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Gulati RK, Hur K, Schneider AL, Price CP, Welch KC. Contralateral Sinonasal Symptoms Following Unilateral Endoscopic Sinus Surgery. EAR, NOSE & THROAT JOURNAL 2022:1455613221125932. [PMID: 36084932 DOI: 10.1177/01455613221125932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To explore the degree to which patients undergoing unilateral endoscopic sinus surgery (ESS) experience post-operative contralateral sinonasal symptoms and determine risk factors for contralateral symptomatology following unilateral ESS. METHODS Patients who underwent unilateral surgery for chronic rhinosinusitis (CRS) were contacted and asked if they felt symptomatic on the contralateral side at that point in time. Nasal Obstruction Symptom Evaluation (NOSE) scores were obtained based on contralateral symptomatology they recalled at the following time points: pre-ESS, 1 month post-ESS, and 3 months post-ESS. Demographics, contralateral symptomatology, and NOSE scores were compared between those with 2 or fewer sinusotomies versus 3 or more sinusotomies. RESULTS Of the 97 patients included in this study, 24% of patients reported contralateral congestion, a median of 24 months post-ESS, and more than 10% of patients reported other contralateral symptoms including swelling, rhinorrhea, difficulty breathing, and hyposmia post-ESS. Those with 2 or fewer sinusotomies were more likely to feel that they had developed worsened sensation of contralateral sinus swelling (P = .008). The median amount of time from the participants' index surgery until the time they were interviewed was 24 months. There were no differences in long-term contralateral symptomatology between those who did and did not have septoplasty (27%). CONCLUSION Patients who have unilateral ESS for CRS may experience long-term contralateral symptoms. Having a septoplasty did not affect contralateral symptoms.
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Affiliation(s)
- Reeti K Gulati
- Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Kevin Hur
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander L Schneider
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Caroline Pe Price
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kevin C Welch
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Soyka MB, Holzmann D. Correlation of Complications during Endoscopic Sinus Surgery with Surgeon Skill Level and Extent of Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900311] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Endoscopic sinus surgery (ESS) produces a great range of potential complications. Rough segregation into “minor” and “major” complications seems insufficient. This study uses a recently published new classification system that is based more on the patient's point of view, with a greater variety of options. Methods A retrospective review was undertaken of 421 ESS procedures. Both, the surgeon's experience and the extent of surgery were correlated with the complication rate. Results The overall complication rate was 39.7% (grades A–D) and did not correlate significantly with either the experience of the surgeon or with the extent of surgery. Conclusion The new classification is simple, precise, and takes complications into account that used to be neglected. ESS is even safe in the hands of less skilled surgeons as long as the degree of difficulty stays highly adapted to his/her ability. Some complications (grade A) seem to be inherent to the procedure.
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Affiliation(s)
- Michael B. Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
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Elsisi H. Safety and efficacy of pediatric functional endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2017. [DOI: 10.4103/ejo.ejo_7_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Min H, Chung H, Seong S, Sim N, Yoon JH, Lee JG, Kim CH, Cho HJ. Differential characteristics of pediatric sinusitis in patients who underwent endoscopic sinus surgery: childrenvs.adolescents. Clin Otolaryngol 2016; 41:579-84. [DOI: 10.1111/coa.12568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- H.J. Min
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - H.J. Chung
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - S.Y. Seong
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - N.S. Sim
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - J.-H. Yoon
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
- The Airway Mucus Institute; Yonsei University College of Medicine; Seoul South Korea
| | - J.-G. Lee
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - C.-H. Kim
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
