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Mimari C, Radulesco T, Penicaud M, Dessi P, Michel J. Surgical management of chronic rhinosinusitis with nasal polyps under local anaesthesia: indications and results. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:42-48. [PMID: 36860149 PMCID: PMC9978296 DOI: 10.14639/0392-100x-n1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 09/19/2022] [Indexed: 03/03/2023]
Abstract
Objective Our objective was to specify the indications and duration of effectiveness of Awake Patient Polyp Surgery (APPS) in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Secondary objectives were to evaluate complications and Patient-Reported Experience (PREMs) and Outcome Measures (PROMs). Methods We collected information regarding sex, age, comorbidities and treatments. Duration of effectiveness was the duration of non-recurrence defined by the time between APPS and a new treatment. Nasal Polyp Score (NPS) and Visual Analogic Scales (VAS, from 0/10 to 10/10) for nasal obstruction and olfactory disorders were assessed preoperatively and one month after surgery. PREMs were evaluated using a new tool: the APPS score. Results Seventy-five patients were enrolled (SR = 3.1, mean age = 60.9 ± 12.3 years). 60% of patients had a previous history of sinus surgery, 90% had stage 4 NPS and more than 60% had overuse of systemic corticosteroids. Mean time of non-recurrence was 31.3 ± 2.3 months. We found a significant improvement (all p < 0.001) for NPS (3.8 ± 0.4 vs 1.5 ± 0.6), VAS obstruction (9.5 ± 1.6 vs 0.9 ± 1.7) and VAS olfactory disorders (4.9 ± 0.2 vs 3.8 ± 1.7). Mean APPS score was 46.3 ± 5.5/50. Conclusions APPS is a safe and efficient procedure in the management of CRSwNP.
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Affiliation(s)
- Clémence Mimari
- Aix-Marseille Univ, APHM, Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Marseille Cedex, France
| | - Thomas Radulesco
- Aix-Marseille Univ, APHM, IUSTI, CNRS, Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Marseille Cedex, France
| | - Martin Penicaud
- Aix-Marseille Univ, APHM, Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Marseille Cedex, France
| | - Patrick Dessi
- Aix-Marseille Univ, APHM, Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Marseille Cedex, France
| | - Justin Michel
- Aix-Marseille Univ, APHM, IUSTI, CNRS, Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Marseille Cedex, France
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Anne J, Sreedharan S, Dosemane D, Shenoy V, Kamath PM, Zubair SM. Predictors of Surgical Outcomes After Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2022; 74:835-841. [PMID: 36452725 PMCID: PMC9702042 DOI: 10.1007/s12070-020-01855-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022] Open
Abstract
Chronic rhinosinusitis has an incidence of 15% in India. Functional endoscopic sinus surgery (FESS), in case of failed medical management, is the current treatment protocol in Chronic rhinosinusitis. This study aims to assess the outcome of FESS as measured by subjective quality of life indices; Rhinosinusitis Disability Index (RSDI) and Sinonasal Outcome Test (SNOT-22. It also assesses the predictive factors which influence the outcome after FESS. The study was conducted among 100 patients with Chronic Rhinosinusitis who underwent FESS, after failure of medical management. Immunocompromised or pregnant patients and patients with history of previous sinus surgery or malignancy were excluded from the study. The evaluation was done using Lund Kennedy endoscopy scores, Lund Mackay CT scan scores and RSDI and SNOT-22 questionnaires (baseline and 3 months post-op). Statistical analysis was done using Wilcoxon signed-rank test, Kruskall Wallis test, Mann Whitney test and Chi-square test. p < 0.05 was considered significant. RSDI and SNOTT 22 scores showed a mean change 34.78 and 33.04 respectively after FESS, with a p value of < 0.001, which was highly significant. The pre-operative factors which predicted a poor quality of life after FESS were smoking, Allergy and Asthma. Higher pre-operative Endoscopic and CT scores resulted in an improved quality of life after FESS. Gender, concurrent septoplasty and sinonasal polyposis did not influence the quality of life outcomes after FESS. The study determines the quality of life after FESS and also analyses the factors responsible for poor prognosis after functional endoscopic sinus surgery. This study will enable the ENT surgeons to adequately counsel the patients before surgery.
