Effect of functional endoscopic sinus surgery in patients of chronic sinusitis with bronchial asthma

Rhinosinusitis and bronchial asthma have been found to be coexistent in different studies. A prospective study of 23 patients with bronchial asthma who underwent Functional endoscopic sinus surgery (F.E.S.S) for coexistent chronic sinusitis was undertaken and the effect of endoscopic sinus surgery on bronchial asthma was analyzed in these patients using both subjective and objective criteria. It is concluded in this study that Functional endoscopic sinus surgery for chronic sinusitis in cases of bronchial asthma helps in reduction of their asthma symptoms, requirement of medication and helps in improving their peak expiratory flow.     

老年慢性鼻-鼻窦炎鼻息肉患者功能性鼻内镜围手术期治疗

目的:探讨老年慢性鼻-鼻窦炎鼻息肉患者在鼻内镜术围手术期的治疗特点。方法:回顾分析187例老年慢性鼻-鼻窦炎鼻息肉患者(年龄≥60岁)的临床资料。结果:经系统有针对性围手术期治疗后,治愈132例(72.5%),好转43例(23.6%),无效7例,总有效率96%,无一例发生手术并发症。结论:老年患者经系统有针对性的围手术期治疗后行鼻内镜手术是安全有效的。     

Functional endoscopic sinus surgery

Summary The Messerklinger technique is a primarily diagnostic endoscopic concept demonstrating that the frontal and the maxillary sinuses are subordinate cavities. Disease usually starts in the nose and spreads through the ethmoidal prechambers to the frontal and maxillary sinuses, with infections of these latter sinuses thus usually being of secondary nature. Standard rhinoscopy and sinus X-rays are frequently not sufficient to demonstrate the underlying causes for chronic or recurring acute sinusitis in the clefts of the anterior ethmoidal sinuses. The combination of diagnostic endoscopy of the lateral nasal wall with conventional or computed tomography in the coronal plane has proven to be the ideal method for the examination of inflammatory diseases of the paranasal sinuses. In so doing, diseases and lesions that other-wise might have gone undiagnosed can be identified and consequently treated. Based on this diagnostic approach, an endoscopic surgical concept was developed, aiming for the underlying causes of sinus diseases instead of the secondarily involved larger sinuses. With usually very limited surgical procedures, diseased ethmoid compartments are operated on, stenotic clefts widened and prechambers to the frontal and maxillary sinuses freed from disease. In our experience, there is rarely a need for major manipulations inside the larger sinuses per se. Based on exact diagnosis, the surgical technique used allows a very individualized staging according to the prevailing pathology. In the extreme, a total sphenoethmoidectomy can be performed with this technique, although the true advantage of the technique is that even in cases of massive disease such radical procedures can be avoided. By reestablishing sinus ventilation and drainage via the natural ostia, there is also no need for fenestration of the inferior meatus. The Messerklinger technique can be applied to a wide spectrum of indications, apart from nasal polyposis. The technique has its clear limits as well as its specific problems. Adequate training and experience are required for the surgical approach, as the technique bears all the risks and hazards of all kinds of endonasal ethmoid surgery but has a minimal complication rate in the hands of an experienced surgeon. Results and complications of a series of more than 4500 patients over a period of over 10 years are presented and discussed in detail.Dedicated to Professor W. Messerklinger on the occasion of his 70th birthdayoffprint requests to: H. Stammberger     

Functional endoscopic sinus surgery on a day case out-patient basis

One hundred patients, aged 13-79 years, have undergone 195 endoscopic ‘ethmoidectomies’. The operative method was entirely based upon the Messerklinger technique. In this study there were two main groups. (1) Patients with moderate to massive nasal/endonasal polyposis. (2) Patients with recurrent sinusitis. In the second group, the preoperative endoscopic findings were dominated by disease in the middle meatus and in the area of the anterior ethmoid, verified either by conventional hypocycloidal or computed tomography. Close to 90% of the patients were treated on an out-patient basis, under local anaesthesia. No serious peroperative complications (major bleeding, CSF leak, or visual problems) have been encountered. Thorough and meticulous post-operative care to avoid adhesions and renewed ostiomeatal obstruction, is felt to be important. The mean follow-up was 14 months. The post-operative results are encouraging, and correspond to larger European and American reports. The Messerklinger technique has proved to be suitable for smaller ENT departments, such as ours, especially as the patients can be treated on an out-patient basis using local/topical anaesthesia.     

