鼻内镜手术治疗非侵袭性真菌性鼻-鼻窦炎

目的探讨非侵袭性真菌性鼻-鼻窦炎的临床特征,鼻内镜手术方法及疗效。方法回顾性分析102例非侵袭性真菌性鼻-鼻窦炎患者临床资料。结果所有患者均行鼻内镜手术治疗,随访6个月至4年,治愈77例,好转20例,复发5例。结论鼻腔鼻窦解剖异常是非侵袭性真菌性鼻-鼻窦炎的主要致病因素。鼻内镜手术是治疗非侵袭性真菌性鼻-鼻窦炎的有效手段,术后复发与手术的彻底性、术后鼻腔鼻窦处理有关。     

鼻内镜手术治疗非侵袭性真菌性鼻-鼻窦炎59例分析

目的：探讨非侵袭性真菌性鼻-鼻窦炎的致病原因、临床特征、鼻内镜手术方法及临床疗效。方法：对2003—01—2006—12的59例非侵袭性真菌性鼻-鼻窦炎的临床资料进行回顾性分析。结果：全部病例随访2～5年,无一例并发症,57例一次性治愈,复发2例,经再次手术后治愈。结论：鼻内镜手术清除病灶是治疗非侵袭性真菌性鼻-鼻窦炎的最有效方法,手术中应尽量扩大鼻窦的自然开口,手术后定期冲洗窦腔及定期复查可防止疾病的复发。     

鼻内镜下治疗非侵袭性真菌性鼻-鼻窦炎的术式选择与疗效

目的探讨鼻内镜手术与传统术式结合治疗非侵袭性真菌性鼻-鼻窦炎的疗效。方法对我科2003年6月～2009年6月有完整随访资料的接受鼻内镜手术治疗的58例非侵袭性真菌性鼻-鼻窦炎患者的临床资料进行分析。其中采用单纯鼻内镜手术32例,鼻内镜联合改良柯-陆术式11例,鼻内镜联合下鼻道开窗15例,并对所有患者术后情况进行随访。结果随访1年以上,仅3例手术后复发,其余55例在随访期内均未见复发。结论鼻内镜手术是治疗非侵袭性真菌性鼻-鼻窦炎安全且有效的手段,可基本完整保留鼻腔、鼻窦正常的解剖结构。彻底清除真菌团块、术后定期随访是治疗成功的关键。     

鼻内镜手术治疗慢性侵袭性真菌性鼻窦炎45例

目的探讨鼻内镜下治疗慢性侵袭性真菌性鼻窦炎的疗效。方法在鼻内镜下对45例慢性侵袭性真菌性鼻窦炎患者行鼻窦清创术,部分病例加行下鼻道开窗术,彻底清除鼻窦病变组织及鼻病变黏膜和骨质,充分开放鼻窦,术后应用大扶康冲洗术腔,并定期行鼻内镜检查。结果随访6个月至6年,治愈41例,复发4例。复发病例经再次鼻内镜手术后治愈,无手术并发症。结论鼻内镜下鼻窦清创术是治疗侵袭性真菌性鼻窦炎的重要手段,术后定期复查并辅以大扶康术腔冲洗,疗效良好。     

鼻内镜手术治疗真菌性鼻窦炎

近年来鼻腔和鼻窦的真菌感染逐渐增多。对于真菌性鼻窦炎传统的治疗方法是采用柯-陆(Caldwell-Luc)手术。随着鼻内镜技术不断发展,为真菌球性鼻窦炎的治疗提供了新方法。我院自2000年以来,采用鼻内镜手术治疗非侵袭性真菌性鼻窦炎47例,疗效满意,报道如下。     

