Deep learning in computed tomography to predict endotype in chronic rhinosinusitis with nasal polyps

BACKGROUND

As treatment strategies differ according to endotype, rhinologists must accurately determine the endotype in patients affected by chronic rhinosinusitis with nasal polyps (CRSwNP) for the appropriate management. In this study, we aim to construct a novel deep learning model using paranasal sinus computed tomography (CT) to predict the endotype in patients with CRSwNP.

METHODS

We included patients diagnosed with CRSwNP between January 1, 2020, and April 31, 2023. The endotype of patients with CRSwNP in this study was classified as eosinophilic or non-eosinophilic. Sinus CT images (29,993 images) were retrospectively collected, including the axial, coronal, and sagittal planes, and randomly divided into training, validation, and testing sets. A residual network-18 was used to construct the deep learning model based on these images. Loss functions, accuracy functions, confusion matrices, and receiver operating characteristic curves were used to assess the predictive performance of the model. Gradient-weighted class activation mapping was performed to visualize and interpret the operating principles of the model.

RESULTS

Among 251 included patients, 86 and 165 had eosinophilic or non-eosinophilic CRSwNP, respectively. The median (interquartile range) patient age was 49 years (37-58 years), and 153 (61.0%) were male. The deep learning model showed good discriminative performance in the training and validation sets, with areas under the curves of 0.993 and 0.966, respectively. To confirm the model generalizability, the receiver operating characteristic curve in the testing set showed good discriminative performance, with an area under the curve of 0.963. The Kappa scores of the confusion matrices in the training, validation, and testing sets were 0.985, 0.928, and 0.922, respectively. Finally, the constructed deep learning model was used to predict the endotype of all patients, resulting in an area under the curve of 0.962.

CONCLUSIONS

The deep learning model developed in this study may provide a novel noninvasive method for rhinologists to evaluate endotypes in patients with CRSwNP and help develop precise treatment strategies.

Predictive significance of computed tomography in bilateral sinonasal respiratory epithelial adenomatoid hamartoma

KEY POINTS

Respiratory epithelial adenomatoid hamartoma (REAH) is easily confused with nasal polyps (NP). The typical manifestation of REAH on CT is the enlargement of bilateral olfactory clefts (OCs). The widening of the OCs in the CT scan is a biomarker for diagnosing REAH associated with NP.

Anatomical findings in patients with chronic rhinosinusitis without nasal polyps requiring revision surgery

OBJECTIVES

For the treatment of chronic rhinosinusitis functional endoscopic sinus surgery is a well-established therapy with high initial success rates. However, a significant proportion of patients have persistent disease requiring revision surgery. To date, studies including data of large patient collectives are missing. In this study, we aimed to identify anatomic factors increasing the need for revision surgery in a large patient collective with chronic rhinosinusitis without nasal polyps.

METHODS

Data were collected retrospectively on patients with recurrent or persistent chronic rhinosinusitis without nasal polyps requiring revision surgery. The patients' symptomatology, endoscopic and radiographic findings were analyzed. Preoperatively, patients were evaluated with endoscopic examination of the nose and paranasal sinuses. In all individuals computed tomography of the sinuses was performed. Images were evaluated according to the Lund-Mackay system. Information was also collected intraoperatively.

RESULTS

253 patients were included. The most common anatomic factor was incomplete anterior ethmoidectomy (51%), followed by residual uncinated process (37%), middle turbinate lateralization (25%), incomplete posterior ethmoidectomy (20%), frontal recess scarring (19%), and middle meatal stenosis (9%). Other factors such as persistent sphenoid pathology was less frequent.

CONCLUSION

Iatrogenic causes with inadequate resection of obstructing structures seem to be a principal risk factor for recurrent chronic rhinosinusitis and the need for revision sinus surgery. Meticulous attention in the area of the ostiomeatal complex during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary endoscopic sinus surgery.

LEVEL OF EVIDENCE

2b.

Preoperative Sinonasal Computed Tomography Score in Chronic Rhinosinusitis with Nasal Polyps

This study investigated the relationship between sinonasal inflammatory involvement according to the computed tomography (CT) staging system (Lund–Mackay score) with clinical, laboratory, histopathological and prognostic features of chronic rhinosinusitis with nasal polyps (CRSwNP). Seventy-eight patients with CRSwNP who had undergone surgery were enrolled. Total (p = 0.0062), ethmoid (p = 0.0496), sphenoid (p = 0.0335), ostiomeatal complex (OMC) (p = 0.0235) and frontal (p = 0.0164) CT scores were predictive of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD) in the univariate analysis. Total (p = 0.0022), ethmoid (p = 0.0290), sphenoid (p = 0.0370), frontal (p = 0.0116), maxillary (p = 0.0357) and OMC (p = 0.0058) CT scores were predictve of asthma at the univariate analysis. No significant differences were found between patients with vs. without allergy in terms of total and partial CT scores. High blood eosinophil counts (>0.24 vs. ≤0.24 cells × 109/L) resulted in being associated with total (p = 0.0213), maxillary (p = 0.0227) and ethmoid (p = 0.0491) CT scores in the univariate analysis. Higher ethmoid (p = 0.0006) and total sinonasal (p = 0.0027) CT scores were found to predict histopathologically eosinophil CRSwNPs in the univariate analysis. CT scores did not result as predictive of NSAID-exacerbated respiratory disease, asthma, or blood eosinophil count at the multivariate analysis. Risk of relapse was related to the presence of NERD (p = 0.0207, HR [95% CI] 3.914 [1.232–12.435]), higher preoperative total (HR = 1.098 95%CI: 1.001–1.204, p = 0.0486) and frontal sinus CT scores (HR = 1.555 95%CI: 1.006–1.886, p = 0.0218), but these results were not confirmed by the multivariable analysis. Sinonasal CT scores showed significant differences in this heterogeneous inflammatory condition. Identifying CRSwNP characteristics is necessary to avoid generic treatments with poor outcomes.

High CT values relative to the brainstem differentiate inverted papillomas from nasal polyps

OBJECTIVES

A diagnostic indicator for the differentiation of inverted papillomas (IPs) from inflammatory nasal polyps (NPs) has not been established. This study aimed to evaluate whether CT attenuation values relative to those of the brainstem (relative CT number) could be useful for differentiating IPs from NPs.

MATERIAL AND METHODS

Consecutive patients who were pathologically diagnosed with IP or NP between 2005 and 2019 were retrospectively identified. Relative CT numbers were compared between the two patient groups. The factors with predictive power for differentiating IPs from NPs were identified by univariate and multivariate logistic regression analyses.

