Reduced sense of smell showed meaningful improvement but remained more persistent than the other symptoms. This pattern is clinically plausible because olfactory dysfunction may be influenced by both mechanical obstruction and epithelial or neuroinflammatory disease and may not recover completely after restoration of sinus ventilation. The 2025 patient-centred outcomes initiative identified nasal obstruction, nasal discharge and altered smell among the outcomes most consistently considered important by patients with chronic rhinosinusitis.[12] The present findings therefore capture outcomes that are directly relevant to daily functioning rather than relying only on radiological change. Extent and selection of surgery The extent of surgery should be individualized according to disease subtype, anatomical distribution and expected long-term treatment requirements. A 2024 systematic review and meta-analysis evaluating limited, complete, extended and radical endoscopic approaches found that surgical extent may influence outcomes in selected disease phenotypes, although heterogeneity among studies limits universal recommendations.[19] The recent surgical guideline similarly advises that the planned extent should not be determined solely by an arbitrary threshold of CT opacification.[11] Taheri et al. found that the preoperative SNOT-22 score may be more useful than the Lund–Mackay CT score for estimating patient-perceived benefit, whereas CT severity alone did not reliably predict postoperative quality-of-life improvement.[21] This supports combining symptoms, SNOT-22, endoscopy, CT findings and previous treatment response when selecting patients for surgery. Comparison with contemporary systematic evidence The 2024 meta-analysis by Algahtani et al. concluded that functional endoscopic sinus surgery generally improves symptoms and quality of life, with low reported complication rates, although the included literature was heterogeneous.[20] A 2026 systematic review of systematic reviews by Dewey et al. similarly concluded that endoscopic sinus surgery produces broad and sustained benefits across several sinonasal outcome domains.[25] These findings support the improvements seen in the present surgical subgroup but do not overcome the limitations arising from its small sample and short follow-up. Tashman et al. demonstrated that general health-related quality-of-life improvement may remain detectable for up to five years after endoscopic sinus surgery.[18] The six-month follow-up in the present study is therefore adequate for assessing early response but insufficient for evaluating long-term recurrence, revision surgery or sustained disease control.

Chronic rhinosinusitis in the present hospital-based cohort occurred most frequently among younger adults and affected men and women in nearly equal proportions. Nasal discharge, nasal obstruction, sneezing and itching were the predominant symptoms, while engorgement of the inferior turbinates was the commonest examination finding. Allergic features were frequently present, although confirmatory allergy testing would be required to establish sensitization and causality.

Most patients achieved marked or partial improvement following individualized medical management. A small subgroup with persistent disease underwent surgery and demonstrated substantial improvement in SNOT-22 scores, symptom severity and endoscopic findings. Postoperative complications were generally minor, and no revision procedure was required within six months.

The findings support a stepwise, patient-centred management approach based on objective confirmation of disease, appropriate medical therapy, assessment of quality-of-life burden and selective use of surgery. The study does not establish comparative equivalence between medical and surgical treatment because the treatment groups were nonrandomized and substantially unequal.

STRENGTHS

The study prospectively evaluated the complete management pathway from presentation and initial medical treatment to surgical escalation and six-month follow-up.

It assessed both subjective and objective outcomes through clinical-response categories, symptom-specific VAS scores, SNOT-22 and nasal-endoscopy scoring.

The study evaluated an unselected adult outpatient cohort rather than limiting analysis to patients already selected for surgery.

The internally consistent six-month follow-up framework permits assessment of early treatment response, persistence and recurrence.

LIMITATIONS

This was a single-centre study, which limits external generalizability.

The reported 1.62% is a hospital-based proportion and cannot be interpreted as community prevalence.

The medical and surgical treatment groups were not randomized. The surgical group was small and represented patients selected after inadequate medical response; direct efficacy comparisons between groups are therefore inappropriate.

Allergy was identified mainly from clinical features unless confirmatory testing was performed. The proportion attributed to allergy may consequently have been overestimated.

Only selected patients underwent nasal endoscopy and CT. Objective disease severity was therefore not measured uniformly throughout the cohort.

SNOT-22 and Lund–Kennedy outcomes were available only for the surgical subgroup, preventing direct comparison of quality-of-life changes between management pathways.

The six-month follow-up period was insufficient to evaluate long-term recurrence, polyp regrowth and revision surgery.

Treatment adherence, exact medication regimens, phenotype, polyp status, asthma, aspirin-exacerbated respiratory disease and inflammatory endotypes were not incorporated into multivariable outcome analysis.

The outcome categories of marked and partial improvement require clear prospective operational definitions and ideally independent or blinded assessment.

FUTURE DIRECTIONS

Future multicentre studies should recruit larger cohorts and use uniform diagnostic criteria requiring at least 12 weeks of symptoms and objective confirmation on endoscopy or CT.

SNOT-22, symptom VAS and endoscopic scores should be collected in both medically and surgically managed patients at baseline and at identical follow-up intervals.

Patients should be stratified according to nasal-polyp status, asthma, allergic sensitization, aspirin-exacerbated respiratory disease, fungal disease and inflammatory endotype.

Long-term follow-up of at least two to five years is needed to assess sustained disease control, recurrence and revision surgery.

Comparative-effectiveness analyses should use randomized allocation where feasible or propensity-score and multivariable methods to account for treatment-selection bias.

Future studies should also examine adherence, direct and indirect treatment costs, productivity loss and patient-defined outcomes.

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