The researchers sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS.

First of all, the researchers screened 2829 ESS procedures to identify patients with a preoperative SNOT-22 score <20. After that, they reviewed disease characteristics, preoperative Lund–Mackay (LM) scores, and pre-and postoperative SNOT-22 scores in patients with at least three months’ follow-up.

One hundred fourteen had low preoperative SNOT-22 scores. Indications for these surgeries included CRS, odontogenic sinus disease, mucocele, recurrent acute sinusitis, fungal ball, and silent sinus syndrome. Specifically, among CRS patients, 45.6% had pulmonary comorbidities and systemic immunodeficiencies. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction postoperatively. In contrast, those with scores between 10 and 14 had a 5.4 point reduction, and preoperative scores <9 resulted in no significant decrease in postoperative symptom scores. Overall, there was a 3.3 point SNOT-22 reduction among all patients at three months postoperatively.

The study concluded that patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores.