Sex differences in outcomes of sinus surgery

PURPOSE: Sex has been demonstrated to affect outcome in many diseases. Our current aim is to investigate the relationship between sex and outcomes of endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). METHODS: Forty-four males and 73 females undergoing ESS for CRS with a mean follow-up of 1.4 years were evaluated prospectively. Computed tomography (CT), endoscopy, and quality of life (QOL) assessment was performed. Univariate analyses were performed to evaluate whether sex was predictive of outcome. Multiple logistic regression analysis was performed to evaluate sex association with patient factors predictive of outcome. RESULTS: Although no sex differences in CT and endoscopy were observed (CT, P=.107 and endoscopy, P>.1), females consistently scored worse than males on disease-specific QOL pre- and postoperatively. Importantly, there was no effect of sex on improvement/change scores for the QOL instruments. PREDICTIVE MODELS AND MULTIPLE LOGISTIC REGRESSION ANALYSIS: Sex was not found to be predictive of QOL or endoscopic outcome. Female sex was, however, associated with acetylsalicylic acid (ASA) intolerance and depression, both factors that have been associated with poorer outcome. CONCLUSION: Despite similarities in objective disease measures, females report significantly worse QOL scores pre- and postoperatively. Postoperative improvement did not differ by sex, nor was sex predictive of postoperative outcome. Sex differences in QOL reflect sex differences in ASA intolerance and depression, both more prevalent in females.     

Impact of age on presentation of chronic rhinosinusitis and outcomes of endoscopic sinus surgery

BACKGROUND: As the population ages, the mean age of patients with chronic rhinosinusitis (CRS) likely will increase as will the frequency of endoscopic sinus surgery (ESS) in the older population. The purpose of this study was to compare symptom presentation, CT scores, endoscopy scores, and quality of life (QOL) measures in patients >60 years of age as compared with younger patients. METHODS: A prospective cohort of 18 patients >60 years and 121 patients < or =60 years undergoing ESS for CRS were studied. Patient factors, symptom severity, and CT scores were examined preoperatively. Endoscopy and QOL scores were compared pre- and postoperatively between the two groups. RESULTS: The prevalence of allergies, polyps, asthma, aspirin sensitivity, and revision surgery was similar in each age group. There was no statistically significant difference in the visual analog scale scores of symptom severity in each age group. Older patients had scores that were similar to younger patients with regard to CT (13.11 versus 11.63; p = 0.419), preoperative endoscopy (8.22 versus 7.96; p = 0.828), postoperative endoscopy (3.06 versus 4.82; p = 0.100), and change in endoscopy (-5.17 versus -3.15; p = 0.083). Older patients had similar preoperative, postoperative, and change scores when compared with younger patients on the Rhinosinusitis Disability Index (-15.33 versus -20.63; p = 0.318) and Chronic Sinusitis Survey (14.35 versus 23.11; p = 0.126). CONCLUSION: Older patients with CRS present with symptoms and patient factors that are comparable with younger patients and have a similar degree of improvement on endoscopy scores and QOL measures after ESS.     

Outcomes of endoscopic sinus surgery for chronic rhinosinusitis associated with sinonasal polyposis