青少年慢性鼻窦炎功能性鼻内镜手术疗效分析

目的探讨青少年慢性鼻窦炎功能性鼻内镜手术的可行性及必要性。方法对131例青少年慢性鼻窦炎患者经保守治疗无效者接受功能性鼻内镜手术,随访1年,并对其疗效进行分析。结果131例中治愈111例（84.7%）,好转17例（13.0%）,无效3例（2.3%）,总有效率97.7%。结论青少年慢性鼻窦炎经保守治疗无效时行功能性鼻内镜手术疗效满意,术后随访及综合治疗影响手术远期疗效。     

鼻内镜下额窦手术

目的：探讨应用鼻内镜进行额窦手术。方法：总结201例鼻内镜下额窦手术。其中额窦炎症性病变190例，额窦粘液囊肿10例，额窦骨瘤1例，合并其它鼻腔病变247侧。术前行鼻窦CT扫描，结合术中鼻内镜准确定位额窦开口，清除或纠正额窦开口及其周围结构病变或变异，以建立良好的符合生理性的额窦通气引流通道。结果：术后随访3～18个月，全部病例症状消失或改善，无一例复发，无术后严重并发症。结论：鼻内镜下额窦手术不失为一种安全、有效及微创的手术方式，适用于大多数额窦病变。     

Correlation between computed tomography scores and symptomatic improvement after endoscopic sinus surgery

OBJECTIVES/HYPOTHESIS: The aim of the study was to determine the correlation between preoperative computed tomography scores and the improvement of symptom scores in patients treated with functional endoscopic sinus surgery. STUDY DESIGN: Retrospective analysis of prospectively collected data. METHODS: Retrospective analysis of prospectively collected data of patients undergoing functional endoscopic sinus surgery at a tertiary care medical center over a 2-year period for rhinosinusitis refractory to medical therapy was performed. Computed tomography scans were graded according to the Lund-Mackay system. Patient symptom scores were recorded from the 20-item sinonasal outcome test (SNOT-20) inventory preoperatively and at 3, 6, and 12 months postoperatively. Correlation was assessed by the Pearson correlation coefficient (r). RESULTS: One hundred thirteen patients were identified with 1-year follow-up. The mean preoperative computed tomography grade was 13.2 with a mean SNOT-20 symptom score of 30.6. Preoperative CT scores did not correlate with preoperative symptom scores (r = 0.314). The SNOT-20 symptom scores improved 72%, 75%, and 77% at 3-, 6-, and 12-month follow-up, respectively, from preoperative values. In addition, there was no correlation between preoperative computed tomography scores and percentage of improvement at 3-, 6-, and 12-month follow-up (r = -0.003, r = -0.015, and r = -0.059, respectively). CONCLUSION: The severity of rhinosinusitis on preoperative computed tomography scan does not predict the severity of symptoms as assessed by the SNOT-20 inventory in patients undergoing functional endoscopic sinus surgery. Further, computed tomography scores fail to predict the amount of symptomatic improvement after functional endoscopic sinus surgery. Patients receive a mean reduction in symptom scores of 77% after treatment with functional endoscopic sinus surgery.     