- The Airway Mucus Institute; Yonsei University College of Medicine; Seoul South Korea
| | - H.-J. Cho
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
- The Airway Mucus Institute; Yonsei University College of Medicine; Seoul South Korea
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Shin JM, Byun JY, Baek BJ, Lee JY. Cellular proliferation and angiogenesis in nasal polyps of young adult and geriatric patients. Int Forum Allergy Rhinol 2015; 5:541-6. [PMID: 25732481 DOI: 10.1002/alr.21506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/12/2015] [Accepted: 01/17/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cellular proliferation and angiogenesis are associated with pathophysiology of nasal polyposis (NP). In a previous report, we showed that patient age is a predictive factor of surgical outcomes among patients with chronic rhinosinusitis and NP, and that geriatric patients exhibit better outcomes than pediatric and adult patients. We postulated that better outcomes in the geriatric population may be secondary to decreased proliferation and angiogenesis within polyps. Therefore, we evaluated the cellular proliferation and angiogenesis in young adult and geriatric patients with NP. This was a prospective case-control study. METHODS Twenty patients were divided into 2 groups according to age (20 to 30 years vs ≥65 years of age). NP tissues were sampled during endoscopic sinus surgery and processed for immunohistochemistry. Cellular proliferation was evaluated with proliferating cell nuclear antigen and Ki67, and angiogenesis was assessed with vascular endothelial growth factor. We also compared objective surgical outcomes using endoscopy scores. RESULTS Immunohistochemical analysis revealed significantly higher expression and positive reactivity of proliferating cell nuclear antigen and Ki67 in the polyps of young adults than in those of geriatric patients, whereas the expression of vascular endothelial growth factor was similar between the 2 groups. Endoscopy scores were better in the geriatric group. CONCLUSION Geriatric patients have a lower cellular proliferative ability than young adults, and angiogenesis does not significantly differ between the 2 age groups. Cellular proliferation seems to be the cause of the different surgical outcomes between the 2 age groups, whereas angiogenesis has no significant influence on the postoperative course.
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Affiliation(s)
- Jae Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Korea
| | - Jang Yul Byun
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Byoung Joon Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Jae Yong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
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Relationship between positive bacterial culture in maxillary sinus and surgical outcomes in chronic rhinosinusitis with nasal polyps. Auris Nasus Larynx 2014; 41:446-9. [PMID: 24928065 DOI: 10.1016/j.anl.2014.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 05/06/2014] [Accepted: 05/13/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES There are many studies on clinical prognosis following endoscopic sinus surgery (ESS) for the treatment of chronic rhinosinusitis with nasal polyp (CRSwNP). However, there are no independent reports on bacterial infection as a factor that influences surgical outcomes. We investigated the association between bacterial infection and surgical outcomes following ESS. METHODS This retrospective review of medical records was performed on 71 patients with CRSwNP that was refractory to medical treatment and who were diagnosed between July 2007 and June 2012. The extent of the polyps and the Lund-Mackay CT score (L-M score) were preoperatively evaluated in all the patients. For this analysis, patients were classified into three groups (normal flora, culture-positive, and culture-negative) according to their intraoperative bacterial culture results. We compared the objective endoscopic findings between these groups at 6-months postsurgery. RESULTS Bacteria were cultured in 55 of the 71 patients (77%). Of these, 43 patients (61%) demonstrated endoscopic improvement at the 6-month follow-up examination. The preoperative L-M score and polyp grade demonstrated no significant statistical differences in terms of surgical outcome, but the cure rate was statistically higher in culture-negative patients in comparison with normal flora and culture-positive patients (87.5% vs. 46.2% vs. 54.8, respectively). CONCLUSION Intraoperative culture results can be a prognostic factor for the clinical outcomes of ESS in CRSwNP patients. Hence, the intraoperative culturing of pathologic secretions and the postoperative administration of susceptible antibiotics could improve surgical results.
