Surgery to treat sinus disease shown to be more effective than antibiotics

A major new trial has found surgery is the most effective treatment for a common sinus condition, helping to inform future care for patients.

One in 10 adults in the UK have chronic rhinosinusitis, or sinusitis. People with this condition have symptoms similar to a bad cold, but these can last for months or even years.

Now, the MACRO trial has found sinus surgery is more effective than antibiotics at treating it.

Patients at University Hospital Southampton (UHS) were part of the UK trial, with visits taking place at the NIHR Southampton Clinical Research Facility.

The research was led in Southampton by Professor Rami Salib, a Consultant Ear, Nose and Throat Surgeon at UHS. He worked with Professor Paul Little, Professor Mike Thomas and Dr Jane Vennik from the University of Southampton.

The results from the trial have been published in The Lancet.

Finding the best treatment

Symptoms of sinusitis include a blocked and runny nose, loss of smell, facial pain and tiredness. The condition can also cause breathing problems, such as asthma, to get worse.

It is a common long-term condition, with a major socioeconomic impact.

More than 500 patients across the UK took part in the MACRO trial, including at UHS. All of them used nasal steroids and saline rinses as part of their usual care.

The researchers compared two treatments for the condition, to see which was most effective. Participants were randomly assigned to have surgery on their sinuses, take antibiotics for three months, or to take a placebo.

Informing future care

Surgery was found to be the most effective at relieving symptoms. Of those who had surgery, 87% said their quality of life had improved six months later.

In contrast, taking antibiotics was not found to be helpful. There was no significant difference in symptoms between those who took antibiotics and the placebo.

The study was part of the MACRO programme, funded by the National Institute for Health and Care Research (NIHR). This involved researchers from University College London, University College London Hospitals, the University of East Anglia, Guy’s and St Thomas’ NHS Foundation Trust, the University of Oxford, Imperial College London, and the University of Southampton.

Professor Salib, also Chair of Otolaryngology / Head & Neck Surgery and Professor of Rhinology at the University of Southampton, said:

“Sinusitis is major cause of morbidity and reduced quality of life for sufferers. This landmark clinical trial has clearly shown that sinus surgery is more effective than medical treatment with antibiotics in adults with chronic sinusitis.

“Surgery was associated with reduced burden of symptoms and improved quality of life. These results are particularly relevant when surgery for this condition under the NHS has been restricted due to concerns about its clinical effectiveness.

“A big thank you goes to the whole Southampton team of co-investigators, research nurses, and of course our patient participants who made this trial a success.”