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.     

功能性内镜鼻窦术后应用氨溴索疗效观察

目的 探讨慢性鼻窦炎功能性鼻内镜患者术后口服氨溴索区别于氨溴索冲洗鼻腔的疗效及应用价值。方法 将192例鼻窦炎患者随机分为4组,治疗一组48例采用术后口服氨溴索治疗,治疗二组48例采用氨溴索行鼻内镜术后鼻腔冲洗,治疗三组48例患者采用联合治疗方法,对照组48例无特殊治疗方案。随访6个月,观察比较四组疗效及术后术腔上皮化时间。结果 治疗组疗效均优于对照组。联合治疗三组疗效均优于单一治疗组（P<0.05）。结论 功能性鼻内镜患者术后口服氨溴索及氨溴索鼻腔冲洗联合治疗具有减轻术腔水肿、缩短术腔上皮化时间,促进术腔愈合及无副作用的优点。     

Long-term asthma outcomes after endoscopic sinus surgery in aspirin triad patients

BACKGROUND: Aspirin triad disease (ATD) is a well-known clinical entity characterized by asthma, polyposis, and aspirin intolerance. Using subjective and objective clinical data, this study examines the short- and long-term outcomes of asthma after sinus surgery in patients with ATD. METHODS: A retrospective review and standardized survey in the setting of an academic tertiary rhinology program. Eighty-five patients with ATD who had endoscopic sinus surgery between 1986 and 1998 were identified from an internal database. Standardized surveys were sent to each patient to assess both objective and subjective improvement of their asthma. RESULTS: The address and location of 20 of 85 patients could not be ascertained. Thirty-four of the remaining 65 patients (52.3%) with ATD who underwent endoscopic sinus surgery responded to the survey. Respondents had a mean follow-up of 10 years. Overall, 29 (94%) of 31 patients who reported asthma symptoms preoperatively noted long-term postoperative improvement. Furthermore, 21 of these 31 patients (68%) reported further improvement of their asthma beyond the first postoperative year. Emergency department visits for asthma exacerbations decreased in 17 (94%) of 18. Inpatient hospitalizations for asthma exacerbations also decreased in the first postoperative year in 10 (91%) of 11 patients. Asthma attacks declined in 12 (41%) of 27 patients the first year, whereas 24 (88.9%) of 27 patients had fewer asthma attacks in the last 12 months of follow-up. Peak flow rates improved from an average of 60% of the predicted value preoperatively to 86% at the time of follow-up. CONCLUSIONS: The asthma component of ATD continues to improve with time after endoscopic sinus surgery. Although the most dramatic decrease occurs in the first year after sinus surgery, the majority of patients noted further improvement in subsequent years.     

Effect of asthma on sinus computed tomography grade and symptom scores in patients undergoing revision functional endoscopic sinus surgery

BACKGROUND: The aim of this study was to determine the influence of asthma on sinus computed tomography (CT) grade, endoscopic appearance, and symptom scores in patients undergoing revision functional endoscopic sinus surgery (FESS). METHODS: Prospective data was collected of patients undergoing revision FESS at a tertiary medical center over a 2-year period. CT scans were graded as per the Lund and Mackay system. Patient symptom scores were recorded from the Sino-Nasal Outcome Test (SNOT 20) inventory and individual symptoms from the Rhinosinusitis Task Force major and minor symptom list were graded on a visual analog scale. RESULTS: Eighty patients underwent revision FESS and 20 of those patients had asthma. The average CT grade in asthmatic patients was 18.6 compared with 11.7 in patients who were nonasthmatic (p = 0.000006). The average SNOT 20 symptom score in patients with asthma was 49.6 and in nonasthmatic patients it was 44.9 (p = 0.238). Both asthmatic and nonasthmatic patients experienced a reduction in SNOT 20 symptom scores at 1 year with reductions of 70% (p = 0.0000) versus 72.6% (p = 0.0000), respectively. CONCLUSION: Patients with asthma undergoing revision FESS had higher sinus CT grades compared with patients without asthma. Asthmatic and nonasthmatic patients had statistically significant reductions in symptoms scores after revision FESS. Asthmatic patients had similar symptomatic relief scores after revision FESS as compared with nonasthmatic patients.     

Revision functional endoscopic sinus surgery

Functional endoscopic sinus surgery (FESS) has recently become a popular procedure for treating chronic sinusitis. However, there is a 2% to 24% rate of primary FESS failure. Revision functional endoscopic sinus surgery (RESS) is indicated for patients who remain symptomatic after primary FESS and optimal medical therapy have failed. A retrospective study was conducted on all patients who underwent RESS in our department between April 1988 and March 1998. During this period, FESS was performed 1,227 times to treat chronic sinusitis; among those procedures, 142 were RESS. Complications occurred in 14 RESS procedures (9.9%). After RESS, 65% patients had improved. In this study, we concluded that although RESS is more difficult than primary FESS because of distorted or missing anatomic landmarks, complications did not increase with RESS if meticulous surgical procedures were performed. However, the 65% improvement rate with RESS was lower than that of primary FESS.     