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Makary CA, Ramadan HH. The role of sinus surgery in children. Laryngoscope 2013; 123:1348-52. [PMID: 23361382 DOI: 10.1002/lary.23961] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/28/2012] [Accepted: 12/06/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Chadi A. Makary
- Department of Otolaryngology; West Virginia University School of Medicine; Morgantown; West Virginia; U.S.A
| | - Hassan H. Ramadan
- Department of Otolaryngology; West Virginia University School of Medicine; Morgantown; West Virginia; U.S.A
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Tsukidate T, Haruna S, Fukami S, Nakajima I, Konno W, Moriyama H. Long-term evaluation after endoscopic sinus surgery for chronic pediatric sinusitis with polyps. Auris Nasus Larynx 2012; 39:583-7. [PMID: 22342567 DOI: 10.1016/j.anl.2011.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 10/25/2011] [Accepted: 01/13/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Long-term retrospective evaluation was performed of computed tomography (CT) images and endoscopic findings after endoscopic sinus surgery for 88 cases of chronic pediatric sinusitis with nasal polyps. The objective was to determine the appropriate duration of such postoperative evaluation for children. METHODS Fifty-one patients had both sinusitis and nasal polyps (BSP group), and the surgical procedure was decided in consideration of each patient's age (for less than 10 years of age, polypectomy (n=12); for 10-13 years old, anterior ethmoidectomy plus opening of the fontanelle and nasofrontal duct (n=20); and for serious cases older than 13 years, total sinusectomy (n=19)). On the other hand, for cases of unilateral sinusitis with antrochoanal polyps (USP group), anterior ethmoidectomy plus opening of the fontanelle was performed regardless of the patient's age (n=37, 5-15 years old). RESULTS The postoperative endoscopic findings indicated that the polyps had been eliminated in approximately 91% of total patients. Good postoperative findings of CT images in most patients of USP group are observed at one year after the operation like the same of the postoperative course of adult chronic sinusitis. On the other hand CT images in BSP group evaluated one year after the operation were rated as unchanged or worsened in approximately half of the patients. However, at 4 years after the operation nearly all the patients were rated as improved or better. In addition, comparison of the age at final observation and the postoperative course found a striking decrease in the proportion of unchanged and worsened patients aged 12 and above. CONCLUSION Accordingly, it was concluded that there is difference of healing process after the operation between USP and BSP group. Postoperative evaluation of BSP group should be performed for 4 years and up to an age of at least 12 years although post-ESS following of USP group is similar to that of adult sinusitis.
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Affiliation(s)
- Toshiharu Tsukidate
- Department of Otorhinolaryngology, Dokkyo Medical University, 880 Kitakobayashi Mibu-machi, Tochigi, Japan
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Lee JY, Byun JY, Shim SS, Lee SW. Outcomes after endoscopic sinus surgery for unilateral versus bilateral chronic rhinosinusitis with nasal polyposis. Am J Rhinol Allergy 2010; 24:83-6. [PMID: 20537280 DOI: 10.2500/ajra.2010.24.3482] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) is a safe and reliable procedure for the treatment of chronic rhinosinusitis (CRS) and nasal polyposis (NP). Although most cases of CRS with NP occur bilaterally, we occasionally encounter patients with unilateral sinus disease with NP. Because no study has been conducted on the surgical outcomes between unilateral and bilateral CRS with NP after ESS, we evaluated subjective and objective outcomes between patients with unilateral and bilateral CRS with NP. METHODS A total of 181 patients diagnosed with CRS with NP were enrolled. Twenty-three patients had unilateral CRS with NP and 158 patients had bilateral disease. The extent of NP, Lund-Mackay score, and involved sinuses were evaluated with nasal endoscopy and preoperative computed tomography (CT). Objective and subjective surgical outcomes were assessed 6 months after ESS, using endoscopic findings, the Sino-Nasal Outcome Test 20 (SNOT-20), and visual analog scales. RESULTS The extent of NP and Lund-Mackay score did not differ significantly between the two groups. The SNOT-20 and six main symptom scores included in the questionnaire were significantly improved 6 months postoperatively in both groups, with no significant difference between the groups. However, the unilateral group showed significantly better objective outcomes than the bilateral group. CONCLUSION Unilateral CRS with NP showed more favorable objective surgical outcomes than bilateral disease. We suggest that the developmental mechanisms of the two disease entities may be different and that bilateral CRS with NP may be more intimately associated with a patient's innate tendency to develop NP.