BACKGROUND: The aim of this study was is to investigate the outcomes of endoscopic sinus surgery (ESS) when performed for chronic rhinosinusitis associated with sinonasal polyps. METHODS: Forty-three patients with polyps were compared with 76 patients without polyps before and after ESS. Mean follow-up was 1.5 years. Patients were analyzed prospectively based on computed tomography (CT), endoscopy, quality-of-life (QOL) assessment, and visual analog scales (VASs). Univariate analyses were performed to evaluate whether the presence of polyps was predictive of outcome. RESULTS: Patients with polyps had worse CT and endoscopy scores both pre- and postoperatively when compared with patients without polyps (p < 0.0001 for each). All patients, regardless of polyps, improved on endoscopic exam; however, patients with polyps showed a greater degree of improvement (p = 0.002). Despite this, postoperative endoscopic scores in patients with polyps were worse than those without polyps (p < 0.0001). Patients with polyps had better QOL as measured by the Chronic Sinusitis Survey (CSS) both pre- and postoperatively (p = 0.001 and 0.044, respectively). The preoperative VAS indicated that patients with polyps had increased nasal obstruction compared with patients without polyps (p = 0.002) while having less facial pain and headache (p = 0.002 and 0.005, respectively). Patients with polyps showed a greater postoperative improvement in nasal congestion (p = 0.003) but no difference in level of improvement in postoperative headache or pressure. CONCLUSION: Despite significantly worse objective testing scores, patients with polyps report significantly better QOL as measured by the CSS and less facial pain/headache as measured by VAS scores pre- and postoperatively. Polyps were not found to be predictive of QOL or endoscopic outcome.     

Impact of aspirin intolerance on outcomes of sinus surgery

OBJECTIVES: To compare objective and quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) in aspirin (ASA)-tolerant patients and ASA-intolerant patients over intermediate and long-term follow-up. STUDY DESIGN: Prospective analysis of a cohort of patients with chronic rhinosinusitis. METHODS: Preoperative computed tomography (CT), pre- and postoperative endoscopy, and two validated disease specific QOL instruments, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were collected. Differences in the proportions of patients who improved were analyzed using Pearson's chi-square and Fisher's exact test. RESULTS: Nineteen ASA-intolerant patients and 104 ASA-tolerant patients were followed for a mean of 17.7 months. Patients with ASA intolerance had significantly worse preoperative CT (P < .0001) and endoscopy scores (P < .0001). After ESS, 57% to 74% of patients improved on endoscopy scores, 63% to 71% improved on the RSDI, and 58% to 73% improved on the CSS; improvement did not significantly differ by ASA status. CONCLUSIONS: Similar proportions of ASA-tolerant and ASA-intolerant patients showed improvement on endoscopy and QOL measures after ESS.     

Impact of depression on disease-specific symptoms and quality of life in patients with chronic rhinosinusitis

BACKGROUND: Depression is associated with increased symptom burden in the setting of chronic medical conditions. Studies investigating the influence of depression on the symptoms of chronic rhinosinusitis (CRS) are lacking. The purpose of this project was to establish the prevalence of depression in patients with CRS and to explore the impact of this disorder on disease-specific symptoms and general quality of life (QOL) in the preoperative and postoperative setting. METHODS: We reviewed the records of 320 consecutive patients presenting with sinonasal symptoms to our specialty sinus clinic. Patients with CRS were evaluated by nasal endoscopy, CT imaging, and validated questionnaires including the Chronic Sinusitis Survey and SF-8 Health Survey, a QOL measurement. Findings in CRS patients with depression were compared with a matched-control group of CRS patients without depression before and after endoscopic sinus surgery. RESULTS: Overall, 26% of patients presenting with sinonasal symptoms had a diagnosis of depression. After evaluation including CT imaging, 33% of the initial population was diagnosed with CRS. The prevalence of depression in these CRS patients was 25%. Disease-specific symptoms were similar between groups; however, depressed CRS patients reported significantly worse pain and energy level and difficulty with daily activities (p < 0.050) when compared with a control group of CRS patients without depression. Postoperatively, nondepressed patients showed a marked improvement in disease-specific as well as general QOL scores (p < 0.050), whereas depressed patients did not. CONCLUSION: CRS patients with and without depression have similarly poor disease-specific symptoms. However, depressed CRS patients have poorer disease-specific and overall QOL outcomes after sinus surgery.     

Recurrent acute rhinosinusitis: presentation and outcomes of sinus surgery

BACKGROUND: Patients with recurrent acute rhinosinusitis (RARS) represent a challenging subset of patients with rhinosinusitis. Data regarding the outcomes of care for these patients is extremely limited. The purpose of this study was to evaluate objective and patient-based measures in patients diagnosed with RARS before and after surgical intervention. METHODS: A prospective, nested case-control study was performed. Cases of RARS (n = 22) were matched to patients with chronic rhinosinusitis (CRS) without polyposis (n = 22) by age, sex, and race/ethnicity. Preoperative computed tomography (CT) and pre- and postoperative endoscopic examinations, the Chronic Sinusitis Survey, and the Rhinosinusitis Disability Index were scored and compared between cases and controls. RESULTS: Patients with RARS were less likely to have asthma or previous sinus surgery. Patients with CRS underwent more extensive surgery. There were no significant differences in preoperative CT, endoscopy, or patient-based, quality-of-life (QOL) scores. Both groups showed statistically significant improvements in total postoperative QOL scores. Patients with CRS showed significant improvement on endoscopy scores. Patients with RARS used significantly fewer sinus medications after endoscopic sinus surgery. CONCLUSION: Patients with RARS were more often primary surgical patients and underwent less extensive surgery than their CRS counterparts. Both groups reported improved QOL after surgery.     

Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and asthma

OBJECTIVE: To investigate the efficacy of endoscopic sinus surgery (ESS) in the management of chronic sinusitis and asthma in patients with nasal polyps and steroid-dependent asthma. STUDY DESIGN: Retrospective chart review. METHODS: The study included 17 patients who underwent ESS with nasal polyps, steroid-dependent asthma with or without aspirin sensitivity and a minimum of 1 year postoperative follow-up. Nine patients were ASA sensitive, and eight patients were ASA tolerant. Chronic sinusitis and asthma were evaluated using subjective (patient complaints) and objective (computed tomography scans, pulmonary function tests, steroid doses) criteria. Preoperative data were compared with data obtained 12 to 18 months postESS. Tissue samples were graded for degree of inflammation and edema. RESULTS: Thirteen of the 17 (76.5%) patients reported improved clinical symptoms postESS. The postoperative Lund-Mackay scores were statistically lower for the 17 patients (P <.0001). The group experienced improvement in postoperative forced expiratory volume at 1 second (FEV1) (P <.014). Twelve of 17 (70.6%) experienced reduction in systemic steroid usage (P <.048). The ASA sensitive patients did not have a statistical improvement in postoperative FEV1 (P >.08) and sinonasal symptoms (P >.16) compared with the ASA tolerant group. Polyp tissue from the ASA sensitive patients demonstrated more edema and more inflammation on average than ASA tolerant polyps, but the results were not statistically significant. CONCLUSION: ESS demonstrates a beneficial effect on the sinonasal and asthma symptomatology in patients with nasal polyps and asthma using objective measures. Subset of aspirin-tolerant patients have statistically better outcome for sinonasal symptoms and pulmonary function testing than aspirin-sensitive patients.     

Comparative outcomes of endoscopic sinus surgery in patients with chronic sinusitis and nasal polyps

This study was carried out to compare the outcomes of endoscopic sinus surgery in patients with chronic sinusitis without nasal polyps (CRS) and those with nasal polyps (NP). We also sought to determine the correlation between preoperative computed tomography (CT) findings and postoperative endoscopy and symptom score improvement. Data were collected from two groups of patients diagnosed as CRS with and without nasal polyps that underwent functional endoscopic sinus surgery with a 1-year postoperative follow up. Preoperative symptoms, CT scores, and endoscopic scores were recorded. Postoperative symptom and endoscopic scores were recorded at 1, 6, and 12 months. Assessment of symptoms was performed subjectively using visual analogue scoring (VAS). CT scan findings were scored using the Lund–Mackay system. Endoscopic examination findings were scored according to the staging system proposed by Lanza and Kennedy. The correlations between the CT score, endoscopic scores and VAS scores were calculated. There was a statistically significant correlation between the preoperative CT, symptom, and endoscopic scores. Postoperative symptom and endoscopic scores also showed a significant correlation. Total CT scores of the CRS group were significantly lower than the scores of the NP group. Also preoperative endoscopy and symptom scores were statistically lower in CRS group compared to NP group. Endoscopy total scores and symptom total scores of both groups were significantly decreased at postoperative 12th month. Statistically significant difference was observed between the preoperative and postoperative symptom and endoscopy scores. The patients with polyps had higher symptom scores and worse objective findings compared to the patients with CRS. In all patients groups, objective and subjective scores seemed to correlate well preoperatively and postoperatively. These data suggest that endoscopic sinus surgery provides significant symptomatic relief and endoscopic healing in patients with CRS and NP.     

Molecular and cellular staging for the severity of chronic rhinosinusitis

OBJECTIVES: To correlate objective and subjective clinical parameters with molecular, cellular, and histologic markers and to acknowledge the importance of these basic science parameters in a severity classification system for chronic rhinosinusitis (CRS). STUDY DESIGN: Retrospective analysis of prospectively collected data of consecutive patients undergoing endoscopic sinus surgery for CRS in an academic institution. METHODS: The preoperative computed tomography (CT) scans of all patients with CRS scheduled for surgery were graded according to Lund and Mackay. The patients completed a Sino-Nasal Outcome Test (SNOT)-20 questionnaire and had a preoperative nasal endoscopy performed, which was graded by assigning an endoscopy score according to Lanza and Kennedy. Subjects had a medical questionnaire regarding presence of aspirin sensitivity, allergic rhinitis, asthma, and medication usage. Subjects also underwent pulmonary function testing and had skin tests for allergies. At the time of surgery, blood was drawn to determine the level of peripheral eosinophilia and the degree of polymorphisms of the leukotriene C4 synthase gene. Sinus mucosal and polyp tissue was examined pathologically for the number of eosinophils per high-powered filed (HPF) and was stained for EG2 to determine the portion of activated eosinophils. Leukotriene C4 levels (pg/g of tissue) were determined using a sensitive competitive enzyme immunoassay. Endoscopy and SNOT-20 scores were reevaluated 1 year after surgery. Data were analyzed for disease-severity correlation to recommend a severity classification system for CRS that incorporates the contribution of clinical, molecular, cellular, and histologic parameters. RESULTS: The presence of polyps resulted in higher preoperative CT scores and higher preoperative and postoperative symptom scores. Average preoperative CT scores were significantly higher in asthmatics and allergy patients and correlated with endoscopy scores. Patients with more than five eosinophils/HPF of sinus tissue had higher frequency of polyps and asthma and higher CT and endoscopy scores than patients without sinus tissue eosinophilia (less than or equal to 5 cells/HPF sinus tissue). The subgroup of patients with eosinophilic nasal polyps (eosinophilic hyperplastic rhinosinusitis) had more severe disease by CT and endoscopy than the subgroup of patients with nasal polyps (hyperplastic rhinosinusitis) but without eosinophilia. Similarly, patients without polyps but with tissue eosinophilia had more severe disease than patients without polyps and without eosinophilia. Leukotriene C4 levels were elevated in all patient groups. Symptom scores did not correlate with any of the parameters. CONCLUSION: We suggest the following severity classification system for CRS: 1) eosinophilic chronic hyperplastic rhinosinusitis (ECHRS): patients with polyps and sinus tissue eosinophilia; 2) noneosinophilic chronic hyperplastic rhinosinusitis (NECHRS): patients with polyps but without sinus tissue eosinophilia; 3) eosinophilic chronic rhinosinusitis (ECRS): patients without polyps but with sinus tissue eosinophilia; 4) noneosinophilic chronic rhinosinusitis (NECRS): patients without polyps and without sinus tissue eosinophilia.     