111例非侵袭性真菌性鼻及鼻窦炎临床特征分析

目的:分析非侵袭性真菌性鼻及鼻窦炎的临床特点、诊治过程及疗效,探讨其诊断要点、处理措施及影响疗效和转归的因素。方法:回顾性总结111例非侵袭性真菌性鼻及鼻窦炎患者的临床资料,分析该疾病的临床症状、鼻内镜及CT检查、手术方法、疗效及复发患者的处理。结果:通过临床症状、鼻内镜及CT检查,86例患者术前已获确诊。全部患者经功能性内镜鼻窦手术治疗均获临床治愈,无一例出现手术并发症,随访1～5年,复发12例,于门诊表面麻醉下鼻内镜处理后7例治愈,5例效果不佳。结论:非侵袭性真菌性鼻及鼻窦炎具有独特的鼻内镜及CT表现,可与一般的慢性鼻鼻窦炎相鉴别;鼻内镜手术是治疗非侵袭性真菌性鼻及鼻窦炎的有效手段;彻底清除病变及术后鼻窦引流通畅是影响疗效和转归的最主要因素。     

72例非侵袭性真菌性鼻-鼻窦炎鼻内镜手术

目的:评价鼻内镜手术在治疗非侵袭性真菌性鼻-鼻窦炎的疗效。方法:采用Storz鼻内镜对72例非侵袭性真菌性鼻-鼻窦炎病例行鼻内镜手术,彻底清除鼻腔、鼻窦病变组织,充分开放鼻窦,扩大上颌窦自然口,使其直径达1.0cm以上,术后应用大扶康冲洗术腔3次。结果:随访6个月~6年,全部病例均治愈,无复发。术前症状如鼻塞、流脓涕、血涕、鼻腔异味及头痛症状消失,经鼻内镜检查:全部病例中鼻道、上颌窦口通畅,鼻腔及窦腔内黏膜正常,腔内无真菌团块及异常分泌物。结论:鼻内镜手术是治疗非侵袭性真菌性鼻-鼻窦炎的主要手段,辅以大扶康液冲洗术腔,疗效更好。     

鼻内镜手术治疗非侵袭型真菌性鼻-鼻窦炎86例的疗效观察

目的观察鼻内镜手术治疗非侵袭型真菌性鼻-鼻窦炎的临床疗效。方法 2015年6月至2016年8月在我科治疗的非侵袭型真菌性鼻-鼻窦炎患者86例,行鼻内镜下鼻窦开放术,术后联合药物治疗及鼻腔冲洗,随访6个月到2年,分析临床疗效。结果 86例非侵袭型真菌性鼻-鼻窦炎患者中,84例术后一次性治愈,随访6个月~2年无复发。2例复发患者,经再次手术后治愈。结论鼻内镜下鼻窦开放术结合药物治疗与鼻腔冲洗,是治疗非侵袭型真菌性鼻-鼻窦炎的有效方法。     

鼻内镜手术治疗真菌性鼻-鼻窦炎26例临床分析

真菌性鼻-鼻窦炎为慢性鼻窦炎里的一种类型,随着CT及鼻内镜的广泛普及,其诊断和治疗取得了较好的效果。2007-01-2011-01期间我科共收治26例真菌性鼻-鼻窦炎患者,均在鼻内镜下手术治疗,随访6个月～3年,效果满意,现报告如下。1资料与方法1.1临床资料通过CT冠状位检查,鼻内镜手术及术后病理证实26例患者为真菌性鼻鼻窦炎,男7例,女19     

真菌性鼻-鼻窦炎研究进展

近年来真菌性鼻-鼻窦炎在临床上日益多见,其病原菌、临床表现、诊断以及治疗均与传统的鼻-鼻窦炎有所不同。不同类型的真菌性鼻-鼻窦炎由于致病的病原菌不同,在临床表现、诊断、治疗以及预后方面有各自的特点,如非侵袭性真菌性鼻-鼻窦炎的治疗以手术为主,而侵袭性真菌性鼻-鼻窦炎除手术外,还需在治疗全身原发疾病基础上全身使用抗真菌药物。本文就各类真菌性鼻-鼻窦炎的病因、临床表现、诊断、治疗及预后等方面做一综述。     

Subjective improvement of olfactory function after endoscopic sinus surgery for chronic rhinosinusitis