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Affiliation(s)
- Jae Yong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University, College of Medicine, Bucheon Hospital, Bucheon, South Korea.
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Weakness of buccal branch of facial nerve after canine fossa puncture. The Journal of Laryngology & Otology 2010; 125:214-6. [DOI: 10.1017/s0022215110001945] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report a case of weakness of the buccal branch of the facial nerve after a canine fossa puncture procedure.Method:A case report and literature review are presented.Results:A 52-year-old woman diagnosed with right chronic maxillary sinusitis underwent canine fossa puncture during endoscopic sinus surgery. Immediately after the operation, she complained of motor weakness of the right upper lip and oral commissure, in the area innervated by the buccal branch of the facial nerve. Electroneurography revealed incomplete paralysis of the right buccal branch. However, facial weakness had recovered spontaneously by three months post-operatively, with no permanent disability.Conclusion:This is the first reported case of an injury to the buccal branch of the facial nerve following canine fossa puncture. Although the incidence of this complication is very low, surgeons should inform their patients of the possibility, and should take care when choosing the puncture site.
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Sgambatti Celis L, Gil Melcón M, Franco Calvo F, de la Fuente Cañibano R, del Rey Tomás-Biosca F, Batuecas Caletrio A. [Complications of endoscopic sinus surgery in a residency training program]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:345-50. [PMID: 20684938 DOI: 10.1016/j.otorri.2010.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 06/17/2010] [Accepted: 06/24/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Endoscopic sinus surgery presents a series of complications that can vary depending on the technique used and the surgeon's experience. This technique needs a learning curve, which must be developed during the residence training program. METHODS Descriptive and retrospective study, reviewing the medical records of endoscopic sinus surgery for nasal polyps of 192 patients who had undergone operations performed by residents at our department between January 2002 and January 2008. Patient sex, age, affectation scale and minor and major complications were described. All these procedures were performed by 3rd or 4th-year residents under the supervision of a faculty member. RESULTS Of the 192 patients, 127 (66.14%) were male and 65 (33.85%) female, aged between 24 and 78 years old, with a mean age of 49 years old. Nasal endoscopy revealed polyposis of grade i, 19 (9.8%) cases; grade ii, 55 (28.6%); and grade iii, 118 (61.45%). There were 44 (22.9%) total complications, 40 (20.8%) minor and 4 (2.08%) major complications. The most common minor complication was synechia formation in 21(10.93%) cases, followed by bleeding without need for transfusion in 12 (6.25%). The major complication was a breach of the lamina papyracea in 4 patients (2.08%). There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. CONCLUSIONS Endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.
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Affiliation(s)
- Luciano Sgambatti Celis
- Departamento de Otorrinolaringología y Patología Cérvico-Facial, Hospital Clínico Universitario, Salamanca, España.
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Tan NCW, Floreani SR, Robinson S, Nair S, Sunkaraneni VS, Faris C, Wormald PJ. Transillumination-assisted maxillary trephination: cadaver validation of a new technique. Laryngoscope 2009; 119:984-7. [PMID: 19266581 DOI: 10.1002/lary.20154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Neil C-W Tan
- Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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Siedek V, Stelter K, Betz CS, Berghaus A, Leunig A. Functional endoscopic sinus surgery--a retrospective analysis of 115 children and adolescents with chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol 2009; 73:741-5. [PMID: 19269044 DOI: 10.1016/j.ijporl.2009.01.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 01/20/2009] [Accepted: 01/26/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Functional endoscopic sinus surgery (FESS) is not frequently performed in children. The aim of our retrospective analysis was to determine symptoms, surgical extent, complications and outcome of operated children. METHODS For a period from 1994 to 2004 the clinical records of the Department of Otorhinolaryngology, LMU Munich, Germany, were screened for pediatric FESS procedures. Subsequently, a retrospective chart review was performed in all cases. For assessment of outcome, symptom- and quality of life-related questionnaires were sent out to all patients. RESULTS 115 children had a FESS procedure due to CRS, 77 were boys and 38 girls. The response rate of the questionnaires was 64% (73 of 115); the mean follow up of these was 5.4 (+/-1.8) years. 76% of the patients reported an improvement of their chief symptoms and 71% of their general quality of life. The overall quality of life had improved significantly (p<0.01) on VAS. In CRS patients nasal obstruction was completely relieved in 62.3%, facial pain in 65.5% and postnasal drip in 72.5%. Improvement of primary nasal symptoms (PNS) of CRS in patients with CF, asthma or allergies as well as in youngsters who had started or continued to smoke 35 out of 73 (48%) was significantly less. CONCLUSIONS Self-assessment after FESS showed in 76% improvement of chief symptoms in children with CRS. Besides known negative prognostic factors for long-term outcome as CF, asthma, nasal polyps, allergies and previous surgery, smoking was correlated with less favourable improvement.