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Affiliation(s)
- Jayakrishna Anne
- Department of ENT & HNS, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinaoutpalli, Gannavaram, Krishna District, Vijayawada, Andhra Pradesh India
| | - Suja Sreedharan
- Kasturba Medical College, Department of Otorhinolaryngology, Manipal Academy of Higher Education, Mangalore, 575001 Karnataka India
| | - Deviprasad Dosemane
- Kasturba Medical College, Department of Otorhinolaryngology, Manipal Academy of Higher Education, Mangalore, 575001 Karnataka India
| | - Vijendra Shenoy
- Kasturba Medical College, Department of Otorhinolaryngology, Manipal Academy of Higher Education, Mangalore, 575001 Karnataka India
| | - Panduranga M. Kamath
- Kasturba Medical College, Department of Otorhinolaryngology, Manipal Academy of Higher Education, Mangalore, 575001 Karnataka India
| | - Sabah Mohd Zubair
- Kasturba Medical College, Department of Otorhinolaryngology, Manipal Academy of Higher Education, Mangalore, 575001 Karnataka India
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Extraction of sphenochoanal polyp with functional endoscopic sinus surgery approach: A rare case and review article. Int J Surg Case Rep 2022; 97:107429. [PMID: 35905676 PMCID: PMC9403174 DOI: 10.1016/j.ijscr.2022.107429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sphenochoanal polyp, a rare case of nasal polyp, is a benign mass that originates in the sphenoid sinus and develops into a choanal polyp. CASE PRESENTATION A 36-year-old Indonesian male complained of irregular right nasal obstruction and runny nose for one year. Physical examination showed soft tissue mass in the right nasal cavity, cyst retention in the right maxillary sinus, right sphenoid sinus, and cervical spondylosis. Diagnosis of sphenochoanal polyp was supported by nasoendoscopy and CT-Scan of paranasal sinuses. The patient got medical care and underwent functional endoscopic sinus surgery (FESS) and rinsed the nose with normal saline and topical steroids. Evaluation at six months after the surgery, the patient came without complaint and showed no sign of polyp mass or cysts recurrence, so the patient was declared to have a full recovery. DISCUSSION FESS is proven effective for managing sphenochoanal polyp and minimizes complications post-surgery and repetition of the polyp. CONCLUSION FESS is recommended for management of sphenochoanal polyp in term of minimizing recurrency.
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The Development of Dry Eye Disease After Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113829. [PMID: 32481640 PMCID: PMC7312531 DOI: 10.3390/ijerph17113829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/29/2022]
Abstract
We aim to evaluate the risk of dry eye disease (DED) occurrence in patients with surgery-indicated chronic rhinosinusitis (CRS) via the national health insurance research database in Taiwan. After exclusion, patients with a diagnostic code of CRS and had received functional endoscopic sinus surgery (FESS) were regarded as having surgery-indicated CRS and enrolled in the study group, then each patient in the study group was age- and gender-matched to four non-CRS patients that served as the control group. The outcome was considered as the development of DED and Cox proportional hazard regression was used for the statistical analysis, which involved multiple potential risk factors of DED. A total of 6076 patients with surgery-indicated CRS that received FESS and another 24,304 non-CRS individuals were enrolled after exclusion. There were 317 and 770 DED events in the study group and the control group during the 16-year follow-up interval, and the study group demonstrated a significantly higher adjusted hazard ratio (1490, 95% confidence intervals (CI): 1.303-1.702) of DED development compared to the control group in the multivariable analysis. In addition, the cumulative probability analysis illustrated a positive correlation of DED occurrence and the disease period of surgery-indicated CRS (p < 0.0001). In the subgroup analysis, both genders revealed a higher but not significant incidence of developing DED in the study group. In conclusion, the existence of surgery-indicated CRS will increase the risk of developing DED, which correlated to the disease interval.