Effects of depression on quality of life improvement after endoscopic sinus surgery

OBJECTIVES/HYPOTHESIS: To determine whether self- reported depression predicts lesser postoperative improvement in health-related quality of life (HRQoL) after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective open cohort. METHODS: An adult (> or =18 yr) cohort of 23 patients with depression and 79 patients without depression undergoing ESS were followed for 12 +/- 2 months. Patient characteristics and computed tomography scores were examined preoperatively. Endoscopy scores and two HRQoL measures, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey, were analyzed pre- and postoperatively. Univariate and multivariate analyses were used to evaluate outcome differences for patients with depression. RESULTS: There was a significantly higher prevalence of women (P = .002) and longer duration of follow-up (P = .004) for the depressed subgroup. Depressed patients reported significantly lower pre- and postoperative HRQoL scores on all RSDI subscales (P < .05). Without baseline adjustment, depression was not associated with significant differences in postoperative change for disease-specific HRQoL scores (P > .10) in multivariate analysis. CONCLUSIONS: Depressed patients with CRS present similarly but have worse pre- and postoperative HRQoL scores and experience similar disease-specific QoL improvements from sinus surgery compared with other CRS patients. Sinus surgery is not effective in alleviating the effect of depression on disease-specific HRQoL, and it is likely that comorbid depression and CRS are operating on independent disease pathways. Additional research and hypothesis testing using continuous, objective measures is warranted.     

慢性鼻及鼻窦炎鼻内镜手术疗效及黏膜上皮化分析

目的总结鼻内镜手术治疗慢性鼻及鼻窦炎的疗效和术腔黏膜上皮化规律,探讨影响疗效和术后黏膜上皮化的相关因素。方法对520例慢性鼻及鼻窦炎接受鼻内镜手术患者的手术疗效和术后黏膜上皮化规律进行临床分析。疗效分析应用X~2检验,黏膜上皮化时间分析用非参数秩和检验。结果治愈率74.4%,好转率21.0%,总有效率95.4%。术后平均黏膜上皮化时间为14.0周。疾病的分型分期、是否合并哮喘、变应性鼻炎和疗效与黏膜上皮化时间有相关性(P<0.05)。结论鼻内镜手术治疗慢性鼻及鼻窦炎是有效和安全的,术后黏膜上皮化时间平均需要3个月。病情重、合并哮喘或变应性鼻炎的患者疗效较差,黏膜上皮化时间长。鼻腔粘连通过定期合理的复查和处理,大多数能够得到有效的解除。     

慢性鼻-鼻窦炎鼻息肉内镜鼻窦手术后生存质量的转归及影响因素

目的 探讨慢性鼻-鼻窦炎鼻息肉内镜鼻窦手术后生存质量(quality of life,QOL)的转归规律及影响因素.方法 以医学结局研究短表36条(medical outcome study short-form 36-items,MOS SF-36)和鼻腔鼻窦结局测试20条(sino-nasal outcome test-20,SNOT-20)量表作为工具,通过前瞻性随机对照设计,对120例慢性鼻-鼻窦炎鼻息肉患者术前和术后3、6、9和12个月QOL状况连续调查评估,同时与200例健康体检者的状况对照,分析患者QOL的变化规律及影响因素.结果 ①SF-36评估:患者术前6个维度评分均低于健康者(P值均＜0.01),术后6个月评分值及正常评分者构成比恢复正常(P值均＞0.05),并保持;②SNOT-20评估:患者术前20个条目总分和5大条目总分均高于健康者(P值均＜0.01),术后9、12个月两项指标分别恢复正常(P值均＞0.05),术后12个月评分值及正常评分者构成比亦恢复正常(P值均＞0.05);③根据SNOT-20评分转归,求得预测QOL恢复正常的时间进度公式:时间(月)=39-(标准QOL评分/术前QOL评分)×50;④通过Logistic回归分析,农村来源、病程长、病变范围大和伴发息肉是术前QOL评分(SNOT-20评分)高的危险因素(OR值分别为0.19、0.88、0.90和4.02),室内工作环境、手术范围不充分和术前SNOT-20评分高是术后QOL评分改善程度的危险因素(OR值分别为0.29、0.99和1.14).结论 慢性鼻-鼻窦炎鼻息肉患者内镜鼻窦手术后需12个月才能全面恢复正常QOL,依此建议术后短期随访时间定为1年.术前QOL状态与城乡来源、病程、病变范围和是否伴发鼻息肉相关,术后QOL改善程度与工作环境、手术范围和术前QOL评分相关.     

