Stihl Clemens, Dombrowski Tobias, Weiss Bernhard G, Spiegel Jennifer L, Guertler Anne, Ihler Friedrich, Freytag Saskia, Bertlich Ines, Gröger Moritz, Oppel Eva, Bertlich Mattis
Department of Otorhinolaryngology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Federal Republic of Germany.
Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Georg-August University of Göttingen, Göttingen, Germany.
Medicine (Baltimore). 2025 Aug 8;104(32):e43714. doi: 10.1097/MD.0000000000043714.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition associated with significant morbidity. While established treatments such as functional endoscopic sinus surgery (FESS) and biologic therapy have demonstrated efficacy, they come with limitations, including cost, accessibility, and patient adherence. Growing evidence suggests that dietary factors, particularly arachidonic acid and salicylic acid, influence inflammatory pathways relevant to CRSwNP, yet real-world data on dietary interventions remain scarce. This retrospective study evaluates the mid-term effects of a structured dietary intervention in patients with CRSwNP who were either unwilling to undergo FESS or biologic therapy. The outcomes were compared to those of patients receiving either FESS or dupilumab. The dietary intervention was based on the avoidance of arachidonic acid and salicylates, an increase in fiber-rich foods, and the exclusion of nonsteroidal anti-inflammatory drugs. A total of 45 patients (mean age 46.5 ± 14.1 years; 25 female and 20 male) were included, with 15 undergoing dietary intervention, 15 FESS, and 15 dupilumab therapy. Disease burden was assessed using the sino-nasal outcome test (SNOT-22), visual analog scale, endoscopy scoring, and the brief smell identification test at baseline and follow-ups at 3 and 6 months. Patients undergoing dietary intervention experienced significant symptom improvement, although the response was less pronounced compared to FESS or dupilumab. At 6 months, mean SNOT-22 scores improved from 69.8 to 19.7 (FESS), 58.0 to 16.1 (dupilumab), and 39.5 to 24.2 (dietary intervention). visual analog scale scores showed a similar trend, decreasing from 8.4 to 2.9 (FESS), 8.1 to 2.2 (dupilumab), and 5.6 to 3.5 (dietary). While objective olfactory scores (brief smell identification test) improved in all groups, it was less pronounced in the dietary intervention group. Notably, patients in the dietary intervention group reported continued adherence and tolerability of the intervention. Dietary intervention may serve as a viable adjunct for CRSwNP patients who are unable or unwilling to undergo surgery or biologics. Despite lower efficacy, its safety and accessibility merit further investigation.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是一种慢性炎症性疾病，会导致明显的发病率。虽然诸如功能性鼻内镜鼻窦手术（FESS）和生物疗法等既定治疗方法已证明有效，但它们存在局限性，包括成本、可及性和患者依从性。越来越多的证据表明，饮食因素，尤其是花生四烯酸和水杨酸，会影响与CRSwNP相关的炎症途径，但关于饮食干预的实际数据仍然很少。这项回顾性研究评估了对不愿接受FESS或生物疗法的CRSwNP患者进行结构化饮食干预的中期效果。将结果与接受FESS或度普利尤单抗治疗的患者的结果进行比较。饮食干预基于避免花生四烯酸和水杨酸盐、增加富含纤维的食物以及排除非甾体抗炎药。总共纳入了45名患者（平均年龄46.5±14.1岁；25名女性和20名男性），其中15名接受饮食干预，15名接受FESS，15名接受度普利尤单抗治疗。在基线以及3个月和6个月随访时，使用鼻窦结局测试（SNOT-22）、视觉模拟量表、内镜评分和简短嗅觉识别测试评估疾病负担。接受饮食干预的患者症状有显著改善，尽管与FESS或度普利尤单抗相比，反应不太明显。在6个月时，平均SNOT-22评分从69.8改善至19.7（FESS组）、从58.0改善至16.1（度普利尤单抗组）、从39.5改善至24.2（饮食干预组）。视觉模拟量表评分显示出类似趋势，从8.4降至2.9（FESS组）、从8.1降至2.2（度普利尤单抗组）、从5.6降至3.5（饮食干预组）。虽然所有组的客观嗅觉评分（简短嗅觉识别测试）均有所改善，但在饮食干预组中改善不太明显。值得注意的是，饮食干预组的患者报告了对干预措施的持续依从性和耐受性。饮食干预可能是无法或不愿接受手术或生物制剂治疗的CRSwNP患者的一种可行辅助治疗方法。尽管疗效较低，但其安全性和可及性值得进一步研究。