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Karakuş MF, Özcan KM, Özcan M, Karakurt SE, Çetin MA, Çolak M, Eravcı FC, Yüksel Y, Titiz A, Ünal A. Does the Change in the Indications of Endoscopic Sinonasal Surgery Continue? Data between 1994-2018. Turk Arch Otorhinolaryngol 2020; 58:5-9. [PMID: 32313888 DOI: 10.5152/tao.2020.4828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/30/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Endoscopic sinonasal surgery (ESS) has changing over the years in parallel with the developments in endoscopy devices, video-imaging techniques, and surgical instruments. In the present study we investigated whether the indications of patients who underwent surgery over a period of 25 years have accommodated to these changes. Methods We retrospectively evaluated 1173 patients who underwent surgery in our clinic from 1994 through 2007, and 954 patients who underwent surgery from 2008 through 2018. The patients were divided into three groups as follows: chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP), and others. The changes in the indications during the first 14 years and the following 11 years were compared, and the results were statistically evaluated. Results A significant decrease was observed in the number of patients who underwent surgery following the diagnosis of CRSsNP (p<0.001). In addition, a statistically significant increase was found in CRSwNP (p<0.001) and other (p<0.001) indications. Conclusion When ESS indications identified in our clinic were reviewed, it was observed that the increasing trend in CRSwNP rate in the first 14 years continued, there was a significant increase in non-CRS indications in the last 11 years, and there has been an increase in patients with fungal sinusitis, especially in this group.
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Affiliation(s)
- Mehmet Fatih Karakuş
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Kürşat Murat Özcan
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Müge Özcan
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Süleyman Emre Karakurt
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Çetin
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mustafa Çolak
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Fakih Cihat Eravcı
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Yeşim Yüksel
- Department of Otorhinolaryngology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Ali Titiz
- Clinic of Otorhinolaryngology, Acıbadem Ankara Hospital, Ankara, Turkey
| | - Adnan Ünal
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
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Chau SF, Wu PH, Sun CC, Huang JY, Nien CW, Yang SF, Chou MC, Lu PT, Chen HC, Lee CY. The Development of Glaucoma after Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224456. [PMID: 31766214 PMCID: PMC6887744 DOI: 10.3390/ijerph16224456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022]
Abstract
This study investigates the development of glaucoma in subjects with surgery-indicated chronic rhinosinusitis (CRS) by the use of the National Health Insurance Research Database in Taiwan. Individuals that received the functional endoscopic sinus surgery (FESS) with a diagnostic code of CRS were regarded as surgery-indicated CRS and enrolled in the study group. Four non-CRS patients were age- and gender-matched to each patient in the study group. The exclusion criteria included legal blindness, ocular tumor, history of eyeball removal, and previous glaucoma. The outcome was regarded as the development of glaucoma, and conditional logistic regression was used for the statistical analysis, which involved multiple potential risk factors in the multivariate model. A total of 6506 patients with surgery-indicated CRS that received FESS and another 26,024 non-CRS individuals were enrolled after exclusion. The age and gender distributions were identical between the two groups due to matching. There were 108 and 294 glaucoma events in the study group and control group, respectively, during the follow-up period, and the study group had a significantly higher adjusted hazard ratio (1.291, 95% confidential interval: 1.031–1.615). The cumulative probability analysis also revealed a correlation between the occurrence of glaucoma and the CRS disease interval. In the subgroup analysis, the chance of developing open-angle glaucoma and normal-tension glaucoma was significantly higher in the study group than in the control group. In conclusion, the existence of surgery-indicated CRS is a significant risk factor for the development of glaucoma, which correlated with the disease interval.