Impact of residual ethmoid cells on postoperative course after endoscopic sinus surgery for chronic rhinosinusitis

Objective

Endoscopic sinus surgery (ESS) is a worldwide standard surgical procedure for chronic rhinosinusitis (CRS). Residual ethmoid cells (RECs), which result from failure to completely remove them, have been thought to be a cause of recurrence of CRS. Our objective was to investigate the relationship between the REC score and post ESS recurrence of CRS.

Methods

From January 2002 through December 2003, a total of 138 consecutive CRS patients (86 men and 52 women; mean age: 44 years) underwent ESS at the Department of Otorhinolaryngology, Ota General Hospital. CT was performed at 6 or more months post ESS for all patients. The left and right ethmoid sinuses were each divided into superior-anterior, inferior-anterior and posterior parts. The extent of RECs in each part was assessed using a 3-grade scoring system. The outcome of CRS was classified into a satisfactory outcome group and a poor outcome group based on the improvement rate determined from the pre ESS and post ESS CT image findings. The two groups were then compared for the age, gender, presence/absence of nasal polyps, presence/absence of allergic rhinitis, presence/absence of asthma, the peripheral eosinophil count (%) and the total REC score. In addition, the individual correlations between the above variables and the poor outcome group were analyzed by logistic regression analysis.

Results

The total REC score was 0 in only 35 (25.4%) of the total patients. The most common total REC scores were 1–6 in 85 (61.6%) patients. The superior-anterior part had the largest number of patients with an REC score of 1 or more. The satisfactory outcome group comprised 97 patients (70.3%), while the poor outcome group comprised 41 patients (29.7%). Comparison of these two groups found that the peripheral eosinophil count, the prevalence rate of asthma and the total REC score were each significantly higher in the poor outcome group than in the satisfactory outcome group. Logistic regression analysis identified a peripheral eosinophil count of ≥9.5%, the presence of asthma and a total REC score of ≥4 as factors that correlated significantly with a poor outcome.

Conclusion

The findings of this study indicate that RECs are involved in the recurrence of CRS following ESS. It can be thought that how to achieve full opening of the superior-anterior part of the ethmoid sinus, which includes the frontal recess, will be an issue in the future.     

Endoscopic and quality-of-life outcomes after revision endoscopic sinus surgery

OBJECTIVES: First, to examine the impact of endoscopic sinus surgery (ESS) on endoscopic and quality-of-life (QOL) outcomes after revision ESS as compared to primary ESS. Second, to evaluate whether or not other risk factors and/or co-morbidities influence the relationship between revision surgery status and outcomes of ESS. STUDY DESIGN: Prospective observational study with an internal comparison group. METHODS: Preoperative computed tomography scores, pre and postoperative endoscopy scores, and two validated disease-specific QOL instruments, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were collected on a prospective cohort of patients undergoing ESS for chronic rhinosinusitis. Data were analyzed using Pearson's chi and multiple logistic regression models. RESULTS: Mean preoperative Lund-Mackay computed tomography scan scores were similar in primary and revision surgery patients. In patients without polyps, revision ESS patients were 3.88 times more likely to improve on endoscopy scores than primary ESS patients (95% confidence interval 1.70, 8.83; P = .001). In nasal polyp patients, there was no difference by revision status (odds ratio 0.48; 95% confidence interval 0.15, 1.59; P = .23). The odds of improving on the RSDI (odds ratio 0.51, 95% confidence interval 0.25, 1.04, P = .065) and CSS (odds ratio 0.98, 95% confidence interval 0.51, 1.89, P = .950) were not significantly different by revision status. CONCLUSIONS: Both revision and primary ESS patients improved after ESS with regard to endoscopy, RSDI, and CSS scores. In non-polyp patients, revision ESS patients were more likely to improve on endoscopy scores than primary ESS patients; there was no difference in polyp patients by revision status. Revision ESS patients and primary ESS patients were equally as likely to improve on two QOL instruments.     