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.     

Imaging for functional endoscopic sinus surgery

Radiologic imaging is an essential part of the presurgical evaluation of patients with sinusitis and of the monitoring of difficult-to-treat,recurrent, and postsurgical disease. In patients with noninflammatory sinus pathology and those who "baffle" clinical diagnosis, ima-ging is extremely helpful in differentiating the various pathological entities and determining the extent of disease. Computerized tomography (CT), when deemed clinically necessary, is the current modality of choice to evaluate sinusitis. CT's ability to display bone,mucosa, and air makes it a perfect tool for imaging of the paranasal sinuses. The fine bony architecture of the nasal cavity and the para-nasal sinus drainage pathways are depicted accurately with CT examination.     

去氨加压素用于鼻窦内镜手术的临床研究

目的观察去氨加压素(DDAVP)用于功能性鼻窦内镜手术(FESS) 的效果.方法择期行FESS的病人59人,随机分成治疗组(n=30)和对照组( n=29),治疗组于麻醉诱导前30 min将DDAVP 0.3 μg/kg用生理盐水稀释到100 ml,15 min 内静滴完毕,对照组输入等量生理盐水.测定两组术前和用药后1 h的血小板计数(PLT)、凝 血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原定量(FIB)、第八因子促凝活性(F ⅧC);监测两组平均动脉压(MAP)、心率(HR),计算心率和收缩压的乘积(RPP);记录术中 出血量和手术时间;据以评价其临床效果.结果治疗组用药1 h后APTT显 著缩短,FⅧC显著升高(P<0.05),术中出血量和手术时间显著少于对照组(P< 0.05),总有效率为90%,显著高于对照组(P<0.05).结论 D DAVP可明显增强病人的凝血功能,减少鼻窦内镜手术的出血量.     

Influence of polyps on outcomes after endoscopic sinus surgery

OBJECTIVE: To determine clinical and comparative outcomes for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) with polyposis. METHODS: Two cohorts of adult patients with refractory CRS with and without nasal polyps were prospectively studied before and after ESS (minimum follow-up, 12 months) with the Rhinosinusitis Symptom Inventory (RSI). For the non-polyp and polyp cohorts, RSI symptom domains and medical resource utilization were compared in the preoperative and postoperative states. Corresponding effect sizes were computed and compared between cohorts to determine the effect of polyps on prognosis after ESS. RESULTS: A total of 165 non-polyp and 86 polyp patients were enrolled. Polyps were more common in female patients (2:1, P = .025); age (mean, 42.9 years) and follow-up (18.5 months) were similar between groups. Lund scores were significantly higher for polyp patients (13.7, SD 4.8) vs. non-polyp patients (8.1, SD 5.3, P < .001). At baseline, polyp patients reported lower symptom scores for facial, oropharyngeal, and systemic RSI symptom domains (all P < .012); nasal and total symptom domains were similar between groups. Both non-polyp and polyp groups obtained significant symptomatic benefit from ESS with effect sizes for RSI symptom domain improvements ranging from 0.89 to 1.38 and 0.43 to 1.19, respectively (all P < .001). There were no significant differences between groups in symptomatic improvement, excepting oropharyngeal symptoms (better improvement in non-polyp group, P = .024). Non-polyp patients decreased medical resource consumption more significantly than did polyp patients. CONCLUSIONS: Both non-polyp and polyp patients derive similar clinically significant symptomatic improvement after ESS. These similarities suggest that polyp patients do not necessarily have a poorer symptomatic outcome after ESS.     

Clinical outcomes after revision endoscopic sinus surgery

OBJECTIVE: To determine if patients undergoing revision endoscopic sinus surgery (ESS) for chronic rhinosinusitis obtain significant symptomatic benefit from surgery. DESIGN: Prospective controlled clinical trial. METHODS: Adult patients undergoing revision ESS were evaluated preoperatively with a computed tomographic scan and the Rhinosinusitis Symptom Inventory. After the revision ESS, patients were reevaluated with the Rhinosinusitis Symptom Inventory. Data were analyzed for symptom score changes and effect sizes, changes in medication, and economic variables. Improvements in sinonasal symptom scores, medication use, and economic variables were compared with those of a contemporaneous control group of patients undergoing primary ESS and matched for age, sex, and Lund score. RESULTS: The 21 patients (mean age, 44.8 years) who completed evaluation after revision ESS had a mean follow-up of 12.4 months. Mean preoperative Lund score was 12.6. Large effect sizes indicating significant symptom improvements were noted for nasal obstruction (effect size, -1.9), hyposmia (-0.9), and headache (-0.6), as well as nasal (-1.1) and total symptom domains (-0.9; P<.05 in all cases). Nasal steroid and nonsedating antihistamine use did not decrease significantly after ESS, but oral antibiotic use showed a downward trend (net change, - 2.9 wk/y; P =.23). Improvements in clinical symptoms were statistically similar to corresponding improvements in the matched cohort of patients undergoing primary ESS. CONCLUSIONS: The symptomatic relief that revision ESS can provide for patients with refractory chronic rhinosinusitis is similar to that following a primary ESS. However, many patients undergoing revision ESS require continued intense medical management of their chronic rhinosinusitis.     