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Affiliation(s)
- Siu-Fung Chau
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (S.-F.C.); (C.-W.N.); (S.-F.Y.); (M.-C.C.)
- Department of Ophthalmology, Taichung Tzu Chi Hospital, Taichung 40201, Taiwan
| | - Pei-Hsuan Wu
- Department of Otolaryngology–Head and Neck Surgery, Tri-Service General Hospital, Taipei 11221, Taiwan;
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 20402, Taiwan; (C.-C.S.); (P.-T.L.)
- Department of Chinese Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Chan-Wei Nien
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (S.-F.C.); (C.-W.N.); (S.-F.Y.); (M.-C.C.)
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 50093, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (S.-F.C.); (C.-W.N.); (S.-F.Y.); (M.-C.C.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Ming-Chih Chou
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (S.-F.C.); (C.-W.N.); (S.-F.Y.); (M.-C.C.)
| | - Pei-Ting Lu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 20402, Taiwan; (C.-C.S.); (P.-T.L.)
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
- Correspondence: (H.-C.C.); (C.-Y.L.)
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 50093, Taiwan
- Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan 717, Taiwan
- Correspondence: (H.-C.C.); (C.-Y.L.)
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Nien CW, Lee CY, Wu PH, Chen HC, Chi JCY, Sun CC, Huang JY, Lin HY, Yang SF. The development of optic neuropathy after chronic rhinosinusitis: A population-based cohort study. PLoS One 2019; 14:e0220286. [PMID: 31390351 PMCID: PMC6685625 DOI: 10.1371/journal.pone.0220286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate the risk of developing optic neuropathy (ON) in patient with both non-surgery and surgery-indicated chronic rhinosinusitis (CRS) via the national health insurance research database in Taiwan. Methodology/Principal findings 44,176 Patients with a diagnostic code of CRS was selected, which included 6,678 received functional endoscopic sinus surgery (FESS) regarded as the surgery-indicated CRS. Each individual in the study group was matched to two non-CRS patients by age and gender. The outcome was set as the occurrence of ON according to the diagnostic codes occurred after the index date. Poisson regression was used to calculate the adjusted relative risk (aRR) and conditional Cox proportional model was used to estimate the adjusted hazard ratio (aHR). There were 131 and 144 events of ON occurred in the study group and the control group respectively during the follow-up period. The whole study group, whether received FESS or not, demonstrated both significant aRR and aHR compared to the control group after adjusting demographic data, prominent ocular diseases, and systemic co-morbidities. In addition, both the aRR and aHR were higher in CRS patient received FESS than those with CRS but without FESS management. Conclusion The existence of CRS, especially the surgery-indicated CRS is a significant risk factor for the following ON using multivariable analysis.
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Affiliation(s)
- Chan-Wei Nien
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Pei-Hsuan Wu
- Department of Otolaryngology–Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jessie Chao-Yun Chi
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Otorhinolaryngology Head and Neck Surgery, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Chinese Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hung-Yu Lin
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Optometry, Chung Shan Medical University, Taichung, Taiwan
- Department of Exercise and Health Promotion, Chung Chou University of Science and Technology, Changhua, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Kumar H, Jain R. Review: The role of computational simulation in understanding the postoperative sinonasal environment. Clin Biomech (Bristol, Avon) 2019; 68:212-220. [PMID: 31325767 DOI: 10.1016/j.clinbiomech.2018.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 02/07/2023]
Abstract
Nasal surgery improves symptoms in a majority of patients for whom medical treatment has failed. In rhinosinusitis patients, endoscopic sinus surgery aims to alleviate obstruction and re-establish mucociliary clearance. Surgery alters the structure-function relationship within the nasal passage, which is difficult to assess clinically. Computational modelling has been used to investigate this relationship by simulating air flow and environmental variables inside realistic three-dimensional models of the human nasal airway but many questions remain unanswered and need further investigation. The application of computational models to improve pre-surgical planning and post-surgical treatment may not be currently possible due to the absence of knowledge correlating the model-predicted parameters to physiological variables. Links between these parameters to patient outcomes are yet to be established. This article reviews the recent application of computational modelling to understand the nasal structure-function relationship following surgery in patients with sinusitis and nasal obstruction.
