Mirza Ahmad A, Alzahrani Maha A, Alkhalifah Khalid M, Almoajil Sadeem J, AlShugaig Reema S, Alghamdi Reem A, Alghamdi Jazmin A, Marglani Osama A
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Am J Rhinol Allergy. 2025 Sep;39(5):379-391. doi: 10.1177/19458924251339100. Epub 2025 May 6.
BackgroundChronic rhinosinusitis (CRS) is a common condition that significantly impacts quality of life. While endoscopic sinus surgery (ESS) has proven effective in the general adult population, its specific effectiveness in older patients remains understudied.ObjectiveThis meta-analysis assessed the therapeutic effect and safety of ESS in patients aged 55 years and older with CRS.MethodsFive electronic databases were queried: PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Therapeutic effectiveness of ESS was quantitatively assessed using random-effects meta-analysis, in which mean changes of pre- versus postoperative scores of the Sino-Nasal Outcome Test-22 (SNOT-22) were pooled. Meta-regression was conducted to predict the variability in SNOT-22 changes. Comparative meta-analyses evaluating surgical complications between older and younger adult patients were conducted.ResultsA total of 12 studies were synthesized. Both short- and long-term follow-up data demonstrated significant improvement by reference to baseline. Our analysis demonstrated statistically significant mean reduction in the SNOT-22 score by 21.4 points (95% confidence interval [CI], -26.9 to -15.9) at an average follow-up of approximately 9 months. This improvement exceeds the minimal clinically important difference for SNOT-22. The presence of nasal polyposis was a favorable prognostic indicator of SNOT-22 improvement (β = -0.21; = .002). The rates of surgical adverse events among older patients were 4.2% for significant bleeding, 0.6% for orbital injury, and 0.2% for skull base injury. A significant difference between the two age groups was observed only in skull base injury (odds ratio = 2.98; 95% CI, 1.53-5.80; < .001).ConclusionESS offers clinically significant benefits for older individuals, particularly those with nasal polyposis. It is a safe treatment option for CRS in the older patients, with outcomes largely comparable to those in younger adults, though certain risks, such as skull base injury, may be slightly higher in older populations.
背景
慢性鼻-鼻窦炎（CRS）是一种常见疾病，严重影响生活质量。虽然内镜鼻窦手术（ESS）在一般成年人群中已被证明有效，但其在老年患者中的具体疗效仍研究不足。
目的
本荟萃分析评估了ESS对55岁及以上CRS患者的治疗效果和安全性。
方法
PubMed、Embase、Web of Science、Scopus和Cochrane对照试验中央注册库。使用随机效应荟萃分析对ESS的治疗效果进行定量评估，汇总鼻鼻窦结局测试-22（SNOT-22）术前与术后评分的平均变化。进行Meta回归以预测SNOT-22变化的可变性。进行比较荟萃分析以评估老年和年轻成年患者之间的手术并发症。
结果
共纳入12项研究。短期和长期随访数据均显示与基线相比有显著改善。我们的分析表明，在平均约9个月的随访中，SNOT-22评分的平均降低在统计学上有显著意义，降低了21.4分（95%置信区间[CI]，-26.9至-15.9）。这种改善超过了SNOT-22的最小临床重要差异。鼻息肉的存在是SNOT-22改善的有利预后指标（β = -0.21；P = 0.002）。老年患者手术不良事件发生率为严重出血4.2%，眼眶损伤0.6%，颅底损伤0.2%。两个年龄组之间仅在颅底损伤方面存在显著差异（优势比 = 2.98；95% CI，1.53 - 5.80；P < 0.001）。
结论
ESS对老年人，特别是患有鼻息肉的老年人具有显著的临床益处。它是老年CRS患者的一种安全治疗选择，其结果在很大程度上与年轻成年人相当，尽管某些风险，如颅底损伤，在老年人群中可能略高。