RESULTS

One hundred and twenty-two sinonasal masses were finally analysed (IP, 51 cases; NP, 71 cases). Relative CT numbers were significantly higher in IP than in NP (P < 0.001). Univariate logistic regression analysis showed relative CT number, bone erosion and bone thickening to have predictive value for differentiating IPs from NPs (relative CT number, P < 0.001; bone erosion, p = 0.04; bone thickening, P < 0.001). In the multivariate logistic regression analysis, relative CT number and bone thickening had predictive value for distinguishing IP from NP (relative CT number, p < 0.001; bone thickening, p = 0.02). The optimum cut off value calculation from the area under the receiver operating characteristics curve indicated that a relative CT number >1.3 was significantly associated with IP (sensitivity, 72.6%; specificity, 87.3%). Within cases not showing bone thickening, only the relative CT number was a predictive factor for differentiating IPs from NPs in the univariate analysis.

CONCLUSIONS

High relative CT numbers could potentially indicate IP, and their measurement could provide a basis for differentiating IPs from NPs.

Nasal Polyposis in mucopolysaccharidosis type II

Mucopolysaccharidosis (MPS) type II is a rare multisystem disorder resulting from the accumulation of breakdown products of glycosaminoglycans in the body tissues. Many patients with this disease undergo ENT (ear, nose and throat) surgeries such as adenotonsillectomy and tympanocentesis at a very early age, much before the diagnosis of MPS. Nasal polyposis is a rare occurrence, with only one case of MPS II with polyposis reported in the literature. We present a patient who presented with recurrent nasal polyposis from the age of 2 years. Hale's colloidal iron was used to stain these 'nasal polyps', which revealed that they are, in fact, mucopolysaccharide-laden sinonasal mucosa prolapsing into the nasal cavities. We believe this is the first time that this stain has been used to stain nasal polyps in MPS. In addition to the histopathological peculiarities of these nasal masses, we also discuss the natural history of nasal polyposis in MPS II.

Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study

BACKGROUND

Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS.

METHODS

It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009-2019.

RESULTS

The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001).

CONCLUSION

Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.

Computed Tomography Findings Can Help Identify Different Chronic Rhinosinusitis With Nasal Polyp Phenotypes

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNPs) has several phenotypes.

OBJECTIVES

The goal of this study was to evaluate computed tomography (CT) findings associated with each CRSwNP phenotype.

METHODS

Patient charts between January 2015 and March 2019 were retrospectively reviewed. Patient groups, including allergic fungal rhinosinusitis (AFRS), aspirin-exacerbated respiratory disease (AERD), central compartment atopic disease (CCAD) and CRSwNP not otherwise specified (CRSwNP NOS), were determined by standard criteria. The oldest CT scan available was reviewed for Lund-Mackay (LM) score, septal involvement of inflammatory disease, opacification of olfactory clefts, nasal cavity opacification, and oblique positioning of the middle turbinates. Nonparametric analyses of variance were performed with correction for multiple comparisons.

RESULTS

A total of 356 patients had scans available for review; 80 (23%) patients were categorized into the AFRS group, 101 (28%) in the AERD group, 43 (12%) in the CCAD group, and 132 (37%) in the CRSwNP NOS group. Septal inflammatory involvement and oblique middle turbinate orientation on CT scans was higher in both AERD patients and CCAD patients as compared to AFRS and CRSwNP NOS patients (P < .05). Olfactory cleft opacification was increased in the AERD group compared to all other diagnoses (P < .05). The CCAD group showed lower LM scores compared to all other groups (P < .05), and the AFRS group revealed the greatest differences between left and right LM grades, representing unilaterality of disease (P < .05).

CONCLUSION

CRSwNP encompasses many subsets of disease, which have varying treatments and intraoperative findings. Preoperative CT findings can be used to differentiate between these groups to improve prediction of diagnoses and patient counseling.

Clinical features and management of antrochoanal polyps in children: Cues from a clinical series of 58 patients

OBJECTIVE

To review the clinical features of pediatric patients affected by antrochoanal polyps (ACPs) and surgically treated at three University settings.

METHODS

Retrospective study. The present research includes the clinical data of subjects affected by ACPs, aged <18 years and referred to three ENT Departments, between January 1st 2003 and September 30th 2016. All patients underwent nasal endoscopy and sinonasal imaging; all subjects have been treated surgically.

RESULTS

Fifty-eight patients underwent functional endoscopic sinus surgery (FESS) for ACPs removal, under general anesthesia. There were no major intraoperative complications. Recurrence occurred in 12 cases (20.5%).

CONCLUSIONS

FESS was the first-choice treatment for APCs in the present series; our recurrence rate was similar to that of other reports available in literature. Recurrences of ACPs in children still represent a clinical challenge; it is likely that an improved comprehension of ACPs biology could help in better understanding the pathophysiology of this disease.

Intracranial Polyps in Patients with Samter's Triad

Background

We describe three patients with Samter's triad (nasal polyps, aspirin intolerance, and asthma) with skull base dehiscence in whom the polyps extended into the extradural space and also resulted in hypertelorism and widening of the nasal bridge.

Methods

One patient died in a road traffic accident while awaiting surgery. The other two patients underwent endoscopic resection of the polyps with a combined osteoplastic flap.

Results

Histology confirmed benign eosinophilic polyps with edematous stroma and a markedly thickened basement membrane. There were no complications or revision procedures. Both are symptomatically well with improvement of the hypertelorism.

Conclusion

These cases indicate that polyps in Samter's triad may be extremely aggressive, resulting in intracranial extension. A combined endoscopic and osteoplastic flap approach is a safe and effective surgical option.

Intranasal Esthesioneuroblastoma: CT Patterns Aid in Preventing Routine Nasal Polypectomy

BACKGROUND AND PURPOSE

Esthesioneuroblastoma is a neuroectodermal tumor that commonly arises in the nasal cavity olfactory recess and, when isolated to the intranasal cavity, can be indistinguishable from benign processes. Because lesional aggressiveness requires a more invasive operation for resection than polypectomy, patients with isolated intranasal lesions were studied to define distinguishing CT characteristics.

MATERIALS AND METHODS

Patients with intranasal esthesioneuroblastoma and controls without esthesioneuroblastoma with olfactory recess involvement were identified by using a report search tool. Studies demonstrating skull base invasion and/or intracranial extension were excluded. The imaging spectrum of these lesions was reviewed on both CT and MR imaging, and CT findings were compared with those of controls without esthesioneuroblastoma. Two blinded readers assessed subjects with esthesioneuroblastomas and controls without esthesioneuroblastoma and, using only CT criteria, rated their level of suspicion for esthesioneuroblastoma in each case.