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Affiliation(s)
- Haribalan Kumar
- Auckland Bioengineering Institute, The University of Auckland, New Zealand.
| | - Ravi Jain
- Department of surgery, The University of Auckland, New Zealand
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Hsu HJ, Lee CY, Yang KL, Chen HC, Sun CC, Huang JY, Lin HY, Yang SF. The Development of Keratopathy after Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071218. [PMID: 30959733 PMCID: PMC6480467 DOI: 10.3390/ijerph16071218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 01/18/2023]
Abstract
The aim of the present study was to evaluate the risk of developing keratopathy in patients with surgery-indicated chronic rhinosinusitis (CRS) via the National Health Insurance Research Database in Taiwan. Patients with a diagnostic code of CRS and who received functional endoscopic sinus surgery (FESS) were considered to have surgery-indicated CRS. The exclusion criteria were legal blindness, an ocular tumor, eyeball removal or previous keratopathy, and each individual in the study group was matched to four non-CRS patients by age and sex. The outcome was set as the occurrence of keratopathy according to the diagnostic codes after the index date. Cox proportional hazard regression was used for statistical analysis. A total of 6053 patients with surgery-indicated CRS and another 24,212 non-CRS individuals were enrolled after exclusions. The age and sex distributions were identical between the two groups due to matching, while comorbidities, including hypertension, diabetes mellitus, and other cardiovascular disorders, were significantly higher in the study group. There were 231 episodes of keratopathy in the study group, and 695 episodes of keratopathy in the control group after the index date, for which study group showed a significantly higher rate of developing keratopathy with an adjusted hazard ratio of 1.208 and a higher cumulative probability. In subgroup analysis, female sex with surgery-indicated CRS showed a significantly greater risk of developing keratopathy. In conclusion, surgery-indicated CRS that needs FESS to relieve symptoms is a potential risk factor for keratopathy.
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Affiliation(s)
- Hung-Jui Hsu
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
- Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan 717, Taiwan.
| | - Kun-Lin Yang
- Department of Otolaryngology⁻Head and Neck Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou 333, Taiwan.
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 333, Taiwan.
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan.
- Department of Chinese Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
| | - Hung-Yu Lin
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
- Department of Optometry, Chung Shan Medical University, Taichung 402, Taiwan.
- Department of Exercise and Health Promotion, Chung Chou University of Science and Technology, Changhua 500, Taiwan.
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
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Abstract
Despite garnering minimal attention from the medical community overall, olfaction is indisputably critical in the manner in which we as humans interact with our surrounding environment. As the initial anatomical structure in the olfactory pathway, the nasal airway plays a crucial role in the transmission and perception of olfactory stimuli. The goal of this chapter is to provide a comprehensive overview of olfactory disturbances as it pertains to the sinonasal airway. This comprises an in-depth discussion of clinically relevant nasal olfactory anatomy and physiology, classification systems of olfactory disturbance, as well as the various etiologies and pathophysiologic mechanisms giving rise to this important disease entity. A systematic clinical approach to the diagnosis and clinical workup of olfactory disturbances is also provided in addition to an extensive review of the medical and surgical therapeutic modalities currently available.