OBJECTIVE: The purpose of this study was to determine the effect of functional endoscopic sinus surgery (FESS) on subjective olfactory dysfunction in patients with chronic rhinosinusitis.Materials and methods Prospective collection of data on consecutive patients undergoing FESS after failing prolonged medical therapy for chronic rhinosinusitis at a tertiary institution. Patients were asked to grade their olfactory dysfunction from 0 to 10, with 0 representing normal function and 10 complete anosmia. In addition, data such as computed tomography scores, presence or absence of nasal polyps, and the presence or absence of asthma were recorded and analyzed. Patients were followed up to 1 year after surgery. RESULTS: Data were collected on 178 patients who had sinus surgery over a 2-year period. The average olfactory dysfunction score before surgery was 4.9. This improved to 0.9 at 1 year after surgery (P =.00). Higher computed tomography scores as per Lund and MacKay correlated with higher olfactory dysfunction scores (r = 0.62, P <.01) and greater improvement after surgery (r = 0.82, P <.01). Asthmatics and patients with polyps had higher subjective olfactory dysfunction scores than nonasthmatics and patients without polyps (6.8 and 7.2 v 4.4 and 4.1, respectively). All groups had subjective improvement at 1 year (2.3 and 1.5 v 0.6 and 0.7, respectively; P =.00). CONCLUSION: Patients with subjective olfactory dysfunction despite appropriate medical management for rhinosinusitis benefit from FESS.     

Olfactory function in patients with chronic rhinosinusitis before and after functional endoscopic sinus surgery

BACKGROUND: The olfactory loss in patients with chronic rhinosinusitis has been measured by different methods. However, the results have been variable and it is not clear whether functional endoscopic sinus surgery (FESS) significantly improves olfactory function. This study was performed to evaluate the influences of FESS on olfactory function in patients with chronic rhinosinusitis using three different types of olfactory tests. METHODS: Seventy patients with chronic rhinosinusitis were administered the University of Pennsylvania Smell Identification Test (UPSIT), a single staircase phenyl ethyl alcohol odor detection threshold test (STT), and a short-term odor memory/discrimination test a day before and 6 months after FESS. A questionnaire inquiring about the patients' self-perception of olfactory function was administered also. Independent ratings of the severity of chronic rhinosinusitis before FESS were established from CT scans. RESULTS: Fifty-two (74.3%) of the patients reported that their olfactory function was impaired before surgery, and 68.6% of the patients reported impaired olfactory function after surgery, a difference that was not significant. No meaningful changes in any of the olfactory test scores were noted 6 or more months after FESS. Preoperatively, small correlations between CT scores and the symptom scores (r = 0.278; p = 0.024), threshold scores (r = -0.27; p = 0.031), and UPSIT scores (r = -0.36; p = 0.003) were observed. CONCLUSION: In patients with severe rhinosinusitis, FESS had little impact on the ability to smell, regardless of the method for assessing smell function. Subtle associations between olfactory function and the severity of chronic rhinosinusitis determined by CT were observed, however, preoperatively. The olfactory test measures were correlated with one another both pre- and postoperatively.     

Changes in nasal resonance after functional endoscopic sinus surgery

BACKGROUND: Hyponasality may be present in patients with chronic rhinosinusitis because of decreased resonance of nasal cavities. Nasalance is a parameter of nasality measured by a nasometer. This study investigated the influence of functional endoscopic sinus surgery (FESS) on nasalance and determined the correlation of the nasalance change with nasal volume change. METHODS: When patients with chronic rhinosinusitis underwent FESS, nasalance was measured by nasometry and nasal volume was measured by acoustic rhinometry before and at least 6 months after surgery. RESULTS: There were 81 eligible patients enrolled in the study. Nasalance scores and nasal volumes were significantly increased after FESS. The increased nasalance value was moderately correlated with the increased midnasal and postnasal volumes. The correlation between postoperative changes in nasalance scores and nasal volumes was more remarkable in patients without nasal polyps than in those with nasal polyps and it was also higher in patients with allergic rhinitis than in those without allergic rhinitis. CONCLUSION: This study showed that the FESS effectively increased nasalance scores and nasal volumes in patients with chronic rhinosinusitis, but the increase in nasalance scores did not appear to be achieved largely through the increased nasal volumes.     

