Clinical Consensus Statement

Objective

To develop a clinical consensus statement on septoplasty with or without inferior turbinate reduction.

Methods

An expert panel of otolaryngologists with no relevant conflicts of interest was assembled to represent general otolaryngology and relevant subspecialty societies. A working definition of septoplasty with or without inferior turbinate reduction and the scope of pertinent otolaryngologic practice were first established. Patients 18 years and older were defined as the targeted population of interest. A modified Delphi method was then used to distill expert opinion into clinical statements that met a standardized definition of consensus.

Results

The group defined nasal septoplasty as a surgical procedure designed to correct a deviated nasal septum for the purpose of improving nasal function, form, or both. After 2 iterative Delphi method surveys, 20 statements met the standardized definition of consensus, while 13 statements did not. The clinical statements were grouped into 8 categories for presentation and discussion: (1) definition and diagnosis, (2) imaging studies, (3) medical management prior to septoplasty, (4) perioperative management, (5) surgical considerations, (6) adjuvant procedures, (7) postoperative care, and (8) outcomes.

Conclusion

This clinical consensus statement was developed by and for otolaryngologists and is intended to promote appropriate and, when possible, evidence-based care for patients undergoing septoplasty with or without inferior turbinate reduction. A complete definition of septoplasty with or without inferior turbinate reduction was first developed, and additional statements were subsequently produced and evaluated addressing diagnosis, medical management prior to septoplasty, and surgical considerations, as well as the appropriate role of perioperative, postoperative, and adjuvant procedures, in addition to outcomes. Additionally, a series of clinical statements were developed, such as “Computed tomography scan may not accurately demonstrate the degree of septal deviation,” “Septoplasty can assist delivery of intranasal medications to the nasal cavity,” “Endoscopy can be used to improve visualization of posterior-based septal deviation during septoplasty,” and “Quilting sutures can obviate the need for nasal packing after septoplasty.” It is anticipated that the application of these principles will result in decreased variations in the care of septoplasty patients and an increase in the quality of care.

Can FESS combined with submucosal resection (SMR)/septoplasty reduce revision rate?

OBJECTIVES

Our study was designed to ascertain the outcomes of functional endoscopic sinus surgery (FESS) combined with submucosal resection (SMR)/septoplasty in reducing FESS revision rates.

STUDY DESIGN

Retrospective population-based study.

SETTING

Academic tertiary medical center.

SUBJECTS AND METHODS

By using the Taiwan Longitudinal Health Insurance Database, we obtained the patients who underwent FESS for chronic rhinosinusitis. These patients were divided into 2 groups: the control group (FESS alone) and the study group (FESS combined with SMR). The primary outcome was the revision operative rate.

RESULTS

In total, 4484 patients who had undergone FESS were recruited into this study. The number of patients who underwent revision FESS was 528 (11.78%). In our sample, 80.45% of patients received FESS alone, whereas 19.54% of the patients underwent concurrent SMR/septoplasty during FESS. There are more female patients and older patients in the control group than in the study group. The revision rates of these 2 groups were significantly different (12.36% vs 9.36%, respectively; P = .016). Moreover, logistic regression analysis came out that patients in the control group had a higher revision rates than those in the study group. Male patients and younger patients were found to have higher revision rates. In addition, patients with asthma or allergic rhinitis had higher revision rates compared with those patients without these 2 comorbidities.

CONCLUSIONS

This study showed an association between FESS combined with concurrent SMR/septoplasty and less incidence of revision rate of FESS. Patients with asthma or allergic rhinitis have an increased risk of requiring more revision surgeries after FESS.

Unilateral pathological lesions of paranasal sinuses removed by endoscopic surgery

INTRODUCTION

The aim of this study was to analyze the incidence and nature of unilateral pathological lesions of paranasal sinuses in patients who had endoscopic sinus surgery performed in ENT.

MATERIALS AND METHODS

In the years 2006-2011 endoscopic sinus surgery for unilateral pathological lesions of paranasal sinuses was performed in 1847 patients (838 women and 1009 men). The enrollment of patients was based on the findings of otolaryngological clinical and subjective examinations, assessment of the paranasal sinuses on three-dimensional CT scans, and laboratory examinations. Based on the analysis of medical history data, including gender, age, the type of surgical procedure performed, and histopathological findings the cases were finally analyzed.