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Affiliation(s)
- Joseph S. Schwartz
- Department of Otolaryngology—Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Bobby A. Tajudeen
- Department of Otolaryngology—Head & Neck Surgery, Rush University, Chicago, IL, United States
| | - David W. Kennedy
- Department of Otorhinolaryngology—Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Correspondence to: David W. Kennedy, M.D., Department of Otorhinolaryngology—Head and Neck Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St Ravdin 5, Philadelphia, PA 19104, United States. Tel: +1-215-662-6971, Fax: +1215-349-5977
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11
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Zanuncio AV, Crosara PFTB, Becker HMG, Becker CG, Guimarães REDS. Setting of an endoscopic nasal reference point for surgical access to the anterior base through an anatomical study on cadavers. Braz J Otorhinolaryngol 2016; 82:630-635. [PMID: 27229657 PMCID: PMC9444746 DOI: 10.1016/j.bjorl.2015.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 10/22/2015] [Accepted: 10/29/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Diseases of paranasal sinuses, nasal cavity, and skull base can be treated by endonasal operations using a nasal rigid endoscope. When conducting this kind of surgery, anatomical references are critical for safety. Objective To measure the distance from the posterior wall of the maxillary sinus to the skull base, according to socio-demographic characteristics, and to detail an anatomical reference point for paranasal sinus operations and for an access to the anterior skull base, comparing anatomical variations between right and left sides, gender, height, weight, age, and ethnicity in cadavers. Methods Measures were taken from the 90° angle (the starting point where deflection of the skull base begins to form the anterior wall of the sphenoid, also known as Δ90°) to the upper, middle, and lower points of the posterior wall of the maxillary sinus. This study used 60 cadavers aged over 17 years, and evaluated these bodies with respect to age, height, BMI, weight, gender, and ethnicity, comparing measurements of right and left sides. Results The measurements were >1.5 cm in all cadavers and did not vary with age, height, weight, gender, and ethnicity on their right and left sides. The lack of association between the measurement from Δ90° to the upper, middle, and lower posterior walls of the maxillary sinus (categorical or quantitative) is noteworthy, considering the characteristics studied. Conclusion The methodology defined the nasal point of reference, considering an absence of variation in the cadavers’ characteristics.
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Affiliation(s)
- Andressa Vinha Zanuncio
- Universidade Federal de São João del-Rei (UFSJ), Campus Centro-Oeste, Divinópolis, MG, Brazil.
| | - Paulo Fernando Tormin Borges Crosara
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Oftalmologia e Otorrinolaringologia, Belo Horizonte, MG, Brazil
| | - Helena Maria Gonçalves Becker
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Oftalmologia e Otorrinolaringologia, Belo Horizonte, MG, Brazil
| | - Celso Gonçalves Becker
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Oftalmologia e Otorrinolaringologia, Belo Horizonte, MG, Brazil
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Thomas AJ, Orlandi RR, Ashby S, Mace JC, Smith TL, Alt JA. Nasal obstruction has a limited impact on sleep quality and quality of life in patients with chronic rhinosinusitis. Laryngoscope 2016; 126:1971-6. [DOI: 10.1002/lary.25956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Andrew J. Thomas
- Division of Head and Neck Surgery; Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah; Salt Lake City Utah
| | - Richard R. Orlandi
- Division of Head and Neck Surgery; Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah; Salt Lake City Utah
| | - Shaelene Ashby
- Division of Head and Neck Surgery; Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah; Salt Lake City Utah
| | - Jess C. Mace
- Division of Rhinology and Sinus Surgery; Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University; Portland Oregon U.S.A
| | - Timothy L. Smith
- Division of Rhinology and Sinus Surgery; Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University; Portland Oregon U.S.A
| | - Jeremiah A. Alt
- Division of Head and Neck Surgery; Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah; Salt Lake City Utah
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Parikh A, Anand U, Ugwu MC, Feridooni T, Massoud E, Agu RU. Drug-eluting nasal implants: formulation, characterization, clinical applications and challenges. Pharmaceutics 2014; 6:249-67. [PMID: 24871904 PMCID: PMC4085598 DOI: 10.3390/pharmaceutics6020249] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/28/2014] [Accepted: 05/07/2014] [Indexed: 12/26/2022] Open
Abstract
Chronic inflammation and infection of the nasal sinuses, also referred to as Chronic Rhinosinusitis (CRS), severely affects patients’ quality of life. Adhesions, ostial stenosis, infection and inflammation relapses complicate chronic sinusitis treatment strategies. Drug-eluting stents, packings or implants have been suggested as reasonable alternatives for addressing these concerns. This article reviewed potential drug candidates for nasal implants, formulation methods/optimization and characterization methods. Clinical applications and important considerations were also addressed. Clinically-approved implants (Propel™ implant, the Relieva stratus™ MicroFlow spacer, and the Sinu-Foam™ spacer) for CRS treatment was an important focus. The advantages and limitations, as well as future considerations, challenges and the need for additional research in the field of nasal drug implant development, were discussed.