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Affiliation(s)
- Vanessa Siedek
- Ludwig Maximilians-University, Department of Otorhinolaryngology, Head and Neck Surgery, Munich, Germany.
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Lee JY, Lee SW, Lee JD. Comparison of the surgical outcome between primary and revision endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Am J Otolaryngol 2008; 29:379-84. [PMID: 19144298 DOI: 10.1016/j.amjoto.2007.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 11/19/2007] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Many studies have examined the prognostic factors affecting the success of endoscopic sinus surgery (ESS), and a history of previous ESS is generally regarded as a factor contributing to a poor surgical outcome. The aim of this study was to investigate whether previous ESS with polypectomy is really associated with poor surgical outcomes after revision ESS (RESS) by comparing the postoperative results between primary ESS (PESS) and RESS groups for chronic rhinosinusitis with nasal polyposis. MATERIALS AND METHODS A retrospective analysis of prospectively collected data was performed on 2 groups with a minimum 1-year follow-up: patients who underwent PESS with polypectomy (101 patients) and those who required RESS with polypectomy (24 patients). The extent of disease was compared using the Lund-MacKay scoring system, and the degree of polyposis was measured. Subjective patient symptom scores were recorded using the Sinonasal Outcome Test 20 (SNOT-20) questionnaire, and objective endoscopic physical findings were scored according to the parameters preoperatively and 6 and 12 months postoperatively. The surgical outcomes of the PESS and RESS groups were compared using the SNOT-20 and nasal endoscopy scores. RESULTS The Lund-Mackay score and degree of preoperative polyposis did not differ statistically between the groups. The preoperative mean SNOT-20 and nasal endoscopy scores were improved significantly at 6 and 12 months postoperatively, and the subjective and objective surgical outcomes of the 2 groups did not differ statistically. The need for additional medications during the follow-up period and the proportion of patients who required additional surgical intervention due to surgical failure was similar in both groups. CONCLUSION The results of this study suggest that a history of ESS with polypectomy does not predict an unsuccessful surgical outcome after RESS and that ESS with polypectomy is a reliable and effective method for improving a patient's quality of life regardless of primary or revision surgery.