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.     

Revision functional endoscopic sinus surgery: objective and subjective surgical outcomes

BACKGROUND: The aim of this study was to report objective and subjective outcomes after revision sinus surgery (RESS) for chronic rhinosinusitis (CRS). METHODS: We performed a retrospective analysis of prospectively collected data in 125 patients requiring revision functional endoscopic sinus surgery after failing both maximum medical therapy and prior sinus surgery for CRS. Patients were seen and treated over a 3-year period (1999-2001) in a tertiary rhinology setting. Computed tomography (CT) scans were graded as per Lund-MacKay and patient symptom scores were recorded using the Sinonasal Outcome Test 20 (SNOT-20) instrument. Individual rhinosinusitis symptoms were evaluated on a visual analog scale (0-10) before and after surgery. All patients had a minimum 2-year follow-up. RESULTS: The mean number of prior sinus procedures was 1.9 +/- 0.1 (range, 1-7) and the mean preoperative CT grade was 13.4 +/- 0.7. Patients with asthma and polyposis had higher CT scores than those without these processes. Preoperative mean SNOT-20 and endoscopy scores were 30.7 +/- 1.3 and 7.3 +/- 0.4, respectively. At the 2-year follow-up, mean SNOT-20 and endoscopy scores improved to 7.7 +/- 0.6 and 2.1 +/- 0.4, respectively (p < 2.8 x 10(-10)). At 12-month follow-up, each individual symptom score decreased significantly. Overall, 10 patients failed RESS and required additional surgical intervention for an overall failure rate of 8.0%. All patients who failed RESS had nasal polyposis. CONCLUSION: Revision functional endoscopic sinus surgery benefits patients that fail maximum medical therapy and prior sinus surgery for CRS by objective and subjective measures.     

Role of nasal endoscopy in patients undergoing endoscopic sinus surgery

BACKGROUND: The goal of this study was to determine the role of nasal endoscopy in patients undergoing endoscopic sinus surgery and to examine the correlation between nasal endoscopy and pre- and postoperative computed tomography (CT) grade, symptom scores, and the patients' asthma status. METHODS: A retrospective analysis of prospectively collected data from 254 consecutive patients treated with endoscopic sinus surgery was performed from 1999 to 2002. There were 131 men and 123 women, with a mean age of 48 years. All patients had at least 1-year follow-up. All patients received preoperative CT scans, which were graded as per Lund-MacKay, completed the sinonasal outcome test 20 questionnaires, and underwent endoscopic nasal examination at both the preoperative and 1-year postoperative visits. The correlation between the endoscopy score, CT grade, and sinonasal outcome test 20 findings was calculated. RESULTS: Nasal endoscopy indicated a statistically significant correlation with preoperative CT grade in this patient population. There was no correlation between endoscopic findings and patient symptom scores. Nasal endoscopy in patients with asthma (n = 47) did not correlate with either CT grade or patient symptom scores. In patients without asthma (n = 207), nasal endoscopy correlated with CT grade but not with symptom scores. CONCLUSION: Nasal endoscopy findings do not correlate with symptom scores in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Nasal endoscopy findings correlated with CT grade in patients without asthma, but no such correlation was found in patients with asthma.     

The effects of endoscopic sinus surgery on level of fatigue in patients with chronic rhinosinusitis