RESULTS

Eight histologically proved cases of intranasal esthesioneuroblastoma were reviewed. All cases had CT demonstrating 3 main findings: 1) an intranasal polypoid lesion with its epicenter in a unilateral olfactory recess, 2) causing asymmetric olfactory recess widening, and 3) extending to the cribriform plate. Twelve patients with non-esthesioneuroblastoma diseases involving the olfactory recess were used as controls. Using these 3 esthesioneuroblastoma CT criteria, 2 blinded readers evaluating patients with esthesioneuroblastoma and controls had good diagnostic accuracy (area under the curve = 0.85 for reader one, 0.81 for reader 2) for predicting esthesioneuroblastoma.

CONCLUSIONS

Esthesioneuroblastoma can present as a well-marginated intranasal lesion that unilaterally widens the olfactory recess. CT patterns can help predict esthesioneuroblastoma, potentially preventing multiple operations by instigating the correct initial operative management.

Comparison of surgical outcomes between patients with unilateral and bilateral chronic rhinosinusitis

BACKGROUND

Although the majority of patients with chronic rhinosinusitis without nasal polyposis (CRSsNP) suffer from bilateral disease, a subset suffer from unilateral disease. Currently, outcomes following endoscopic sinus surgery (ESS) for medically recalcitrant CRS are inferred from outcomes for patients with bilateral disease. This study compares outcomes of ESS between patients with unilateral and bilateral disease.

METHODS

Patients with CRSsNP who failed appropriate medical therapy and elected ESS were enrolled between 2011 and 2015. Patients were dichotomized according to radiographic evidence of unilateral disease (Lund-Mackay [LM] score = 0 for 1 side) or bilateral disease (LM ≥ 1 for both sides). The primary outcome of interest was the 22-item Sino-Nasal Outcome Test (SNOT-22), with secondary outcomes including the Brief Smell Identification Test (BSIT) and the Lund-Kennedy (LK) endoscopy staging system.

RESULTS

A total of 190 patients met inclusion criteria consisting of 19 with unilateral (10%) and 171 with bilateral CRSsNP (90%). Both groups were similar across all preoperative demographic factors, SNOT-22, and BSIT scores. Postoperatively, patients with bilateral disease reported greater improvement in mean SNOT-22 scores compared to unilateral disease, but this difference was not statistically or clinically significant (-24.3 ± 21.1 vs -21.5 ± 24.0, p = 0.582). Mean LK scores improved for patients with bilateral disease but not unilateral disease, without a difference between groups (-2.0 ± 3.5 vs -0.4 ± 2.4, p = 0.090).

CONCLUSION

Patients with unilateral CRSsNP experience improvement after ESS comparable to patients with bilateral disease on patient reported outcome measures.

The evaluation of pattern and quality of sleep in patients with chronic rhinosinusitis with nasal polyps

OBJECTIVE

The goal of this study is to evaluate the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on sleep pattern and sleep quality before and after functional endoscopic sinus surgery using subjective and objective parameters.

METHODS

Twenty-two patients with CRSwNP were evaluated. All subjects underwent assessment by nasal endoscopy, rhinomanometry and computed tomography. Sleep pattern and sleep quality were evaluated by Pittsburgh sleep quality index (PSQI) and polysomnography (PSG). All patients were reassessed 6 months after surgery.

RESULTS

Nasal resistance decreased after the surgery (p<0.001). Postoperative PSQI scores were significantly lower than preoperative scores (p<0.001). The preoperative mean values of total apnea index and apnea-hypopnea index were 25.4 and 13.3, respectively. After surgery, the total apnea and apnea-hypopnea index had decreased significantly to 7.8 and 11.2, respectively (p=0.009 and 0.019, respectively).

CONCLUSION

In patients with CRSwNP, functional endoscopic sinus surgery significantly ameliorates sleep pattern and sleep quality. CRSwNP may be a predisposing factor for sleep related respiratory disorders.

Heterogeneous inflammatory patterns in chronic rhinosinusitis without nasal polyps in Chicago, Illinois

CRSsNP is a heterogenous disease but type 2 inflammation in CRSsNP was more common than type 1 inflammation among patients in Chicago, Illinois. Distinct therapeutic strategies may be needed depending on the type of inflammation found in CRSsNP.

[Significance of differential diagnosis for sinonasal mass by CT value]

OBJECTIVE

To explore whether CT value is useful in identifying different disease in tumors of rhinosinus parenchyma.
 Methods: The data of preoperation noncontrast CT in 277 patients were retrospectively reviewed. The final diagnosis and classification were based on the result of surgical histopathological examination. The CT value range for different classification was calculated and was compared. All patients were re-diagnosed according to CT value range combined with pathological results by the same doctor team. The diagnosis rates according to CT value range were compared.
 Results: The CT value was (25.3±3.5) Hu in nasal polyp, (7.9±3.5) Hu in serous cyst, (42.2±4.7) Hu in mucocele, (40.7±5.3) Hu in papilloma, (112.3±10.9) Hu in fungus ball, (41.7±4.8) Hu in hemangioma, (51.2±9.9) Hu in malignant melanoma, and (47.1±9.9) Hu in squamous carcinoma. The CT value in nasal polyp is significantly higher than that in serous cyst, which was significantly lower than that in mucocele, papilloma, fungus ball, hemangioma, malignant melanoma and squamous carcinoma (all P<0.05); the CT value in serous cyst was significantly lower than that in other classification diseases (all P<0.05); the CT value in fungus ball was significantly higher than that in other classification diseases (all P<0.05); there was no significant difference in CT value among mucocele, papilloma, hemangioma, malignant melanoma, squamous carcinoma (all P﹥0.05). The diagnosis rate was elevated (from 71.1% to 92.4%) according to CT value range, with significant difference (χ2=42.150, P<0.01).
 Conclusion: CT value in nasal polyp, serous cyst, fungus ball is different from other diseases, and the 3 diseases can be distinguished only by CT value range; the CT value in mucocele, papilloma, hemangioma, malignant melanoma and squamous carcinoma is similar, and their differential diagnosis should combine with imaging data and other clinical characters. The diagnosis rates can be improved when the CT value range is taken into account.

Density of Middle Turbinate Subepithelial Mucous Glands in Patients with Chronic Rhinosinusitis

OBJECTIVE: Histologic changes have not been systematically assessed in chronic rhinosinusitis. Quantitative histochemical studies evaluated the extent of sinus disease and gland density in the middle turbinates.