Important clinical symptoms in patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis

OBJECTIVE: To evaluate the prevalence and severity of individual Rhinosinusitis Task Force (RSTF) symptoms in patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS). METHODS: Retrospective analysis of prospectively collected data in 201 patients treated with FESS. The prevalence and severity of individual RSTF major and minor symptom scores graded on a visual analogue scale (VAS) were compared. Correlation between absolute improvement in individual symptom scores at 1-year postoperative was performed. RESULTS: One-hundred fifty-eight of 201 patients met inclusion criteria giving a response rate of 78%. The average age was 49.4 (range 18-80) with a male-to-female ratio of 1.1:1. The preoperative leading mean symptom scores were postnasal drip (5.8 +/- 0.3), nasal obstruction (5.7 +/- 0.3), and facial congestion (5.1 +/- 0.3). These symptoms were also the most prevalent with 82%, 84%, and 79% of patients reporting these symptoms, respectively. Postoperative symptom improvements were significant (P < .0001) across all RSTF domains except fever. The highest percentage improvement was seen with facial congestion (93%), nasal obstruction (92%), and postnasal drip (85%). Multivariate analysis revealed significant (P < .0001) high correlation between improvements of facial pain/pressure with facial congestion (R = 0.72), facial congestion with nasal obstruction (R = 0.65), and facial pain/pressure with headache (R = 0.72). CONCLUSION: The top three RSTF symptoms were postnasal drip, nasal obstruction, and facial congestion in terms of prevalence and severity. Symptom scores improved after FESS. Of these symptoms, the degree of improvement of facial pain/pressure, facial congestion, nasal obstruction, and headache are highly correlated.     

Long-term results after endoscopic sinus surgery involving frontal recess dissection

OBJECTIVE: To assess long-term follow-up on a cohort of patients who underwent endoscopic frontal sinus surgery with identification and preservation of the natural frontal outflow tract. STUDY DESIGN AND SETTINGS: Retrospective chart review, telephone interview, and endoscopic evaluation on a previously studied cohort of patients at a university affiliated medical center. RESULTS: Two hundred patients who underwent endoscopic frontal sinus surgery were previously studied and reported after short-term (mean = 12.2 mo) follow-up. One hundred fifty-two (76%) patients were available for long-term (mean 72.3 mo) follow-up and assessment of subjective symptoms. Fifty-seven of 152 (37.5%) patients also had nasal endoscopy for evaluation of objective findings. The percentage of patients responding to telephone interview reporting overall improvement after surgery was 92.4%. Endoscopic assessment revealed patency of the frontal sinus in 67.6% of the patients after initial surgery. Thirteen additional patients had patent sinuses after revision procedures, bringing overall patency rate to 71.1%. We found statistically significant correlation of asthma and smoking and poor subjective and objective outcome. CONCLUSION: Long-term assessment of subjective and objective findings in our previously reported cohort of patients who underwent frontal sinus surgery indicates that the frontal sinus, similar to any other sinus, can be successfully treated surgically by preserving the natural frontal sinus outflow tract.     

鼻窦内窥镜手术处理病变中鼻甲的意义

目的：探讨功能性鼻窦内窥镜于术（ＦＥＳＳ）中处理病变中鼻甲的临床意义。方法：按照成人中鼻甲解剖学标准,在３２例鼻窦炎、鼻息肉患者ＦＥＳＳ中,对病变中鼻甲进行适当处理,并于术后对中鼻甲形态恢复、筛窦术腔及上凳窦窦中开放率进行随访观察。结果：术后６个月中鼻甲形态恢复正常２４例（７５％）,发生粘连８例（２５％）,其中术腔闭塞２例（６．３５％）;上颌窦窦口开放良好２５例（７８．１％）,狭窄６例（１８．８％     

鼻腔,鼻窦冠状位CT扫描解剖学观测及其指导意义

对１００例无明显鼻部疾病的成人行鼻腔，鼻窦冠状位ＣＴ扫描，从不同层面观测鼻腔，鼻窦重要解剖结构的值限范围和形态。结果昌：高台型筛板与筛顶间的平均高度差为５．１７ｍｍ，筛泡宽度为１１．１５ｍｍ，中鼻甲的宽度为５．４０ｍｍ；Ｈａｌｌｅｒ气房的出现率为１４．０％，中鼻甲气化为１４．０％，Ｏｎｏｄｉ气房的出现率为８．５％。     

