Medical and surgical considerations in patients with Samter's triad

Background: The aim of this study was to report on objective and subjective outcomes of patients with Samter's triad (ST) treated with functional endoscopic sinus surgery (FESS), and correlate these results with aspirin desensitization (DS) in patients. Methods: We performed a retrospective analysis of prospectively collected data in 15 patients requiring revision FESS after failing maximum medical therapy and prior sinus surgery for chronic rhinosinusitis in the context of ST. Five patients underwent aspirin DS and 10 patients did not (non-DS). These patients represent a subset of patients previously reported who were treated in a tertiary rhinology setting over a 3-year period (1999-2001). CT scans were graded according to the Lund-Mackay grading scale and symptom scores were assessed using the Sino-Nasal Outcome Test (SNOT-20). Endoscopy was scored according to the Rhinosinusitis Task Force methodology. All patients had a minimum 2-year follow-up. Results: Preoperative CT scores were 20.1 +/- 1.9 for non-DS patients and 20.4 +/- 2.0 for DS patients (p = NS). Preoperative and postoperative SNOT-20 scores for non-DS patients were 31.8 +/- 3.9 and 8.8 +/- 1.7, respectively, as compared with 32.0 +/- 3.6 and 7.3 +/- 1.7 for DS patients (p = NS). Preoperative and postoperative endoscopy scores for non-DS patients were 7.6 +/- 1.2 and 2.0 +/- 0.4, respectively, as compared with 7.6 +/- 1.3 and 1.1 +/- 0.4 for DS patients (p = NS). Of DS patients, none required additional surgery whereas 8 of 10 non-DS patients required additional revision during the follow-up period (p = 0.003). Conclusion: Revision FESS benefits patients with ST; however, the addition of aspirin DS decreases the likelihood that patients with ST will require additional surgical intervention over a 2-year period.