Abstract
Background and Objectives
To investigate the impact of pathogenic bacterial distribution in the nasal cavity on postoperative nasal function recovery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), and to analyze the risk factors for postoperative recurrence.
Methods
A total of 178 CRSwNP patients who underwent ESS in our hospital from May 2021 to May 2023 were selected. Based on preoperative nasal secretion pathogen culture results, patients were categorized into the pathogen-negative group (42 cases), bacterial-positive group (90 cases), and fungal-positive group (46 cases). The nasal symptom visual analogue scale (VAS) score, Lund–Kennedy endoscopic score, and Lund–Mackay computed tomography (CT) score were assessed preoperatively and at 12 weeks postoperatively. Patients were followed up for 24 months and categorized into the recurrence group (36 cases) and the recurrence-free group (142 cases) based on postoperative recurrence. Relevant risk factors for recurrence were analyzed.
Results
Among the 178 patients, the bacterial positivity rate was 50.56% (mainly Corynebacterium, Staphylococcus, and Haemophilus influenzae), while the fungal positivity rate was 25.84% (mainly Candida albicans and Aspergillus). Postoperatively, the nasal symptom VAS scores for individual items, Lund–Kennedy endoscopic scores, and Lund–Mackay CT scores showed significant improvement compared to preoperative values (P < 0.05). Comparisons among the 3 groups revealed a trend of pathogen-negative group < bacterial-positive group < fungal-positive group in nasal symptom VAS scores, Lund–Kennedy endoscopic scores, and Lund–Mackay CT scores, with significant differences observed between each pair of groups (P < 0.05). Univariate analysis showed that the proportions of asthma, history of revision surgery, eosinophilic (EOS)-type nasal polyps, and preoperative Lund–Mackay CT scores were all higher in the recurrence group than in the recurrence-free group (P < 0.05). Multivariate analysis identified history of revision surgery (OR = 6.963, 95% CI: 2.275–21.313), EOS-type nasal polyps (OR = 4.566, 95% CI: 1.449–14.392), and high preoperative Lund–Mackay CT scores (OR = 1.928, 95% CI: 1.475–2.522) as independent risk factors for postoperative recurrence (P < 0.05). Corynebacterium infection might reduce the risk of recurrence (P = 0.065).
Conclusion
Nasal bacterial and fungal colonization in patients with CRSwNP are associated with poor postoperative nasal function recovery, with fungal colonization leading to the worst prognosis. Postoperative recurrence is closely related to EOS-type nasal polyps, a history of previous surgery, and a high preoperative Lund–Mackay CT score. Corynebacterium may serve as a protective microbial population.
Keywords
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Supplementary Material
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