Comparative outcomes of re-boot surgery versus traditional functional endoscopic sinus surgery (non-re-boot) in chronic rhinosinusitis with nasal polyps- a randomised controlled trial

The terms Reboot Surgery and Traditional Functional Endoscopic Sinus Surgery (non Reboot) are used to distinguish between two approaches in sinus surgery for chronic rhinosinusitis with nasal polyps:

1. Reboot Surgery: This approach involves extensive removal of the diseased mucosa to address the underlying inflammation that drives polyp recurrence. The procedure can vary in extent:

o Total Reboot: All affected sinus mucosa is removed, targeting a complete "reboot" of the sinus environment.

o Partial Reboot: Select areas, such as the frontal sinus, are spared to retain some mucosal tissue, while still aiming to reduce disease recurrence by eliminating other inflamed areas. Disease-Modifying Concept: Reboot surgery aims to achieve long-lasting disease-modifying effects by replacing the inflamed Type 2 sinus mucosa with healthy nasal mucosa, potentially resulting in sustained improvements in smell and reduced polyp recurrence. This effect resembles the disease modifying benefits observed in allergen immunotherapy, which can suppress mucosal inflammation and prevent disease progression long after treatment ends.

2. Non Reboot Procedures: This includes traditional Functional Endoscopic Sinus Surgery (FESS), polypectomy, and similar techniques that focus on preserving the existing mucosa. These procedures primarily aim to reestablish drainage and ventilation without extensive mucosal resection, targeting symptom relief rather than profound modification of the disease’s course. This distinction emphasizes that Reboot surgery9s aggressive mucosal removal is intended for durable, long-term remission, aligning with a disease-modifying approach, while non Reboot procedures focus on short-term relief and preservation of mucosa.