STUDY DESIGN AND SETTING: Sinus computed tomography scans of 34 patients with chronic rhinosinusitis were retrospectively graded 0 to IV according to the May classification. Middle turbinates from patients with chronic rhinosinusitis (n = 46) and normal patients (n = 7) were harvested during endoscopic sinus surgery. The areas of Alcian blue-stained glands were assessed in paraffin sections using a computer-assisted microscopy video system.

RESULTS: Alcian blue-stained glands occupied 7.94% of normal mucosa. The staining in all grade III rhinosinusitis subjects was increased to 12.94% ( P < 0.01). In contrast, grade IV pansinusitis was associated with nasal polyposis (6 of 6) with decreased gland area (3.04%, P < 0.01). When polyp patients were excluded from grade III rhinosinusitis, the Alcian blue-staining area was 17.68% ( P < 0.01).

CONCLUSIONS: Distinct polypoid and glandular histopathologic patterns are present in chronic rhinosinusitis.

Cholesteatoma and coexisting findings diagnosed incidentally on MRI

The explosive growth in the use of diffusion-weighted magnetic resonance imaging (MRI) in the pre- and postoperative evaluations of patients with cholesteatoma has led to a concomitant increase in the number of incidental findings in this population. We describe our retrospective examination of MRI studies in cholesteatoma patients to look for the presence of other coexisting abnormalities. We examined the brain MRIs of 103 patients-45 males and 58 females, aged 3 to 81 years (mean: 31.9 ± 21.3)-who had undergone pre- or postoperative imaging during the management of a cholesteatoma. The MRIs revealed the presence of at least one other anomaly in 79 of these patients (76.7%)-36 males and 43 females, aged 3 to 81 years (mean: 43.5 ± 18.2). These 79 MRIs detected a total of 124 lesions that had been coexisting with cholesteatomas; some of these lesions had overlapped with the cholesteatoma. The two most common findings were sinonasal mucoperiosteal thickening and polyposis (n = 66) and white-matter changes (n = 29). Our results establish the need for routine skilled interpretation of brain MRIs by expert neuroradiologists to ensure that findings coexisting with cholesteatoma are detected so that appropriate management can be provided.

Unilateral Opacification of Paranasal Sinus CT Scans

Objectives

The aim of study was to describe the histopathology in patients with unilateral sinus opacification and to identify variables that may predict neoplastic pathology.

Study Design

A retrospective review of paranasal sinus CT scans performed between 2000 and 2003 was conducted to identify patients with unilateral sinus opacification.

Results

Twenty-eight of 1118 CT scans showed unilateral sinus opacification. Twelve patients had neoplastic disease, 13 had inflammatory disease. Nasal discharge was more common in inflammatory than neoplastic disease (P = 0.009). A polyp or mass lesion was more common on nasendoscopy in neoplastic than inflammatory disease (P = 0.01). Bony erosion was only identified in malignant disease.

Conclusion

A wide variety of pathologies present with unilateral sinus opacification on CT scanning. In our series, neoplastic disease was more associated with a visible polyp or mass lesion and less with nasal discharge. Bony erosion on CT scan was only seen in malignant disease. Histologic confirmation remains obligatory for diagnosis.

The Impact of Atopy, Sinus Opacification, and Nasal Patency on Quality of Life in Patients with Severe Nasal Polyposis

OBJECTIVES: Nasal polyposis has a great impact on the quality of life. The aim of this study was to evaluate the association between quality of life and atopy, sinus opacification, and nasal patency in severe nasal polyposis.

METHODS: One hundred nine patients completed the Medical Outcome Study Short Form-36 (SF-36) survey. Symptoms, polyp size, atopy, nasal patency, and sinus opacification were also scored.

RESULTS: Patients showed worse scores in all SF-36 domains, except for physical functioning, compared with Spanish population. Atopic patients had worse scores in role physical, body pain, vitality, and mental health than nonatopic patients. Atopic patients showed lower physical component summary (44.7 ± 1.1) and mental component summary (38.4 ± 1.0) than nonatopic patients (48.3 ± 1.6, 40.6 ± 1.3; P < 0.05), respectively. There were no correlations between quality of life and symptoms, polyp size, CT scan, nasal patency, and atopy.

CONCLUSION: Nasal polyposis has a considerable impact on quality of life and atopy worsens this impact.

EBM rating: C-4

Respiratory epithelial adenomatoid hamartoma of the olfactory groove: A report of 4 cases and a review of the literature

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign lesion that affects the nasal cavity and paranasal sinuses. We present 4 cases of REAH that involved the olfactory clefts; 1 case was bilateral. Each of the cases was treated surgically, and no recurrence was observed. Most reports have indicated that REAH occurs in the presence of sinonasal inflammation, particularly nasal polyposis, yet all 4 of our cases occurred in the absence of concurrent rhinosinusitis. This suggests that the etiology of REAH is multifactorial. In addition, we review the literature on REAH, and we discuss its presentation, differential diagnosis, radiology, histopathology, and underlying treatment principles.

Volumetric computed tomography analysis of the olfactory cleft in patients with chronic rhinosinusitis

BACKGROUND

Commonly used computed tomography (CT) staging systems for chronic rhinosinusitis (CRS) focus on the sinuses and do not quantify disease in the olfactory cleft. The goal of the current study was to determine whether precise measurements of olfactory cleft opacification better correlate with olfaction in patients with CRS.

METHODS

Olfaction was assessed using the 40-item Smell Identification Test (SIT-40) before and after sinus surgery in adult patients. Olfactory cleft opacification was quantified precisely using three-dimensional (3D), computerized volumetric analysis, as well as via semiquantitative Likert scale estimations at predetermined anatomic sites. Sinus opacification was also quantified using the Lund-Mackay staging system.

RESULTS

The overall cohort (n = 199) included 89 (44.7%) patients with CRS with nasal polyposis (CRSwNP) and 110 (55.3%) with CRS without nasal polyposis (CRSsNP). The olfactory cleft opacified volume correlated with objective olfaction as determined by the SIT-40 (Spearman's rank correlation coefficient [Rs ] = -0.461; p < 0.001). The correlation was significantly stronger in the CRSwNP subgroup (Rs = -0.573; p < 0.001), whereas no appreciable correlation was found in the CRSsNP group (Rs = -0.141; p = 0.141). Correlations between sinus-specific Lund-Mackay CT scoring and SIT-40 scores were weaker in the CRSwNP (Rs = -0.377; p < 0.001) subgroup but stronger in the CRSsNP (Rs = -0.225; p = 0.018) group when compared to olfactory cleft correlations. Greater intraclass correlations (ICCs) were found between quantitative volumetric measures of olfactory cleft opacification (ICC = 0.844; p < 0.001) as compared with semiquantitative Likert grading (ICC = 0.627; p < 0.001).

