Sinus Surgery for AERD (Samter's Triad)

Nasal polyps grow like weeds in AERD (Samter's Triad) patients. If you have Aspirin Exacerbated Respiratory Disease, you've probably already had a sinus surgery (or many of them). 

Surgery for AERD usually involves nasal polyp removal and opening the blocked sinus cavities. Sinus surgery can also be referred to as “FESS,” which stands for Functional Endoscopic Sinus Surgery. In some cases, it is possible to have surgery to remove nasal polyps in an outpatient setting, without general anesthesia. However, due to the extensive sinus disease in AERD, patients usually require more extensive surgical procedures. Research has found that AERD patients experience greater quality of life following a complete surgery, rather than a more focused approach. It is recommended that surgery should remove nasal polyps and also provide wide-opening of the sinus cavities. This increases the effectiveness of topical steroid treatment following surgery.

The need for surgical removal of nasal polyps is common in AERD, but the rate of polyp recurrence is high. In fact, if you have AERD, you are almost certain to undergo additional sinus surgeries unless you get desensitized to aspirin. It is recommended that aspirin desensitization be performed 3 to 6 weeks after surgery to minimize the chance of polyp regrowth occurring prior to desensitization. It is also recommended that patients be given a steroid sinus rinse or an oral steroid taper in the interim between surgery and desensitization. It is important that your sinuses are in optimal condition prior to desensitization, because this will lead to the best possible results. 

Stents, such as the Propel Sinus Stent, can be implanted after surgery. These stents contain steroid medication that will help keep the sinuses open after surgery. They dissolve on their own and do not need to be removed.

Research has found that sinus surgery temporarily reduces reactions to NSAID medications. Therefore, if an aspirin challenge is needed for diagnosis, it is recommended to do this prior to polyp removal. Performing an aspirin challenge soon after surgery may result in misdiagnosis. 

Unfortunately, AERD causes aggressive sinus disease and surgery alone is not a cure. Max Samter himself, in his original description of the disease, reported that surgery is an ineffective treatment. A 2011 study found that 90% of AERD patients had polyp regrowth by 5 years following surgery and 37% had undergone an additional surgery by that time. It is recommended that patients undergo aspirin desensitization 3 to 6 weeks following surgery to delay or prevent polyp regrowth.

This data, provided by the Brigham & Women's AERD Center, demonstrates that here is an extremely high rate of polyp recurrence in AERD (Samter's Triad) patients.

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