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Relationship between the frequency of postoperative debridement and patient discomfort, healing period, surgical outcomes, and compliance after endoscopic sinus surgery. Laryngoscope 2008; 118:1868-72. [PMID: 18641526 DOI: 10.1097/mlg.0b013e31817f93d3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the optimal frequency of postoperative care after endoscopic sinus surgery, we evaluated the relationship between the frequency of postoperative debridement and patient discomfort, healing period, surgical outcomes, and compliance. STUDY DESIGN A prospective randomized study. METHODS Patients diagnosed with chronic rhinosinusitis with or without nasal polyposis were randomly allocated to three groups (N = 10 each group), according to the frequency of office visits for postoperative debridement during a 4-week postoperative period. Group 1 underwent debridement twice a week, group 2 once a week, and group 3 once every 2 weeks. Four weeks after the procedure, the patients in each group were asked about discomfort between visits for postoperative debridement, including nasal obstruction, nasal discharge, foul odor, postnasal drip, and headache. Responses were scored using the visual analogue scale (VAS). Six months after surgery, the healing period was evaluated and both subjective and objective surgical outcomes were assessed using the Sinonasal Outcome test 20 and endoscopic findings. Patient compliance to postoperative debridement was also evaluated using the VAS. We compared the statistical significance of these parameters among the three groups. RESULTS In groups 1, 2, and 3, nasal polyposis was present in eight, eight, and six patients, respectively, and five, one, and four patients had unilateral sinusitis. The VAS scores for four of the five main symptoms regarding patient discomfort differed significantly among the groups; group 3 reported the worst scores. However, healing periods, Sinonasal Outcome test-20 scores, and objective endoscopic findings did not show statistical differences among the groups. Patient compliance to the frequency of postoperative debridement differed significantly among the groups. Patients in group 1 reported the greatest disturbance in academic and socioeconomic activities, whereas the patients in groups 2 and 3 demonstrated similar scores. CONCLUSIONS One-week intervals seem to be the optimal frequency for postoperative debridement during the healing period after endoscopic sinus surgery. However, patient individualization should be taken into account depending on the extent of surgery and healing progress.
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Is the canine fossa puncture approach really necessary for the severely diseased maxillary sinus during endoscopic sinus surgery? Laryngoscope 2008; 118:1082-7. [PMID: 18388769 DOI: 10.1097/mlg.0b013e318169028d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the necessity of canine fossa puncture (CFP) by comparing the symptom scores and postoperative computed tomography (CT) findings between patients with severe maxillary sinus disease who underwent CFP and those who underwent maxillary sinus clearance through a middle meatal antrostomy (MMA). STUDY DESIGN A prospective, randomized study. MATERIALS AND METHODS Fourteen patients met the inclusion criteria for each of the CFP and MMA groups. In both groups, all diseased sinuses were addressed in the same manner using the same surgical techniques; the only difference was management of the maxillary sinus. Most of the patients completed the Sinonasal Outcome Test 20 (SNOT-20) and visual analogue scales (VAS) for the six main symptoms preoperatively and 3, 6, and 12 months postoperatively. The Lund-Mackay scores for the maxillary sinus and for all sinuses were calculated from the preoperative CT scan and another scan taken 12 months postoperatively. The mucosal thickening as a percentage of the total volume of the maxillary sinus was also evaluated on the postoperative CT scans, and complications related to both procedures were investigated. RESULTS Twenty-four patients completed the follow-up, questionnaires, and postoperative CT scans and were included in the analysis: 11 CFP patients and 13 MMA patients. All of the patients had chronic rhinosinusitis with nasal polyposis (NP). There were no significantdifferences in polyp extent or Lund-Mackay score for the maxillary sinus and for all sinuses on the pre- and postoperative CT scans between the groups. The volume of mucosal thickening also did not differ significantly between the groups on the postoperative CT scans. The SNOT-20 and VAS scores improved significantly 3, 6, and 12 months after the procedure in both groups. However, there were no significant differences between the two groups except for the VAS for postnasal drip 3 months postoperatively, which was better in the CFP group. Six of 11 patients in the CFP group experienced one or more complications after the procedure, although all of the symptoms resolved spontaneously within 3 months. In the MMA group, three patients had bleeding from the branches of the sphenopalatine artery during widening of the ostium, which was controlled intraoperatively with suction cauterization. CONCLUSIONS We could not find any benefits of the CFP procedure over the conventional MMA method in the present study. Although CFP is a useful method for removing severe mucosal disease that cannot be reached through the MMA, it does not guarantee a better subjective or objective surgical outcome in patients who have accompanying NP.
