Efficacy of Endoscopic Sinus Surgery for Allergic Fungal Rhinosinusitis: A Systematic Review With Meta-analysis.

Abstract

Endoscopic sinus surgery (ESS) plays a central role in the management of allergic fungal rhinosinusitis (AFRS); however, outcomes vary across studies. The goal of this study is to systematically review and synthesize evidence on the outcomes of ESS in patients with AFRS. PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials. A systematic search of the literature was conducted from inception to October 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies reporting postoperative outcomes and recurrence following ESS in AFRS were included. Thirty-one studies encompassing 1474 AFRS patients were analyzed. Follow-up durations ranged from 1.5 to 32.5 months (mean = 13.7 months), with substantial variability in postoperative medical therapy. The overall disease recurrence rate was 31% (95% CI, 25%-38%), and the pooled ESS revision rate was 19% (95% CI, 14%-25%). ESS significantly improved sinonasal quality of life, with a pooled reduction in 22-item sinonasal outcome test (SNOT-22) score of 23.37 points (95% CI, 18.71-28.02). Postoperative oral itraconazole use was not associated with a lower recurrence rate (30.7% vs 31.1%, P = .957), nor a lower surgical revision rate (18.2% vs 20.3%, P = .643). ESS substantially improves postoperative quality of life in AFRS, with an overall recurrence rate of 31% and surgical revision rate of 19%. Further high-quality studies are needed to define optimal postoperative adjuvant therapy to minimize recurrence and enhance long-term outcomes.