Endoscopic physiologic approach to allergy-associated chronic rhinosinusitis: a preliminary study.

Patients with allergy-associated chronic rhinosinusitis respond poorly to functional endoscopic sinus surgery (FESS), probably because of the altered nasosinus ventilatory physiology and the increased contamination of the nasosinus mucosa by the offending allergens. With this in mind, we describe the concept and technique of functional endoscopic nasosinus surgery (FENS) in such cases. The advantages of this technique are that it preserves the uncinate process, it limits ethmoidal exenteration via a transbullar approach, and it simultaneously corrects both septal and lateral wall pathologies. The aim of our randomized prospective study was to subjectively and objectively compare the efficacy of FESS and FENS in 64 patients with allergy-associated chronic rhinosinusitis. Subjective assessment was ascertained by visual analog scores, and objective assessment was made by nasal endoscopy. In this preliminary study, we found that FENS was superior to FESS in treating chronic sinusitis associated with nasal allergy.     

Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery

Fungal rhinosinusitis is an important clinical problem with diverse manifestations. Although many literatures had found low recurrence rate after surgical treatment of fungus ball rhinosinusitis, patient satisfaction and treatment outcomes (symptom-free and symptom improvement rate, etc.) for fungus ball sinusitis are not yet well established. The purpose of this study is to estimate the patient satisfaction and treatment outcome in patients with fungus ball rhinosinusitis undergoing functional endoscopic sinus surgery (FESS). Medical records of consecutive patients with diagnosed fungus ball rhinosinusitis treated by FESS between 1995 and 2005 were reviewed retrospectively. The post-operative improvement in individual symptom was assessed by chart review and telephone visiting. Ninety consecutive patients (21 men and 69 women) were eligible for the study. Six patients (7%) presented bilateral fungus ball rhinosinusitis. Multiple paranasal sinus fungus ball involvements were found in 48 patients (53%). Complete resolution of complaints with respect to nasal discharge, postnasal drip, cough with sputum, nasal bleeding, fetid odor of nose, olfactory dysfunction, nasal obstruction, headache, and facial pain or pressure were described in 74 patients (82%). The overall patient satisfaction rate was 96%. The estimated recurrence rate of fungus ball rhinosinusitis treated with FESS was 3%, with a mean follow-up of 81 months. Treatment protocol of fungus ball rhinosinusitis with FESS and without postoperative antifungal drugs is efficient because of very low recurrence rate, high patient satisfaction, and very high symptom-free rate. Furthermore, the obvious difference of symptom-free rate between fungus ball rhinosinusitis and chronic rhinosinusitis highlights the need of further studies to discover the pathophysiology of fungal sinusitis.     

Comparative analysis of the outcome of external and endoscopic frontal sinus surgery in children

Abstract

Background: Both open and functional endoscopic sinus surgery (FESS) are performed in the case of pediatric frontal rhinosinusitis. However, data from comparative analysis of these surgery types are insufficient.

Objective: Prospective randomized trial for comparison of open and endoscopic surgery outcome in pediatric chronic rhinosinusitis.

Material and methods: The cohort included 30 pediatric patients (7–17?years) with open frontal sinus surgery and 34 patients who underwent FESS using DrafIIa. Lund‐Kennedy and Lund-Mackay scores, as well as Sino-Nasal Outcome Test-20 (SNOT-20)questionnaire was used for pre- and postoperative assessment.

Results: Open surgery and FESS resulted in a significant improvement in total Lund‐Kennedy, Lund-Mackay, and SNOT-20 scores, being more profound in FESS group. Using FESS significantly reduced surgery duration by 15% as compared to open surgery. In addition, open surgery was associated with a higher rate of scar formation, reduced local sensitivity, as well as local soreness, lacrimation, and psychological discomfort. In regression models FESS was negatively associated with postoperative total Lund‐Kennedy, Lund-Mackay, and SNOT-20 scores.