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Affiliation(s)
- Ankit Parikh
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
| | - Utkarshini Anand
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
| | - Malachy C Ugwu
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
| | - Tiam Feridooni
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
| | - Emad Massoud
- Queen Elizabeth II (QEII) Health Sciences Centre, 1278 Tower Road, Halifax, NS B3H 2Y9, Canada.
| | - Remigius U Agu
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
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Myller JP, Luukkainen AT, Huhtala HSA, Torkkeli TVM, Rautiainen MEP, Toppila-Salmi SK. Satisfaction with maxillary sinus surgery might be influenced by risk factors. ALLERGY & RHINOLOGY 2013; 4:e6-e12. [PMID: 23772330 PMCID: PMC3679571 DOI: 10.2500/ar.2013.4.0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chronic rhinosinusitis (CRS) is an inflammation of the nose and paranasal sinuses lasting for ≥12 weeks. Endoscopic sinus surgery (ESS) is considered during difficult to treat CRS. The minimally invasive technique focuses on the transition areas rather than on the ostia. The aim of this study was to evaluate symptoms, the number of acute sinusitis episodes, and satisfaction after ESS with either preservation or enlargement of the maxillary sinus ostium. Thirty patients with moderate nonpolypous CRS were enrolled. Uncinectomy only and additional middle meatal antrostomy were randomized for each side of each patient and performed single blindly. The symptoms questionnaires were filled at four time intervals. Significant symptom reduction was achieved independently of operation technique. The number of acute sinusitis episodes indicating the exacerbation rate decreased significantly at 9 and, on average, 68 months postoperatively. However, the exacerbation rate began to increase after 9 months postoperatively. Three revisions were performed on the side with uncinectomy only and one on the side with additional antrostomy. Most patients reported good satisfaction with both procedures. There was a trend for patients with asthma and/or job exposure to report insignificantly more frequently no satisfaction with surgery, especially with the uncinectomy-only procedure. Both procedures seem to be efficient in providing symptom relief and satisfaction. More studies are needed to evaluate if patients with risk factors benefit more from an ostium-enlarging procedure.
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Affiliation(s)
- Jyri P Myller
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland, ; Department of Otorhinolaryngology, Paijat-Hame Central Hospital, Lahti, Finland
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Chen XB, Lee HP, Chong VFH, Wang DY. Aerodynamic characteristics inside the rhino-sinonasal cavity after functional endoscopic sinus surgery. Am J Rhinol Allergy 2012; 25:388-92. [PMID: 22185741 DOI: 10.2500/ajra.2011.25.3669] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to evaluate effects of functional endoscopic sinus surgery (FESS) on transient nasal aerodynamic flow patterns using computational fluid dynamics (CFD) simulations. METHODS A three-dimensional model of the nasal cavity was constructed from CT scans of a patient with FESS interventions on the right side of the nasal cavity. CFD simulations were then performed for unsteady aerodynamic flow modeling inside the nasal cavity as well as the sinuses. RESULTS Comparisons of the local velocity magnitude and streamline distributions inside the left and right nasal cavity and maxillary sinus regions were presented. Because of the FESS procedures in the right nasal cavity, existences and distributions of local circulations (vortexes) were found to be significantly different for the same nasal airflow rate but at different acceleration, deceleration, or quiet phases in the maxillary sinus region on the FESS side. Because of inertia effects, local internal airflow with circulation existences was continuous throughout the whole respiration cycle. With a larger peak inspiration flow rate, the airflow intensity inside the enlarged maxillary sinus increased significantly. Possible outcomes on functional performances of the nose were also examined and discussed. CONCLUSION Surgical enlargements of natural ostium of the maxillary sinus will change the aerodynamic patterns inside the main nasal cavity and maxillary sinus regions, which may affect normal nasal physiological functions. Local inertia effects play more important roles for the internal nasal airflow pattern changes and thus such conventional FESS procedures should be carefully planned.