鼻内镜手术对成人慢性鼻-鼻窦炎伴哮喘患者疗效的影响

目的　分析并探讨鼻内镜手术对成人慢性鼻-鼻窦炎（chronic rhinosinusitis,CRS）伴哮喘患者疗效的影响。方法　采用前瞻性对照分组设计,对我院诊断为CRS并接受鼻内镜手术治疗的325例患者依入组标准选择92例患者进行跟踪随访,于术前、术后评估所有患者鼻部和哮喘各指标变化情况。结果　共92例完成3个月随访,90例完成12个月随访。鼻内镜手术后鼻部总体症状和鼻塞、流涕的视觉模拟量表评分以及鼻内镜Lund-Kennedy评分均明显改善,喷嚏、嗅功能、头面部疼痛视觉模拟量表评分结果也有不同程度改善。伴哮喘患者鼻内镜手术后哮喘控制测试评分在术后明显升高,而肺功能各指标变化无统计学差异。结论　以鼻内镜手术为中心的综合治疗对成人CRS伴哮喘患者的鼻部症状改善和减少用药量有显著作用;短期内鼻内镜手术对提高哮喘患者哮喘控制水平和减少哮喘用药量有积极作用。     

Major complications of functional endoscopic sinus surgery

The results of a postal questionnaire indicate an exponential rise in the practice of functional endoscopic sinus surgery (FESS) in the UK and a major complication rate of 0.23%. Cerebrospinal fluid leak was the most common serious complication accounting for 24 of the 36 reports.     

三种鼻腔填塞材料在鼻内镜手术中的疗效比较

目的：探讨三种鼻腔填塞材料在鼻内镜手术中的应用效果。方法：2004年1月至8月为慢性鼻窦炎、鼻息肉75例行内窥镜鼻窦手术,男49例,女26例,平均42 岁。Ⅱ型2期36例,Ⅱ 型3期21例,Ⅲ型18例。局部或全身麻醉下行Messerklinger鼻窦内窥镜手术,术后随机予以凡士林油纱条、Merocel高分子止血棉、瑞纳凝胶快速止血材料中的一种填塞鼻腔,每组25例,48～72?h后取出填塞物,观察患者鼻痛、头痛的程度及取出填塞物后的渗血情况,判断疗效。结果：凡士林油纱条组80％的患者出现鼻痛、头痛等症状,64％的患者抽出鼻腔填塞物后有渗血;瑞纳凝胶快速止血材料组60％的患者出现鼻痛、头痛等症状,12％的患者抽出鼻腔填塞物后有渗血;Merocel高分子止血棉组44％的患者出现鼻痛、头痛等症状,24％的患者抽出鼻腔填塞物后有渗血;三组比较差异有统计学意义(P＜0.05)。结论：三种鼻腔填塞材料中凡士林油纱条疗效可靠,价格低廉,但痛苦明显;Merocel 高分子止血棉、瑞纳凝胶快速止血材料止血效果好,痛苦小,但价格略昂贵,临床应用中可视情况而定。     

Effects of functional endoscopic sinus surgery on intraocular pressure

OBJECTIVE: To investigate whether functional endoscopic sinus surgery (FESS) for the treatment of chronic rhinosinusitis will induce changes in intraocular pressure (IOP). DESIGN: Prospective, nonrandomized, preoperative and postoperative study. SETTING: University-affiliated medical center. PATIENTS: Thirty patients who underwent FESS for chronic rhinosinusitis with or without polyps were prospectively enrolled in this study. Patients with diabetes mellitus, hypertension, glaucoma, previous ocular trauma, history of ocular surgery, and previous use of topical corticosteroid eyedrops were excluded. MAIN OUTCOME MEASURES: The IOPs were measured by Goldmann tonometry preoperatively, postoperatively on days 1 and 2, and on day 3 after the removal of the nasal packs. Physiological factors such as heart rate and systolic and diastolic blood pressures, which may have some effects on the IOPs, were also recorded. RESULTS: Ten women and 20 men with a mean age of 39.7 years were enrolled in the study. Twenty-one patients had bilateral chronic rhinosinusitis and 9 patients had unilateral sinus disease. The postoperative ocular discomforts were epiphora (13 of 30 [43%]) and eye pressure (6 of 30 [20%]). The mean +/- SD IOP of the eye on the side of the operated-on sinus was 13.63 +/- 2.33 mm Hg preoperatively. Postoperatively, the mean +/- SD IOPs were 14.08 +/- 2.52 mm Hg on day 1, 13.96 +/- 2.64 mm Hg on day 2, and 14.10 +/- 2.91 mm Hg on day 3 after removal of the nasal packs (P = .82). The IOP-related factors of heart rate and systolic and diastolic blood pressures also showed no significant difference. CONCLUSIONS: Although FESS may cause variations in the IOP compartment, the changes in IOP are not statistically significant. Therefore, FESS is a safe surgical procedure with respect to ocular physiological function.     

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.