Follow-up results of 415 patients after endoscopic sinus surgery

Endoscopic sinus surgery (ESS) is a method used with success in the treatment of chronic inflammatory paranasal sinus diseases. Between February 1991 and June 1995 the Messerklinger technique for ESS was used in 415 patients who had been pre-operatively evaluated in detail according to the staging system used in our clinic. Average post-operative follow-up was 23 months. Our general success rate was found to be 86.3% upon evaluating the subjective improvements in the patients’ symptoms in the post-operative period. The major and minor complication rates in our series were 0.24 and 20.24%, respectively. Received: 29 August 1997 / Accepted: 8 May 1998     

Informed consent in functional endoscopic sinus surgery

OBJECTIVES: Functional endoscopic sinus surgery (FESS) is one of the more common procedures performed by otolaryngologists. Before performing FESS, surgeons are obligated to discuss the procedure and its risks through the process of informed patient consent. The study identifies current practices in informed consent for FESS and formulates guidelines for informed consent for FESS. STUDY DESIGN: Survey. METHODS: Surveys were sent to 1000 American Academy of Otolaryngology-Head and Neck Surgery members in the United States. Surveys inquired about current informed consent practices related to FESS. RESULTS: Three hundred forty-six surveys were returned. Nearly 60% of respondents thought that 1% incidence of a complication warrants a discussion with patients. The percentage of respondents who discuss specific risks were as follows: bleeding, 96.7%; infection, 84.8%; cerebrospinal fluid leak, 99.1%; orbital injury, 96.7%; smell changes, 40.2%; cerebrovascular accident, 17.9%; myocardial infarction, 81%; and death, 28.0%. CONCLUSIONS: The study suggests that there is variability in specific informed consent practices for FESS among otolaryngologists. It also suggests that the incidence or severity of a complication does not necessarily correlate with whether or not it is mentioned during the informed consent process. The authors think that practicing otolaryngologists may be able to use this information to improve their consent practices.     

The role of functional endoscopic sinus surgery (FESS) in patients with asthma with chronic sinusitis

25 patients of bronchial asthma with chronic sinusitis were operated with the aim to evaluate the efficacy of functional endoscopic sinus surgery (FESS) on asthma symptoms. The mean postoperative daytime asthma symptom scores, nocturnal asthma symptom scores, mean postoperative nocturnal awakening scores and number of asthma attacks reduced significantly (p<0.001). The mean FEV₁ observed postoperatively showed significant increase (p<0.001). 21 patients reported overall significant improvement in the asthma. 6 patients were completely taken off from all sort of anti-asthmatic drugs [inhalational corticosteroids (ICS) + long acting β₂ agonist (LABA) ]. In 3 patients there was significant / substantial decrease in the dosage of anti-asthma drugs. It is concluded that FESS is a viable option for improving the control of asthma.     

Sorbalgon藻酸钙敷料在功能性鼻内镜手术中的应用

目的：选择有效的鼻腔堵塞止血材料。方法：比较功能性鼻内镜手术凡士林纱条和Sorbalgon藻酸钙敷料鼻腔堵塞止血效果及堵塞后鼻腔反应情况。结果：应用Sorbalgon藻酸钙敷料止血效果好，头痛及鼻腔疼痛较轻，抽除堵塞物时鼻腔很少出血，术后鼻粘膜反应轻。结论：Sorbalgon藻酸钙敷料是一种良好的鼻腔，鼻窦手术后堵塞止血材料。     

低能量He-Ne激光促进鼻内镜鼻窦手术后黏膜上皮化的临床观察

目的探讨低能量He—Ne激光照射对鼻内镜鼻窦手术后术腔黏膜转归的影响。方法符合标准的64例慢性鼻窦炎患者随机分为治疗组和对照组,治疗组以He-Ne激光术腔照射辅助术后治疗,以术腔黏膜病变情况及术腔上皮化时间为观察指标,与对照组比较评价疗效。结果He-Ne激光治疗组病例术后4周时术腔的囊泡、息肉样水肿、窦腔积脓及粘连均较对照组轻;治疗组平均上皮化时间6.1周,对照组平均上皮化时间8．2周,2组差异有统计学意义（P〈0．05）。结论He—Ne激光照射可促进鼻内镜鼻窦手术后黏膜良性转归。