CONCLUSION

Quantitative measures of olfactory cleft opacification correlate with objective olfaction, with the strongest correlations seen in patients with nasal polyps.

Endoscopic management of antrochoanal polyps: a single UK centre's experience

Antrochoanal polyps (ACPs) are benign lesions that originate from the mucosa of the maxillary sinus, and extend into the nasal cavity to reach the choana and nasopharynx. The treatment of ACPs is surgical, with a number of different surgical techniques having been described. We describe the first case series of ACPs from the UK and the endoscopic surgical technique that we have employed. A retrospective case note review of patients with ACPs managed under the care of the senior author was conducted. Demographic and clinical data for all patients were reviewed. The main outcome parameter measured was any sign of recurrence. A total of 29 consecutive patients were included for analysis from a 5-year study period, with 19 males and 10 females, and a mean age of 37.4 ± 13.6 years. Four patients within our group were referred to us with recurrent ACPs for revision surgery. All patients underwent surgery via the same endoscopic technique. The mean follow-up period was 14.7 ± 16.9 months, with an average follow-up of 22.5 months for the four revision cases. There were no recurrences in any of our patients. We describe the first reported series of endoscopic sinus surgery for antrochoanal polyps in the UK, and the largest worldwide series described for endoscopic management of ACPs in adults. We have had no recurrent cases, with a mean follow-up period of 14.7 months.

Periostin and receptor activator of nuclear factor κ-B ligand expression in allergic fungal rhinosinusitis

BACKGROUND

Allergic fungal rhinosinusitis (AFRS) is a disease demonstrating substantial eosinophilic inflammation and characteristic radiographic bony erosion/expansion. Periostin is an extracellular matrix protein associated with eosinophil accumulation in eosinophilic esophagitis, allergic asthma mucus production, and chronic rhinosinusitis (CRS) polyp formation. Receptor activator of nuclear factor κ-B ligand (RANKL) is an osteoclast activator present in osteoporosis and periodontal disease. We sought to evaluate periostin and RANKL expression in AFRS and correlate these levels with radiographic scales of disease severity.

METHODS

Thirty sinus tissue specimens were intraoperatively collected from 3 patient groups: AFRS; CRS without nasal polyps (CRSsNP); and controls (n = 10 per group). Specimens were analyzed by semiquantitative reverse-transcription polymerase chain reaction (sq-RT-PCR) and immunofluorescence (IF) labeling/confocal microscopy for the presence of both periostin and RANKL. Immunofluorescence staining intensity was quantified by pixel density analysis. Preoperative computed tomography (CT) scans from each patient were scored using both the Lund-Mackay and CT bone erosion scoring systems.

RESULTS

Periostin was significantly elevated in AFRS sinus tissue compared to CRSsNP and controls, as demonstrated by IF (p < 0.001) and PCR (p = 0.011). RANKL was not detected in sinus tissue by IF or PCR. Periostin levels positively correlated with radiographic indices of disease severity for both soft tissue and bone, using Lund-Mackay (r = 0.926 [PCR] and r = 0.581 [IF]) and CT bone erosion (r = 0.672 [PCR] and r = 0.616 [IF]) scoring systems, respectively.

CONCLUSION

Periostin is increased in AFRS tissue compared to CRSsNP and controls. Periostin levels positively correlate with radiologic disease severity scores. The increased levels of periostin in AFRS are possibly tied to its intense eosinophilic inflammatory etiology.

An incidental finding on a diagnostic CBCT: a case report

It is known that Cone Beam Computed Tomography (CBCT) provides reliable spatial data and has many clinical applications for dental and particularly orthodontic patients. The present article provides a short review of the literature and reports an unusual CBCT finding in an orthodontic patient referred for the assessment of impacted upper canines. A unilateral lesion in the left maxillary sinus, was an incidental finding. Following a histological examination, which revealed unilateral nasal polyps, surgical removal was performed as the treatment of choice.

The prevalence of allergic fungal rhinosinusitis in sinonasal polyposis

Allergic fungal sinusitis (AFS) is a noninvasive form of fungal rhinosinusitis with a prevalence of 6-9 % among all rhinosinusitis cases requiring surgery. The fungi causing AFRS have a great diversity and regional variation in the incidence of AFS has been reported worldwide. The aim of this study was to evaluate the prevalence of AFS among rhinosinusitis patients in the north east of Iran. In a prospective cross-sectional study 127 patients with sinonasal polyposis who were candidates for surgery were recruited. All cases were evaluated by sinonasal CT scan, Prick test for common regional allergens, total serum immunoglobulin E (IgE) level, and allergic mucin culture for fungi in suspected cases. Data analyses were done using SPSS version 13.0. Their mean age was 37.4 ± 11.6 years, the male-to-female ratio was 69/58. Eleven patients (9.45 %) met the AFS criteria. Nine cases had a positive culture for Aspergillus specimen and three for Alternaria. Prick test was positive for at least one allergen in 28 cases (22.05 %). The most common allergen was weed. The total IgE level was significantly higher in AFS patients. This study showed the prevalence of AFS among patients with nasal polyposis to be 9.45 %.

Correlation of computed tomography with pathological features in angiomatous nasal polyps

Background

Angiomatous nasal polyps (ANPs), also known as angiectatic polyps, have rarely been reported in the literature. ANPs are characterized by extensive vascular proliferation and ectasia. ANPs can grow rapidly and exhibit aggressive clinical behavior that could simulate malignancy preoperatively, and they are easily confused with other diseases. In the present study, we analyzed the correlation between the computed tomography (CT) findings of nasal angiomatous polyps and their pathological features.

Methods

We evaluated CT findings and pathological features of 31 surgically proven ANPs.

