USA: Hormone Replacement Therapy and Chronic Rhinosinusitis Management

A recent study published in The Laryngoscope has shed light on the effect of hormone replacement therapy (HRT) on chronic rhinosinusitis (CRS) management. Analyzing data from over 65,000 women aged 55 or older, the study found that those undergoing HRT were significantly less likely to require endoscopic sinus surgery (ESS) for chronic rhinosinusitis treatment versus those not on HRT (OR: 0.28). This effect was particularly pronounced in patients with nasal polyps. However, hormone replacement therapy was associated with higher antibiotic utilization.

Chronic rhinosinusitis is a disease that represents a significant health burden, estimated to affect 1.0–12.1% globally. CRS patients have been found to have worse quality-of-life scores versus those with chronic obstructive pulmonary disease and congestive heart failure. Kevin Hur, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA, and colleagues aimed to investigate whether hormone replacement therapy impacts healthcare resource utilization in the management of chronic rhinosinusitis in older women.

The study included women 55 years or older with a diagnosis of CRS using the TriNetX US health record database and followed for three years. The cohort was stratified into two groups: women who received HRT at the beginning of the study were compared to women who did not receive HRT. The groups were matched by race, age, history of asthma, ethnicity, and history of nasal polyps. Outcomes included whether the patient underwent endoscopic sinus surgery and the frequency of antibiotic use. Kaplan–Meier analysis, measures of association, and cohort descriptive statistics were calculated.

Findings

• Of the 65,400 women included, the mean age was 66.9 years. 27.0% and 3.6% of patients had a history of asthma or nasal polyps, respectively.
• 2.0% of CRS patients underwent ESS, with the HRT group less likely to undergo ESS [OR: 0.28] versus patients who did not receive HRT.
• When stratified by polyp status, HRT patients with nasal polyps had a greater decrease in ESS rates compared to control than HRT patients without nasal polyps.
• The HRT group had a higher mean number of antibiotic prescriptions compared to the non-HRT group.

In conclusion, postmenopausal CRS patients concurrently receiving hormone replacement therapy are less likely to undergo endoscopic sinus surgery but receive more antibiotic prescriptions. CRSwNP-HRT patients when stratified by polyp status have a greater decrease in ESS rate versus patients with CRSsNP-HRT.

"There is a need for further research investigating potential immunologic mechanisms behind this effect and how menopause itself may affect disease burden to improve care within this population," the researchers wrote.

Reference

Herrera, K., Parikh, M., Vemula, S., & Hur, K. Effect of Hormone Replacement Therapy on Chronic Rhinosinusitis Management. The Laryngoscope. https://doi.org/10.1002/lary.31433