Symptom outcomes in endoscopic sinus surgery: a systematic review of measurement methods

OBJECTIVE: To determine the type and prevalence of measurement methods used to analyze symptom outcomes after endoscopic sinus surgery (ESS). DATA SOURCES: Data were derived from PubMed, MEDLINE, EMBASE, Web of Science, Cochrane databases, Google Scholar, and manual searches. STUDY SELECTION: All English-language studies consisting of more than 10 adult patients from January 1980 to December 2006 reporting ESS symptom outcome results were reviewed. Studies of radical surgery and studies involving patients with significant comorbidities were excluded. RESULTS: The ESS symptom outcome results of 29,333 patients were reported in 204 studies. Symptom outcome was determined by survey instruments in 47 (23.0%) studies and individual symptom scoring in 63 (31%) studies. Of 18 validated instruments used, almost two thirds of studies that reported results by survey measures used the following three instruments: Chronic Sinusitis Survey (12 studies), Sinonasal Outcome Test-20 (11 studies), and Medical Outcomes study 36-Item Short-Form Health Survey (10 studies). The percentages of studies that reported specific results of the 1997 American Academy of Otolaryngology-Head Neck Surgery Rhinosinusitis Task Force (RSTF) chronic rhinosinusitis symptom criteria varied as follows: facial pain/pressure, 35%; facial congestion/fullness, 10%; nasal obstruction/blockage, 42%; nasal discharge/purulence/discolored postnasal discharge, 47%; hyposmia/anosmia, 35%; fever, 2%; halitosis, 4%; fatigue, 11%; dental pain, 3%; cough, 10%; and ear pain/pressure/fullness, 6%. CONCLUSIONS: ESS symptom outcome is assessed inconsistently by numerous measures. Individual report- ing of all RSTF chronic rhinosinusitis symptom criteria, as recommended by the RSTF and by subsequent consensus conferences, is rarely noted. Many RSTF symptom criteria are seldom studied.     

79例复发性鼻窦炎修正性鼻内镜手术

目的探讨慢性鼻窦炎鼻息肉术后复发的原因及影响修正性鼻内镜手术疗效的相关因素。方法对79例(105侧)复发性鼻窦炎鼻息肉患者实施修正性鼻内镜手术,并对所有患者进行围手术期用药及术后鼻内镜定期复查。结果 79例(105侧)患者,术后经12个月以上随访,治愈55例(70侧),好转14例(22侧),无效10例(13侧),治疗总有效率87.34%,无严重的并发症发生。结论术前CT检查、术中有效的止血及找准解剖标志是手术成功的关键。     

Microdebriders used in functional endoscopic sinus surgery: secondary analysis and validation of a new tissue model

OBJECTIVES/HYPOTHESIS: To validate a previously reported in vitro tissue model for microdebrider comparison and determine which microdebrider, tissue type, blade type, and suction strength is most efficient. Specifically, the goal of the secondary analysis is to expand on the results of the preliminary analysis by increasing the sample size, and introduce an aspiration efficiency score (AES) to facilitate microdebrider comparison. STUDY DESIGN: Prospective randomized comparison. METHODS: A prospective randomized comparison of the Diego Powered Dissector and XPS 3000 Powered ENT System was conducted using a soft tissue and a firm tissue model. In addition to evaluating tissue aspiration with straight and angled blades, clogging rates and clearance times were measured. Both standard wall suction and liposuction were used. Basic statistical analysis, a one-way analysis of variance, and a post hoc Student's t test were performed to compare outcomes. RESULTS: With standard wall suction, the microdebriders were equivalent for the overall microdebrider comparison. For the 'head to head' comparison with standard wall suction, the devices were also equivalent when using the straight blades, but the XPS 3000 aspirated more tissue when using the angled blades. With liposuction, the XPS 3000 and liposuction independently aspirated more tissue but clogged more often compared with the Diego PD and regular suction. The aspiration efficiency of soft tissue (oysters) and straight blades was superior compared with firm tissue (scallops) and angled blades. For the 'head to head' comparison with liposuction, the XPS 3000 aspirated more tissue regardless of tissue type, but the Diego PD clogged less with firm tissue (scallops). Overall, the AES favored the XPS 3000, soft tissue (oysters), straight blades, and liposuction. CONCLUSION: Our tissue model represents a reliable and reproducible means of microdebrider comparison. Statistically significant differences between the Diego PD and XPS 3000, as well as between tissue types, blade types, and suction strengths, are reported. Using these results, microdebrider manufacturers can adopt similar tissue models, expand on the current AES, and include other commercially available microdebrider devices to test and report product performance to the consumer. Perhaps an optimal open to closed ratio or liposuction pressure can be determined that yields the greatest tissue aspiration with the fewest number of clogs.     

Smoking in chronic rhinosinusitis: a predictor of poor long-term outcome after endoscopic sinus surgery

OBJECTIVE: This study was designed to determine whether smoking patients have poorer outcomes after endoscopic sinus surgery (ESS) based on a reliable validated rhinosinusitis-specific quality-of-life outcomes test. STUDY DESIGN: Retrospective chart and computed tomography (CT) review with telephone and letter questionnaire. METHODS: Charts of 230 adult patients undergoing ESS for chronic rhinosinusitis between January 1995 and December 1998 were reviewed. Each participating patient completed a detailed questionnaire, including the Sino-Nasal Outcome Test-16 (SNOT-16), at an average of 52 months after surgery. Preoperative CT scans were reviewed and the findings used to stage the patients' conditions. Multivariate analysis was used to assess these data. RESULTS: Eighty-two patients completed the questionnaire, with 26 who smoked at the time of surgery and continued to smoke at the time of answering the questionnaire (Smokers). Average SNOT-16 score in Smokers was 27.5, versus 18.2 in those who did not smoke at the time of surgery (Non-Smokers). There was a statistically significant correlation between elevated SNOT-16 scores and smoking (P <.001) and antibiotic use within the past year (P <.001). There was an association between high SNOT-16 scores and both prior smoking and passive smoke exposure that did not reach statistical significance (P =.055 and P =.267, respectively). CT staging scores and prior ESS were not statistically correlated with SNOT-16 scores. CONCLUSIONS: Smoking is associated with statistically worse outcomes after ESS based on average SNOT-16 scores. Although no investigator has proved that the effects of smoking on sinonasal health are reversible, we counsel smoking patients considering ESS about the desirability of smoking cessation (for this and many health reasons), and the possibility of a poorer postsurgery outcome should they continue smoking.