Results

The study population included 16 males and 15 females aged between 27 and 81 years (mean age, 53.5 years). On CT, the masses were heterogeneous; they had a soft tissue density and filled the maxillary and/or nasal cavities. Calcifications were found in 2 of the 31 cases. The lesions showed a clear boundary (15/31). The low-density shading on CT was related to the inflammatory, necrotic, and cystic changes, and the high-density shading on CT was related to hemorrhagic areas of the mass. On contrast-enhanced CT, the center of the lesions was non-enhanced with peripheral intensification due to occlusion or compression of feeder vessels of the polyp center, and the inflammatory cells and neovascularization around the edge of the mass. The most common site of maxillary wall erosion was the medial wall (21/31), followed by the posterior lateral wall (3/31), upper wall (2/31), and septum (3/31). Of these, the nasal cavity and/or maxillary sinus were enlarged in 28 cases. These findings were associated with the chronic progress of nasal angiomatous changes.

Conclusions

CT of ANPs may demonstrate benign bone changes associated with the lesions and may also reflect the fact that ANPs do not invade peripheral soft tissue. CT demonstrated these lesions consistently and provided information useful for surgical planning.

[Clinical observation on the origin of antrochoanal polyp]

OBJECTIVE

To explore the origin and etiopathogenesis of antrochoanal polyp (ACP) based on the clinical data.

METHODS

Twenty-six patients with ACP were included in the study. All the ACP patients were documented by preoperative endoscopy and computer tomographic (CT) scans. All patients were treated under endonasal endoscopic surgery. The relationship between polyp in middle meatus and lesions in the antrum was observed during the surgery. Following surgical removal, the polyps and lesions in the antrum were studied under macroscopy and microscopy.

RESULTS

Among 26 cases with ACP, 17 cases were confirmed by preoperative endoscopic examination that polyp originating from antrum ostium, 19 cases showed intimate relationship between the polyp and antrum lesions in CT scan, and 23 cases were found that the polyp originating from the antrum cyst. The pedicle of polyp connected the cyst through autrum ostium, and the polyp existed as a part of capsule wall.

CONCLUSION

Based on the data obtained, it is tempting to suggest that the ACP mainly develops from antral cyst, an increase in pressure in cyst forced capsule wall to herniate to middle meatus through the antral ostium, and the continuous herniation and hyperplasy leading to the formation of ACP.

Olfactory neuroblastoma presenting as bleeding polyp

Malignant tumours of the nasal cavity are rare. Olfactory neuroblastomas (esthesioneuroblastomas) account for only 6% of these neoplasms. Fewer than 1,000 cases have been reported in the literature since this tumour was first described more than 75 years ago. A 13 year old girl presented with bleeding nasal polyp to ENT Department. She was operated as there were no signs of tumour the histopathology report revealed it to be olfactory neuroblastoma. As there was no intracranial extension she was given postoperative radiotherapy.

Antrochoanal polyps: report of 94 cases and review the literature

OBJECTIVE

The aim of this study was to evaluate the management of antrochoanal polys (ACPs) with functional endoscopic sinus surgery and review literatures.

METHODS

We retrospectively studied the clinical presentations and operative records of 94 patients with ACPs treated surgically in the period of September 1999 to March 2008 (about 9 years). Age, gender, side, Clinical symptoms, duration of follow up, associated rhinological findings, forms of surgical treatment, postoperative complications and recurrence rate were reviewed.

RESULTS

Total records of 94 patients [mean (+/- SD age of 26.5 +/- 12.8 years, 55 males (58.5%) and 39 females (41.5%)] were studied. Postoperative follow-up duration ranged from 8 to 68 months. The most common clinical symptom was nasal obstruction (100%) and Rhinorrhoea (57.4%). The origins and sites of the pedicle in the maxillary sinus were mostly present in medial wall in 32 patients. Recurrence rate in our study was of 5.3% (5 cases) after 10 months postoperatively. For the revision surgery, endoscopic resection was combined with Caldwell-Luc procedure.

CONCLUSION

The antrochoanal polyp happens predominantly in children and young adults of both male and female patients. Endoscopic sinus surgery is an effective, safe and reliable method with major advantage for the treatment of antrochoanal polyps.

[A preliminary study of radionuclide imaging of the nasal lymphatic system in nasal polyps]

OBJECTIVE

To explore the role of nasal mucosal lymphatic drainage in the pathogenesis of nasal polyps.

METHODS

There were 25 cases in the experimental group who had nasal polyps (which was further divided into Malm-1, Malm-2, Malm-3 level 3 subgroups) and 6 cases in the control group, including thyroid cancer and laryngeal cancer patients who had normal nasal structure. The nasal polyps in the experimental group and the middle turbinate in the control group were injected with a radionuclide and a radionuclide imaging technique was used to image the nasal mucosal lymphatics. The lymphatic drainage status of the nasal mucosa through the imaging results was analysed.

RESULTS

The T/NT ratio (radioactivity counting) of the region of interest (ROI) was 20. 66 +/- 1.89 in the control group and 29. 33 +/- 6.34 in the experimental group. The difference was significant (t = 3.275, P < 0.05). The T/NT ratio of the ROI was 24.40 +/- 3.19 in the Malm-1 level group, 29.31 +/- 3.39 in the Malm-2 level group, 39.21 +/- 3.15 in the Malm-3 level group. The differences of qualitative analysis were significant (F = 38. 980, P < 0.05). The quantitative analysis showed that at the injection site, signs of lymphatic development and drainage were not found in the control group or experimental group, but the phenomenon of contrast media retention existed at the injection site in the experimental group.

CONCLUSION

Lymphatic drainage dysfunction exists in patients with nasal polyps, and it may play a role in the pathogenesis of nasal polyps.

[Correlation between patient-based questionnaires and computer tomography staging in chronic rhinosinusitis]

OBJECTIVE

To investigate the relationship between the patient-based questionnaires and the computed tomography (CT) staging in patients with chronic rhinosinusitis (CRS).

METHODS

Quantitative data of 121 preoperative recruits with CRS were collected by using the Lund-Mackay CT staging system, a visual analogue scale (VAS), sino-nasal outcome test-20 (SNOT-20), and the medical outcome study short-form 36 items (SF-36). The patients were classified into several subgroups according to whether CRS was associated with nasal polyps (NP) or not, sex, duration of disease, and educational background. Correlation between the patient-based questionnaires and the CT staging were analyzed in the total cohort patients and subgroups.

RESULTS

In the total cohort patients, there were significant correlations between SNOT-20 and SF-36 (r = -0.561, P < 0.01), SNOT-20 and VAS (r = 0.743, P < 0.01), and SF-36 and VAS (r = -0.504, P < 0.01), however, the CT staging did not correlate with the patient-based questionnaires (P > 0.05). Significant but weak correlations were found between the CT staging and the patient-based questionnaires in the CRS with NP subgroup (CT vs SNOT-20, r = 0.318, P = 0.005; CT vs SF-36, r = -0.358, P = 0.002; CT vs VAS, r = 0.358, P = 0.002). Compared between CRS with NP and without NP subgroup, there were statistic differences on the Lund-Mackay CT stage and the SNOT-20 and VAS scores (t value was 3.249, -2.409, -2.957, respectively, all P < 0.05).