RESULTS

Pathological lesions of the paranasal sinuses were localized on the left side in 132 (57%) patients, and on the right side in 100 (43%) patients. Of the 232 patients with unilateral pathological changes, 41.8% subjects underwent endoscopic sinus surgery for polypotic changes in the ethmoid and maxillary sinuses; 28.4% for the maxillary sinus; 10.8% for the ethmoid, maxillary and frontal sinuses; and 8.6% patients for all paranasal sinuses on one side. The number of operations of only one sinus was considerably lower: sphenoid sinus, 4.7%; ethmoid sinus, 2.2%; and frontal sinus, 1.7% patients. The histopathological analysis of unilateral pathological lesions removed by endoscopic surgery showed chronic paranasal sinusitis with polyps in 56.5% patients; chronic paranasal sinusitis in 22.8% patients; and maxillary sinus cyst was confirmed in 11.6% patients. In 5.1% patients inverted papilloma was diagnosed and in 2.2% patients the presence of osteoma was found.

CONCLUSIONS

Unilateral paranasal pathological lesions, leaving aside rather typical maxillary sinus cysts, require a particularly thorough pre-operative diagnosis and a precise histopathological assessment.

There is no structural relationship between nasal septal deviation, concha bullosa, and paranasal sinus fungus balls

This study aims to determine the relationship between nasal septal deviation, concha bullosa, and chronic rhinosinusitis by using a definitive pathological and simplified model. Fifty-two consecutive sinus computed tomography scans were performed on patients who received endoscopic sinus surgery and whose final diagnosis was paranasal sinus fungus balls. The incidences of nasal septal deviation and concha bullosa for patients diagnosed with paranasal sinus fungus balls among the study group were 42.3% and 25%, respectively. About 63.6% sinuses with fungus balls were located on the ipsilateral side of the nasal septal deviation, and 46.2% were located on the ipsilateral side of the concha bullosa. When examined by Pearson's chi-square test and the chi-squared goodness-of-fit test, no significant statistical difference for the presence of paranasal sinus fungus balls between ipsilateral and contralateral sides of nasal septal deviation and concha bullosa was noted (P = 0.292 and P = 0.593, resp.). In conclusion, we could not demonstrate any statistically significant correlation between the location of infected paranasal sinus, the direction of nasal septal deviation, and the location of concha bullosa, in location-limited rhinosinusitis lesions such as paranasal sinus fungal balls. We conclude that the anatomical variants discussed herein do not predispose patients to rhinosinusitis.

A systematic analysis of septal deviation associated with rhinosinusitis

OBJECTIVES/HYPOTHESIS

Rhinosinusitis might have many etiologies that lead to a common presentation of inflammation and impaired mucociliary clearance. Anatomic factors were once thought to play a large role in the pathogenesis of rhinosinusitis, and septal deviation was examined in multiple studies with conflicting results. With the more recent appreciation that the development of rhinosinusitis is likely multifactorial, it is appropriate to re-examine possible anatomic etiologies. A systematic analysis of septal deviation and rhinosinusitis was therefore performed to better define this association and describe possible etiologic mechanisms. Examination of a large sample, accomplished through systematically identifying and combining previous studies, may compensate for the several shortcomings of these separate analyses. A systematic analysis was therefore performed to answer the question, is septal deviation associated with rhinosinusitis?

STUDY DESIGN

Systematic analysis of previously published studies.

METHODS

Following a structured literature search, articles examining the association of septal deviation and rhinosinusitis were analyzed quantitatively and qualitatively. Based on the quantitative results, a septal deviation angle (SDA) cutoff of 10 degrees was chosen for distinguishing positive from negative for septal deviation in the qualitative analysis.

RESULTS

Of over 300 references initially identified, 13 articles comprised the basis of this review. Increasing angles of septal deviation were associated with increasing prevalence of rhinosinusitis in multiple studies. Combining the results of five previous studies on this subject demonstrated significant association of septal deviation and rhinosinusitis (P = .0004, chi(2) analysis). The clinical effect was found, however, to be modest with an odds ratio of 1.47. Interestingly, in all studies that examined the laterality of rhinosinusitis associated with septal deviation, inflammation was found bilaterally. Based on the data from this analysis, it appears that many of the previous analyses were insufficiently powered to detect an association between rhinosinusitis and septal deviation. Others failed to find an association by examining subjects with small SDAs.

CONCLUSIONS

Septal deviation is associated with an increased prevalence of rhinosinusitis, although the impact of this anatomic anomaly is limited. It appears to be one of many possible factors that might lead to the development of rhinosinusitis.