BACKGROUND: Fatigue is a common symptom of chronic rhinosinusitis (CRS), but the response of fatigue to endoscopic sinus surgery (ESS) is rarely studied. METHODS: A prospective, open cohort of adult patients undergoing ESS for CRS was studied using 10-cm fatigue visual analog scales (VASs), Lund-MacKay computed tomography (CT), and Lund-Kennedy nasal endoscopy scoring. RESULTS: Two hundred seventy-two patients, followed for a mean (+/-SD) of 16.5 +/- 8.5 months after ESS, noted significant fatigue improvement with an effect size defined as large by Cohen (0.8 [95% CI, 0.5-1.3]). Neither preoperative CT scores nor preoperative endoscopy scores correlated with preoperative fatigue severity. Compared with the mean preoperative fatigue score (6.1 +/- 2.9 cm), preoperative fatigue was more severe in women (6.9 +/- 2.6 cm; p < 0.001) patients with depression (7.7 +/- 2.4 cm; p < 0.001) and patients with fibromyalgia (7.9 +/- 2.2 cm; p = 0.013), but less severe in patients with nasal polyposis (5.4 +/- 3.2 cm; p = 0.009). Significantly greater postoperative reduction in fatigue was noted in patients with fibromyalgia when compared with study patients without fibromyalgia (effect size = 1.8 [95% CI, 1.6-2.2]; p > 0.001) with final fatigue severity scores similar to the entire study group. Similarly, patients with severe fatigue (n = 112; mean VAS score, 8.8 +/- 0.8 cm) showed a more pronounced improvement than patients less severely fatigued (n = 160; mean VAS score 4.2 +/- 2.4 cm; effect size = 2.2 [95% CI, 2.0-2.9]; p > 0.001). CONCLUSION: Fatigue improves after ESS, with significantly greater improvement in patients with fibromyalgia and in patients that are more severely fatigued at presentation.     

修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻-鼻窦炎

目的探讨修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻一鼻窦炎的手术效果及应用价值。方法35例难治性鼻一鼻窦炎经CT检查、鼻内窥镜检查、局部用药等规范术前准备,行改良鼻丘径路额窦开放为主修正手术加中鼻甲全部或部分切除,术后凭鼻内镜保健手册进行定期复查,规范随访。26例合并鼻中隔偏曲者其中16例行内镜下传统矫正切除,10例行局限性矫正切除;15例合并变应性鼻炎者对下鼻甲前端、中鼻甲对应鼻中隔等部位黏膜电凝。结果35例患者门诊内镜随诊3～6月以上,治愈11例（31．4％）,黏膜完全上皮化;好转18例（51．4％）,黏膜可以上皮化,但变应性鼻炎发作时,术腔黏膜水肿,经局部处理及药物治疗后可恢复上皮化;无效6例（17．2％）。总有效率82-8％,6例无效均为合并变应性鼻炎及哮喘患者。结论修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻鼻窦炎,疗效较为确切,值得临床推广。     

Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery

ObjectivesLatest literature proposes laryngopharyngeal reflux (LPR) as the underlying contributory factor for chronic inflammation in both upper and lower airways. In this study, we investigated LPR symptoms and signs of CRS patients and the various factors on their LPR symptoms and signs. We also evaluated the effect of the LPR symptoms and signs of CRS patients after endoscopic sinus surgery (ESS).MethodsWe performed a retrospective analysis from 91 patients who underwent primary ESS. They were assessed for LPR symptoms with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before ESS. Sino-Nasal Outcome Test (SNOT)-22, Lund–Mackay (LM) scoring system, and Lund-Kennedy (LK) scoring system were evaluated for CRS severity. They had to fulfill SNOT-22, RSI, and RFS at 6 months after surgery.ResultsNasal polyps, smoking, asthma, allergy, LM scores and LK scores didn't have significant correlations with preoperative RSI and RFS (P > .05 for all). RSI had significant correlations with SNOT-22 preoperatively and postoperatively (P < .05 for all). RFS had a significant correlation with postoperative SNOT-22 (P = 0.034). RSI and RFS decreased significantly more after ESS (P < 0.001 for both). Smoking had a significant effect on the postoperative RFS (P = 0.003). Non-smoker showed significantly lower scores of postoperative RFS (P = .0.003).ConclusionOur study suggests that subjective CRS symptoms were related with subjective LPR symptoms and ESS was effective in reducing signs and symptoms of LPR in CRS patients. Especially, smoking was associated with less improvement of laryngoscopic findings after ESS.