CONCLUSIONS

The patient-based questionnaires correlate well with each other, but CT staging correlated significantly but weakly with the patient-based questionnaires only in the CRS with NP subgroup. Nasal polyps do not appear to be responsible for the adverse effects of CRS on quality of life.

Eosinophilic chronic rhinosinusitis in Japan

Chronic rhinosinusitis is a heterogeneous disease. In Europe and the United States, it has recently been divided into two subgroups: chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). The majority of CRSwNP cases have a strong tendency to recur after surgery and show eosinophil-dominant inflammation. However, this definition has proved difficult to apply in Japan and East Asia, because more than half of the CRSwNP cases do not exhibit eosinophil-dominant inflammation in these areas of the world. In Japan in the 1990s, refractory CRSwNP to the standard treatment was focused on in clinical studies and the term "eosinophilic chronic rhinosinusitis" (ECRS) was introduced to identify this subgroup of chronic rhinosinusitis in 2001. ECRS is different from non-ECRS in terms of many clinical features: symptom appearance, occurrence site of nasal polyps, CT scan findings, the histology of nasal polyps, blood examination findings, clinical course after surgery, and co-morbid asthma, etc. In this review, we describe these clinical features and mention how to make a clinical diagnosis of ECRS as well as how to treat it. Finally, we discuss the pathophysiology of ECRS. The concept of ECRS in Japan would be applicable for CRSwNP in other countries including Europe and the United States.

Significance of osteomeatal complex obstruction

INTRODUCTION

Classic teaching suggests that disease in the osteomeatal complex (OMC) plays a pivotal role in the establishment of chronic rhinosinusitis (CRS). We sought to test this hypothesis.

METHODS

Retrospective review of 106 consecutive patients enrolled prospectively into an allergy/sinus centre database, meeting Task Force criteria for CRS. Inflammatory disease was scored radiologically via a modification of Lund-Mackay methodology, omitting the OMC itself (maximum score 10 per side).

RESULTS

Patients were stratified into three groups: no osteomeatal complex (NOMC) obstruction (n = 38; 35.8%), unilateral osteomeatal complex (UOMC) obstruction (n = 24; 22.6%), and bilateral osteomeatal complex (BOMC) obstruction (n = 44; 41.5%). The mean adjusted total disease score was 3.6, 6.3, and 12.3 for each, respectively (p < .0001). BOMC obstruction patients were significantly more likely to have asthma than those with UOMC or NOMC obstruction (52%, 17%, 16%, respectively; p < .0001). Nasal polyposis was more frequently observed in the setting of BOMC obstruction (59%) compared with either UOMC (38%) or NOMC (13%) obstruction (p < .0001). The series was also stratified by sides with osteomeatal complex (wOMC) obstruction (wOMC, n = 112) and those without osteomeatal complex (sOMC) obstruction (sOMC, n = 100). The mean ipsilateral score was calculated for the sinus cavities on each side, and this was significantly greater in the wOMC obstruction group (5.7 vs 2.0, p < .0001). The frequency of ipsilateral maxillary sinus disease was also significantly greater in the wOMC obstruction sides (p < .0001).

CONCLUSIONS

More than 35% of patients meeting the Task Force definition of CRS did not manifest OMC obstruction radiologically. When present, OMC obstruction did correlate with the presence of asthma and polyps. OMC obstruction was also associated with increased disease burden overall and ipsilaterally.

[The comparison of the expansion of polyps according to the Ki-67 and computed tomography scores]

OBJECTIVES

The disease extention in nasal polyps was compared by using the mitotic activity rates and the computed tomography scores.

PATIENTS AND METHODS

This study was conducted on 19 nasal polyposis patients (8 males, 11 females; mean age 40.0+/-13.7 years; range 20 to 63 years). The preoperative computed tomography records of the patients were evaluated according to the Lund-Mackay grading system. The polyp tissues of the same patients were stained with the Ki-67 antigen for immunohistochemical evaluation. The correlation between the radiologic results and the Ki-67 values was compared by means of the Spearman's correlation test.

RESULTS

The mean computed tomography score was observed as 14.3+/-4.7 (range 7-24). The mean Ki-67 score resulting from the immunohistochemical staining was calculated as 24.3+/-18.5 (range 3.3-73.5%). A significant correlation was determined between the Ki-67 values and the computed tomography scores. ("Spearman's" correlation factor: 0.677; p<0.001).

CONCLUSION

As the mitotic activity rate of nasal polyps increases, both the volume of the polyps and the computed tomography scores increase as a result of the blockage of the sinus ostiums by the increased polyp volume.

Choanal polyp originating from the nasal septum: septochoanal polyp

Most of the nasal polyps arise from the lateral walls of the nasal cavity. Nasal polyps originating from the nasal septum with choanal extension are extremely rare. We report a case of large choanal polyp that arised from the posterosuperior aspect of the nasal septum, and extended down to the oropharynx. A 52-year-old woman presented with a two-year history of progressive nasal obstruction and snoring. Findings of anterior rhinoscopy were in normal limits. We think that the term "septochoanal polyp" which, as far as we know, has not been mentioned in the literature before, can be used for this rare lesion.

Frontochoanal polyp: case report

Choanal polyps are solitary benign growths that can cause unilateral nasal obstruction. A frontochoanal polyp originates from the frontal sinus and extends to the nasopharynx. These lesions are rare and are usually diagnosed by endoscopic examination and computed tomography. A 20-year-old man presented with unilateral nasal obstruction and headache. Findings on endoscopy and computed tomography suggested frontochoanal polyp, and endoscopic treatment was successful. We discuss the case and review the pertinent literature.

United airways again: high prevalence of rhinosinusitis and nasal polyps in bronchiectasis

BACKGROUND

Although various relationships between the lower and upper airways have been found, the association of bronchiectasis with chronic rhinosinusitis and nasal polyps has not been thoroughly evaluated. This study was undertaken to examine the association of idiopathic and postinfective bronchiectasis with chronic rhinosinusitis and nasal polyposis.

METHODS

In a prospective study, 56 patients with idiopathic and 32 with postinfective bronchiectasis were evaluated for chronic rhinosinusitis and nasal polyposis by using EP(3)OS criteria and assessing: symptoms score, nasal endoscopy, sinonasal and chest CT scan, nasal and lung function and nasal and exhaled NO.

