Postoperative Recurrence Risk of Nasal Polyps Greater in Young Men

An increased risk of nasal polyp recurrence after endoscopic sinus surgery (ESS) was identified in young adult men, who were also more likely to report incidence of allergy. Results were published in the American Journal of Otolaryngology–Head and Neck Medicine and Surgery.

In examining the pathological and prognostic characteristics of chronic rhinosinusitis with nasal polyps (CRSwNP), researchers noted sex and age of patients as variables affecting all disease endotypes. However, a lack of data on the impact of sex on endotypes, clinical presentation, and behavior of CRSwNP was cited, as well as a paucity of studies that focus on older patients with the condition.

“There is increasing evidence of a lower CRSwNP recurrence rate after ESS in the elderly than in young adult patients,” they said. “Several diseases demonstrate sex differences in their presentation and response to therapy—male sex is a risk factor for childhood asthma, whereas females are more at risk for asthma in adolescence and adulthood.”

The study authors conducted a retrospective cohort study to compare the clinical, laboratory, pathological, and prognostic characteristics of CRSwNP in male vs female patients stratified by age.

A total of 105 consecutive young adult patients (between ages 20 and 40; male, n = 63) and 67 elderly patients (age ≥ 65 years; male, n = 44) with CRSwNP who had undergone ESS between 2009 and 2018 at the Padova University Hospital, Italy, were enrolled.

All patients were treated postoperatively with isotonic saline solution irrigations, nasal steroids, or fluticasone furoate. Follow-up endoscopes were scheduled 3, 6, and 12 months after ESS, and yearly thereafter. Recurrence was classified as having endoscopic evidence of at least grade I polyposis.

Overall, recurrence rate of nasal polyps was significantly associated with the age and sex combination (P = .0165). A markedly higher recurrence rate was seen in young adult male patients with CRSwNP (29.0%) compared with young adult females (11.6%; OR, 0.322; 95% CI, 0.109-0.949) and elderly males (4.5%; OR, 0.116; 95% CI, 0.025-0.533). All relapses reported among the 4 subgroups with CRSwNP occurred within 48 months of surgery.

Allergy was also shown to be associated with the age and sex combination (P = .0158), in which young adult males reported the highest allergy rate (50.0%) compared with elderly males (29.5%; OR = 0.419; 95% CI, 0.185-0.949) and elderly females (13%; OR = 0.150; 95% CI, 0.040-0.557). Moreover, the allergy rate was found to be higher in young adult females (41.9%) vs elderly females (13%; OR = 0.208; 95% CI, 0.054-0.809).

“Taken together, our data suggest the possibility of an interaction between sex and age in the recurrence of nasal polyposis after ESS,” concluded researchers. “Nevertheless, more studies are needed to better understand the role of sex hormones in the pathogenesis and prognosis of CRSwNP.”

Reference

Brescia G, Contro G, Ruaro A, et al. Sex and age-related differences in chronic rhinosinusitis with nasal polyps electing ESS. Am J Otolaryngol. Mar-Apr 2022;43(2):103342. doi:10.1016/j.amjoto.2021.103342