In-clinic Endoscopic Polypectomy for Chronic Sinusitis With Nasal Polyps

Recruiting now · Not applicable

Conditions studied: Sinusitis, Nasal Polyps

In brief

Chronic rhinosinusitis, also called chronic sinusitis, is a very common life-long disease affecting over 5% of the Canadian population. Its symptoms, including daily facial pain and headache, an inability to breath through the nose and complete smell loss, regularly impair one's ability to work and to enjoy and participate in daily activities. The annual cost of chronic sinusitis to Canada is estimated at $1.3 billion while the government pays an estimated $860 million yearly for chronic sinusitis treatment. Chronic sinusitis with polyps, the most common type of chronic sinusitis, is usually treated with a combination of medications and surgery. Until now, surgical treatment has only been performed in the operating room, at a cost of about $3500 per procedure. But, recent studies have shown that a new procedure, "in-clinic polyp removal", can provide an improvement in patient symptoms to levels equal to those for sinus surgery performed in a hospital operating room. Moreover, in clinic polyp removal has additional advantages including a shorter procedure recovery time, a significantly lower cost to the health care system (about one-tenth the cost or $450), and a shorter wait time for treatment. With the proposed pragmatic trial, the investigators will determine whether the in clinic polyp removal procedure is as good as sinus surgery in the operating room at controlling patient symptoms of chronic sinusitis. The investigators will also determine the cost and health-benefits for a patient, the healthcare system and for society of in clinic polyp removal in comparison to sinus surgery done in a hospital operating room. The investigators will then know if this new treatment, in clinic polyp removal, can replace sinus surgery as the standard of care for these patients.

Key facts

Study ID: NCT02975310
Run by: Ottawa Hospital Research Institute
People needed: 140
Starts: 2017-04-11
Expected to finish: 2026-12-01
Last updated by the study team: 2025-12-30

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Age 18 years or older
Diagnosis of chronic rhinosinusitis with polyps requiring surgical treatment after having been treated with medical therapy as designated by the Canadian clinical practice guidelines for acute and chronic sinusitis. 15
Bilateral nasal polyps present of Grade ≥ 2 on each side as determined by the Lildholdt scale score measured by nasal endoscopy at the screening visit.
Must have nasal blockage score greater than or equal to 2 on the sinonasal outcome test SNOT-22 at the screening visit.
Must have an American Society of Anesthesiologists physical status PS3 classification or less.
Participants with comorbid asthma or chronic obstructive pulmonary disease (COPD) must have stable disease with no exacerbations (no emergency room visits, hospitalisations, or oral or parental steroid use for these lower respiratory conditions) within 3 months before the screening visit.
Must be capable, in the opinion of the investigator, of providing informed consent to participate in the study. Participants must sign an informed consent document indicating that they understand the purpose of and procedures of the study and are willing to participate in the study.

You may not qualify if…

Women who are pregnant or breast feeding as per patient's report
Patients with hyperplastic polyps or polyps large enough that they result in external nasal deformity
Facial pain/pressure score higher than 2 on the sinonasal outcome test SNOT-22 at the screening visit.
History of any surgical procedure that prevents the ability to accurately grade the nasal polyps
Participants who will not be able to complete the follow-up appointments/evaluations
Have significant oral structural abnormalities, e.g. unrepaired cleft palate
Septal deviation requiring correction in order to perform either EPIC or ESS procedures
Diagnosis of an immunodeficiency or immunocompromised state
Diagnosis of cystic fibrosis
Diagnosis of allergic fungal sinusitis
Contraindication to the use of oral corticosteroids (e.g. uncontrolled diabetes, congestive heart failure, uncontrolled hypertension, known renal insufficiency, known peptic ulcer disease, known glaucoma, pregnancy)
History of either Churg-Strauss syndrome, primary ciliary dyskinesia, or vasculitis (e.g. granulomatosis with polyangiitis(GPA))
Allergy, hypersensitivity, or contraindication to the use of local or topical lidocaine anesthetics, nasal topical 1:1000 adrenaline, nasal decongestants, nasal steroid spray
Any serious or unstable concurrent disease, psychiatric disorder, or any significant condition that, in the opinion of the investigator, could confound the results of the study or could interfere with the participant's participation or compliance with the study
A recent (within 1 year of the screening visit) clinically significant history of drug or alcohol abuse, or dependence that, in the opinion of the investigator could interfere with the participant's participation or compliance with the study
Inability to read and understand English
Any medical condition that in the opinion of the investigator would interfere with the treatment
Any participant who is unfit to undergo surgery under general anesthesia
Current participation in another clinical trial at the time of the screening visit.
Participant is unable to undergo an awake procedure
Diagnosis or Aspirin Exacerbated Respiratory Disease (AERD)

Where it is running

Vancouver General Hospital — Vancouver, British Columbia, Canada (enrolling)
St. Joseph's Hospital London — London, Ontario, Canada (enrolling)
Ottawa Hospital Research Institute — Ottawa, Ontario, Canada (enrolling)
McGill University Health Center — Montreal, Quebec, Canada (enrolling)

Full record on ClinicalTrials.gov

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