Introduction

Aspirin Exacerbated Respiratory Disease (AERD) is a chronic inflammatory condition characterized by the triad of eosinophilic asthma, chronic rhinosinusitis with nasal polyposis, and a non-IgE mediated hypersensitivity to non-steroidal anti-inflammatory drugs. The gold-standard treatment of AERD consists of complete functional endoscopic sinus surgery (FESS) of all 8 sinuses followed by aspirin treatment after aspirin desensitization (ATAD). This treatment protocol has been found to result in an improvement in sinonasal outcome test (SNOT-22) score, decreased overall corticosteroid use, lower rate of revision surgery, and improved control of asthma. In this study, we seek to compare the outcomes of ATAD between males and females with AERD.

Methods

A retrospective chart review was conducted of male and female patients who successfully completed aspirin desensitization. All of these patients had challenge-proven AERD and were desensitized following a complete FESS. In order to match our male and female cohorts, we compared them based on age, previous FESS procedures, asthma control test score, exhaled nitric oxide, and daily prednisone dosage prior to the desensitization. Values for previous FESS procedures, asthma control test score, and exhaled nitric oxide were recorded prior to FESS. Values for age and daily prednisone dosage were recorded after FESS and prior to ATAD.

We tracked patient SNOT 22 scores at the following time points: post-FESS/pre-desensitization, 1-3 months post-desensitization, 4-6 months post-desensitization, 7-12 months post-desensitization, and 13-24 months post-desensitization. Based on this, we compared average SNOT-22 scores at the aforementioned time points for the male and female cohorts. Student’s t-tests were used to match the cohorts and to compare SNOT-22 scores over time. Significance level was set to p < 0.05 and all reported p values are two tailed. All statistical analysis was done on SPSS.

Results

There were 216 patients who met the inclusion criteria for this study. These patients were divided into male (N = 97) and female (N = 119) cohorts. There were no significant differences (p > 0.05) in between the male and female groups in terms of age, previous FESS procedures, asthma control test score, exhaled nitric oxide, daily prednisone dosage, and SNOT 22 score prior to the desensitization.

The male cohort had a significantly lower (p < 0.05) mean SNOT 22 score compared to the female cohort at the 2-3 months post-desensitization, 4-6 month post-desensitization, and 13-24 month post-desensitization time points. There was no significant difference between the groups at the 7-12 month post-desensitization time point.

Conclusion

In conclusion, our study found that males have significantly superior long-term sinonasal outcomes with ATAD compared to females. This difference in responsiveness should be taken into account when considering treatment options for patients with AERD.