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Affiliation(s)
- Xiao Bing Chen
- Department of Mechanical Engineering, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Drug delivery in the nasal cavity after functional endoscopic sinus surgery: a computational fluid dynamics study. The Journal of Laryngology & Otology 2012; 126:487-94. [PMID: 22414292 DOI: 10.1017/s0022215112000205] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intranasal medication is commonly used for nasal disease. However, there are no clear specifications for intranasal medication delivery after functional endoscopic sinus surgery. METHODS A three-dimensional model of the nasal cavity was constructed from computed tomography scans of an adult Chinese male who had previously undergone functional endoscopic sinus surgery in the right nasal cavity. Computational fluid dynamic simulations modelled airflow and particle deposition, based on discrete phase models. RESULTS In the right nasal cavity, more particles passed through the upper dorsal region, around the surgical area, and streamed into the right maxillary sinus region. In the left cavity, particles were distributed more regularly and uniformly in the ventral region around the inferior turbinate. A lower inspiratory airflow rate and smaller initial particle velocity assisted particle deposition within the right maxillary sinus cavity. In the right nasal cavity, the optimal particle diameter was approximately 10(-5) m for maxillary sinus cavity deposition and 3 × 10(-6) m for bottom region deposition. In the right nasal cavity, altered back head tilt angles enhanced particle deposition in the top region of the surgical area, and altered right side head tilt angles helped enhance maxillary sinus cavity deposition. CONCLUSION This model indicates that a moderate inspiratory airflow rate and a particle diameter of approximately 10(-5) m should improve intranasal medication deposition into the maxillary sinus cavity following functional endoscopic sinus surgery.
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Levine H, Rabago D. Balloon sinuplasty: a minimally invasive option for patients with chronic rhinosinusitis. Postgrad Med 2011; 123:112-8. [PMID: 21474899 DOI: 10.3810/pgm.2011.03.2269] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rhinosinusitis affects ~37 million people in the United States and accounts for almost 2% of all primary care office visits. Chronic rhinosinusitis (CRS) is often successfully managed in the primary care setting using antibiotics, topical or oral steroids, and saline nasal irrigation. Surgery is an option when medical management fails. Balloon sinuplasty is a minimally invasive endoscopic treatment, which is often used in combination with surgery. It aims to restore ostial patency with minimal mucosal damage, and it is indicated for dilatation of the paranasal sinuses for diagnostic and therapeutic purposes. The technology gently displaces, microfractures, and molds the bone surrounding the sinus outflow and may be used alone or in combination with conventional endoscopic surgery. Recent uncontrolled retrospective and prospective studies have reported the effectiveness and safety of balloon sinuplasty, including radiographic evidence of sinus patency and improved sinus-related quality of life scores for up to 2 years after balloon dilation. An examination of adverse events during a postmarketing assessment of balloon sinuplasty identified a total of 3 major complications among 28 500 patients, with a total of > 85 000 treated sinuses. While randomized controlled trials comparing balloon sinuplasty with conventional functional endoscopic sinus surgery have not been conducted, existing prospective and retrospective assessments suggest that balloon sinuplasty is a viable option for sinus intervention, either alone or in combination with conventional surgical treatment.
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Affiliation(s)
- Howard Levine
- Cleveland Nasal Sinus and Sleep Center, Associate Staff, Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44124, USA.
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