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Lee JY, Lee SW. Influence of age on the surgical outcome after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope 2007; 117:1084-9. [PMID: 17545871 DOI: 10.1097/mlg.0b013e318058197a] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether patient age is associated with the surgical outcome after endoscopic sinus surgery (ESS) with polypectomy. STUDY DESIGN A prospective, controlled case series. MATERIALS AND METHODS This study consisted of 60 patients who were diagnosed as having chronic rhinosinusitis (CRS) with nasal polyposis (NP) that was refractory to medical treatment. Three groups were classified according to patient age: pediatric (5-18 yr), adult (19-65 yr), and geriatric (over 65 yr). We collected 20 patients in each age group after applying the exclusion criteria. The extent of the polyps and the Lund-Mackay score were calculated for each patient, and they underwent ESS with polypectomy. We compared the objective endoscopic findings and subjective improvements in symptoms among the groups 6 months after the procedure. RESULTS There were no statistical differences in polyp extent or Lund-Mackay score between the three age groups. The objective surgical outcome based on the endoscopic findings was worst in the pediatric group (45%), whereas the geriatric group showed the best results (90%). The differences in objective outcome among the three groups were significant, and patient age was a predictive variable for surgical result based on multiple logistic regression analysis. No major complications occurred, and the overall improvement in subjective symptoms was statistically significant in all three age groups at 6 months postoperatively. The subjective surgical outcome did not differ statistically between the groups, with the exception of olfactory disturbance. CONCLUSIONS The results of the present study suggest that patient age influences the objective postoperative outcome in the endoscopic treatment of CRS with NP, and that ESS is an effective and reliable method for improving the subjective symptoms in patients of all age groups despite the statistically different objective surgical outcomes between the groups.
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Affiliation(s)
- Jae Yong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea.
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Lusk RP, Bothwell MR, Piccirillo J. Long-Term Follow-Up for Children Treated With Surgical Intervention for Chronic Rhinosinusitis. Laryngoscope 2006; 116:2099-107. [PMID: 17146379 DOI: 10.1097/01.mlg.0000244387.11129.a0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The goal of this study is to retrospectively compare the long-term, 10 year, outcomes of surgical versus medical management of young children with chronic rhinosinusitis. STUDY DESIGN This is a retrospective, age-matched, cohort outcome study performed at a tertiary-care hospital. METHODS Two groups of young children (2-5 yr old) with chronic rhinosinusitis were treated with endoscopic sinus surgery or medically managed and evaluated 10 years after their initial therapy. Of the 131 eligible patients, 67 could be located and consented to participate in the study. Six symptoms (day cough, night cough, irritability or crankiness, headaches, nasal airway obstruction, and purulent rhinorrhea) were used to assess the outcome of their treatment. RESULTS Children undergoing endoscopic sinus surgery had more significant disease as noted on the computed tomography (CT) scans. Their symptom severity, however, was similar. When individual symptoms were compared, there were no statistically significant differences between the surgically and medically managed groups. When the mean was controlled for baseline symptom severity and CT severity, there was statistical improvement in nasal airway obstruction and decreased rhinorrhea. There was a trend toward improvement in cough, but this was not statistically significant. Parenteral assessment of improvement (change) in symptoms (P = .001) and their degree of satisfaction with treatment (P = .005) was significantly higher in the surgically managed group. CONCLUSIONS Children who have chronic rhinosinusitis improve in their symptoms of nasal airway obstruction and purulent discharge if they undergo surgery. Parents of young children with chronic rhinosinusitis appear to be more satisfied with the outcome of surgical management than medical management when assessed 10 years later.
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Affiliation(s)
- Rodney P Lusk
- Department of Pediatric Otolaryngology, Boys' Town National Research Hospital, Nebraska, USA.