Conclusion and significance: Generally, FESS resulted in better surgery outcome as compared to open surgery, although both approaches resulted in a significant improvement in chronic rhinosinusitis.     

Effect of functional endoscopic sinus surgery on bronchial asthma outcomes

BACKGROUND: For more than 70 years, the coexistence of asthma and paranasal rhinosinusitis has been noted in the medical literature. Causal relationships have been proposed but not proved. To date, limited evidence exists suggesting that asthma improves after surgical correction of rhinosinusitis. OBJECTIVE: To determine whether asthma control improved after first-time functional endoscopic sinus surgery (FESS). PATIENTS AND METHODS: A retrospective medical record analysis was performed on 13 patients with chronic bronchial asthma who underwent FESS for medically refractory chronic rhinosinusitis. Patients received comprehensive asthma care before and after FESS (mean, 19.3 and 33.1 months, respectively). Outcomes analyzed included pre- and post-FESS individual and group mean asthma symptom scores, medication use scores, pulmonary function test results, and emergency department visits or hospital admissions for asthma. Patient medical records were obtained from a private allergy-immunology practice affiliated with a medical school. The surgical procedure was performed at a tertiary care teaching hospital by a single ear, nose, and throat surgeon (R.L.). RESULTS: Following FESS, there was no statistically significant change in group mean asthma symptom scores, asthma medication use scores, pulmonary function test results, and the number of emergency department visits or hospital admissions. Only a few patients demonstrated statistically significant improvement after FESS in asthma symptom scores (1 patient), medication use scores (1 patient), or pulmonary function test results (2 patients). CONCLUSIONS: The data do not support the hypothesis that first-time FESS for medically refractory chronic rhinosinusitis in adult patients with chronic asthma leads to reduced postoperative asthma symptoms or asthma medication use or improved pulmonary function. Based on this limited study, a reexamination of the benefits of sinus surgery to coexisting asthma is in order.     

Treatment of invasive rhinosinusitis--the case report

The frequency of fungal etiology of sinusitis contains between 9 and 49 % according to different authors. Fungal rhinosinusitis has been divided into noninvasive and invasive forms. Noninvasive infections include fungus ball (mycetoma) and allergic fungal rhinosinusitis. Invasive infections include acute (or fulminates) fungal rhinosinusitis and invasive chronic rhinosinusitis. The case of chronic invasive rhinosinusitis was presented. Patient performed surgery--Functional Endoscopic Sinus Surgery and paranasal sinuses operation from subcranial approach. Surgery procedures were followed by antifungal pharmacotherapy (Orungal and Worykonazol). The presented case of fungal invasive chronic rhinosinusitis was treated according to recommended procedures with surgery followed by adequate antifungal farmacotherapy. In this case we have reached a successful outcome.     

鼻内镜术后病情迁延的细菌学分析

目的:探讨慢性鼻-鼻窦炎(CRS)鼻内镜术后迁延不愈者鼻腔分泌物的细菌学特征。方法:选取单纯鼻中隔偏曲患者20例(对照组),取其中鼻道分泌物;选取首次接受鼻内镜手术的CRS患者30例(手术组),术中取中鼻道分泌物;取FESS术后随访3个月以上未达治愈标准的患者20例(迁延组),在鼻内镜下取中鼻道分泌物,分别做细菌培养和药物敏感试验,3组结果进行比较分析。结果:对照组检出细菌13株,手术组检出15株,迁延组检出15株,其检出阳性率差异无统计学意义;迁延组G-菌检出率明显高于对照组和手术组;对常用抗生素耐药的菌株比例迁延组显著高于手术组。结论:需氧菌可存在于正常鼻腔内;CRS术后迁延不愈者,G-杆菌的感染和细菌的耐药性明显增加。因此,强调要合理应用抗生素,对术后迁延性鼻窦炎的抗生素治疗,应建立在细菌培养和药敏试验的基础上。