RESULTS

Most bronchiectasis patients (77%) satisfied the EP(3)OS criteria for chronic rhinosinusitis, with anterior (98.5%) and posterior (91%) rhinorrhea and nasal congestion (90%) being the major symptoms. Patients presented maxillary, ethmoidal and ostiomeatal complex occupancy with a total CT score of 8.4 +/- 0.4 (0-24). Using endoscopy, nasal polyps with a moderate score of 1.6 +/- 0.1 (0-3) were found in 25% of patients. Nasal NO was significantly lower in patients with nasal polyposis (347 +/- 62 ppb) than in those without them (683 +/- 76 ppb; P < 0.001), and inversely correlated (R = -0.36; P < 0.01) with the ostiomeatal complex occupancy. In the chest CT scan, patients with chronic rhinosinusitis showed a higher bronchiectasis severity score (7.2 +/- 0.5; P < 0.001) than patients without (3.7 +/- 0.7). The prevalence of chronic rhinosinusitis, nasal polyps and other outcomes were similar in idiopathic and postinfective bronchiectasis.

CONCLUSIONS

The frequent association of chronic rhinosinusitis and nasal polyposis with idiopathic and postinfective BQ supports the united airways concept, and it suggests that the two type of bronchiectasis share common etiopathogenic mechanisms.

Sinus balloon dilators: one surgeon's experience and proposed indications for their use

From October 2006 through September 2007, balloon sinusotomies were attempted on 89 sinuses in 45 patients with chronic sinus disease. Ninety-eight percent of sinuses were successfully dilated, 3.4% required revision surgery, and one complication (unlikely related to use of the balloon) occurred. Forty-four percent had previous conventional endoscopic sinus surgery (ESS), 87% were hybrid cases (combination of balloon and conventional ESS instruments used), 33% had nasal polyposis, and 1.98 sinuses per patient were dilated. Preoperative Lund-Mackay radiographic sinus-staging scores averaged 12.62. Sinus balloon dilators (SBDs) were used on the frontal sinuses 81% of the time, sphenoids 13%, and maxillary sinuses 6%. SBDs were found to be efficacious and safe. The devices were useful in identifying and dilating the frontal recess, especially in cases with altered anatomy or limited visibility. When compared to conventional ESS instrumentation, however, SBDs were found to offer little advantage in opening the maxillary or sphenoid sinuses. In frontal sinus hybrid cases, using the author's proposed surgical algorithm reduces operative time, costs and, in some cases, the need for balloon dilatation. SBDs have limited indications in a select group of patients.

Biofilm in nasal polyps

INTRODUCTION

Bacterial biofilms are involved in many human bacterial infectious processes and in chronic rhinosinusitis as well. The aim of this study was to determine whether biofilm exists in nasal polyps, both in diffuse nasal polyposis (DNP) and antrochoanal polyps (ACP).

METHOD

Tissue samples were taken from seven patients suffering from DNP and three patients suffering from ACP, based on the defined patient inclusion and exclusion criteria. After the preparation, the tissue samples were analyzed by means of scanning electron microscopy (SEM) for signs of biofilm formation.

RESULTS

Signs of biofilm presence were found in all DNP patients. In ACP cases, biofilm was found in the stalk and nasal, polypoid part of the ACP, whereas there were no signs of biofilm on diseased mucosa of the posterior wall of the maxillary sinus.

CONCLUSIONS

Our preliminary study showed a possible role of bacterial biofilm in pathogenesis and maintenance of both DNP and ACP. There are no obvious differences in the SEM appearance of biofilms in DNP and ACP. Future research is needed to explain why biofilm is present in cases of diffuse nasal polyposis and at the nasal part of ACP, but not on the maxillary sinus part of ACP.

Lund-Mackay score is predictive of bleeding in ethmoidectomy for nasal polyposis

OBJECTIVES

To assess the correlation between intraoperative bleeding during endoscopic ethmoidectomy for chronic rhinosinusitis with nasal polyps and objective parameters of disease severity.

STUDY DESIGN

A prospective cohort of 40 patients with nasal polyposis treated by endoscopic ethmoidectomy was analyzed from January 2007 to July 2007.

METHODS

Polyp size and CT scan opacifications were noted. The surgical procedure was performed with a standardized protocol. Intraoperative blood loss was measured. The Spearman test was used to correlate these data.

RESULTS

On nasal endoscopy, the mean polyps' size score was 2.2 (+/- 0.65). On CT scan, the Lund-Mackay grading was 17.2/24 (+/- 5.8). The rate of flow of intraoperative bleeding was 0.077%/min (+/- 0.070%/min). A significant positive correlation was found between the CT scan score and the rate of flow of intraoperative bleeding for the patients who were surgically treated for the first time (n = 23, Spearman Rho = 0.411, p = 0.05).

CONCLUSION

The Lund-Mackay CT score is useful in predicting intraoperative bleeding during endoscopic ethmoidectomy. It could help to identify patients for whom specific measures like preoperative treatment with antibiotics and steroids, topical perioperative preparation of the nose or hypotensive anesthesia are required in order to reduce the risk of intraoperative complications.

[The effectiveness of endoscopic sinus surgery in nasal polyposis]

OBJECTIVES

We evaluated the effectiveness and outcomes of functional endoscopic sinus surgery in the treatment of nasal polyposis.

PATIENTS AND METHODS

The study included 407 patients (262 males, 145 females; mean age 42+/-12 years; range 20 to 76 years) with nasal polyposis. Of these, 102 patients (25%) had asthma, 25 patients (6.1%) had asthma and aspirin sensitivity, and 142 patients (34.8%) had anatomic variations. The patients were operated on using the Messerklinger and Wigand techniques. Functional endoscopic sinus surgery was performed bilaterally. Evaluations were made preoperatively and at six months by endoscopic examination and paranasal sinus computed tomography (Lund-Mackay score). Postoperatively, the patients were treated with nasal irrigation and topical steroid spray.

RESULTS

Following surgery, the mean computed tomography score decreased from preoperative 17.0+/-4.3 to 8.5+/-4.7. Major complication occurred in one patient. Nasal mucosal adhesion was the most frequent minor complication (5.4%). Nasal polyposis recurred in 78 patients (19.1%), of whom 57 patients underwent revision surgery.

CONCLUSION

Our data show that functional endoscopic sinus surgery combined with corticosteroid administration is effective in the treatment of nasal polyposis.