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Rudnick EF, Mitchell RB. Improvements in quality of life in children after surgical therapy for sinonasal disease. Otolaryngol Head Neck Surg 2006; 134:737-40. [PMID: 16647526 DOI: 10.1016/j.otohns.2005.12.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 12/20/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To study changes in quality of life in children with chronic sinonasal disease after surgical therapy. STUDY DESIGN AND SETTING Prospective, nonrandomized quality of life study of children with sinonasal disease who undergo adenoidectomy or functional endoscopic sinus surgery (FESS) at an academic institution. Caregivers completed a preoperative SN-5 quality of life survey and a second survey within 6 months after surgery. RESULTS Twenty-two children were enrolled in the study (mean, 6.5 years; range, 1.4 to 15.9). The majority (59%) of children underwent adenoidectomy. The mean total score was 25.8 at initial presentation and 12.0 at follow-up (P>0.001). Postoperative scores for all domains were significantly different from preoperative scores. The domains with the greatest change in mean score were nasal obstruction and emotional distress. There were no significant differences in outcome between children who underwent adenoidectomy and those who underwent FESS. CONCLUSIONS After either adenoidectomy or FESS, caregivers report a dramatic improvement in the quality of life of children with sinonasal disease. EBM RATING B-3b.
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Affiliation(s)
- Emily F Rudnick
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
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Sobol SE, Samadi DS, Kazahaya K, Tom LWC. Trends in the Management of Pediatric Chronic Sinusitis: Survey of the American Society of Pediatric Otolaryngology. Laryngoscope 2005; 115:78-80. [PMID: 15630371 DOI: 10.1097/01.mlg.0000150671.45484.87] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The management of chronic sinusitis (CS) in children has yet to be fully elucidated. The objective of this study is to assess practice trends within the pediatric otolaryngology community for the management of children with CS. METHODS A multiple choice survey of the members of the American Society of Pediatric Otolaryngology (ASPO) was performed to assess for various factors related to the management of CS in children. RESULTS A total of 175 ASPO members responded to the survey. The majority of respondents initially treat patients medically with oral antibiotics (95%), topical steroids (90%), and nasal saline sprays (68%). Fifty-five percent performed adenoidectomy as part of the treatment of CS, with 81% performing the operation before endoscopic sinus surgery (ESS). Compared with 3 years before the survey, 47% of respondents performed approximately the same number of ESS cases, whereas 35% reported doing fewer cases annually. Seventy-two percent of practitioners do not routinely perform a second-look surgery. CONCLUSIONS The majority of pediatric otolaryngologists use oral antibiotics, nasal steroids, and saline lavage, and will perform adenoidectomy when managing patients with CS. More than a third of pediatric otolaryngologists are using more stringent criteria for surgery and performing less extensive surgery than 3 years before the survey. Surgical outcomes for CS do not appear to have changed over the past 3 years.
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Affiliation(s)
- Steven E Sobol
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
PURPOSE OF REVIEW Allergic rhinitis and rhinosinusitis are common diseases occurring in both children and adults that consume enormous amounts of health care dollars. In addition to its own costs, allergic rhinitis is considered a major predisposing factor for the development of rhinosinusitis. Whereas many authors suggest a clinical association between these two diseases, the mechanism of how allergic rhinitis predisposes to rhinosinusitis or affects the course of rhinosinusitis remains unclear. RECENT FINDINGS Limited progress has been made in understanding the pathophysiologic mechanism involved in the interaction. Progress in immunologic technique emphasizes the importance of inflammatory cells, especially eosinophils, mast cells, and T lymphocytes, and their mediators. Some authors have proposed a role for neurogenic pathways, whereas others have focused on systemic involvement. Little progress has been made in intervention studies that support the importance of allergic rhinitis in altering the course of acute or chronic rhinosinusitis. SUMMARY This paper reviews the limited new literature available to update knowledge that supports the association of allergic rhinitis with rhinosinusitis, mechanisms potentially underlying the association, and implications of this knowledge for therapy.
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Affiliation(s)
- Virat Kirtsreesakul
- Section of Otolaryngology-Head and Neck Surgery, The Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
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Endoscopic sinus surgery: what we know from the literature. Curr Opin Otolaryngol Head Neck Surg 2002. [DOI: 10.1097/00020840-200202000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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