Bilateral Functional Endoscopic Sinus Surgery Research Articles

Pembrolizumab-Induced Nasal Polyposis: The First Reported Case

The last decade has seen the emergence of immune checkpoint inhibitors for the treatment of a wide variety of cancer types. While these medications are generally speaking well tolerated, the full long-term side effect profiles of these medications have not been fully elucidated. We describe a case of chronic rhinosinusitis with nasal polyposis induced treatment with pembrolizumab, the first reported case. We present the case of a 48-year-old man with a background history of stage IV non-small cell lung cancer with bone metastases. He was commenced on pembrolizumab and over the course of the subsequent 5 years he developed significant nasal polyps bilaterally, and was commenced on medical therapy. Sinus CT scan demonstrated bilateral total opacification of all his sinuses and nasal cavity. He subsequently underwent bilateral functional endoscopic sinus surgery. He remains symptom-free and at his last clinical follow-up visit 1 year later. There are limited case reports of nasal polyposis occurring in patients receiving immune checkpoint inhibitors, with only one case requiring surgery. We describe the first case of severe nasal polyps due to pembrolizumab and successfully treated with polypectomy. From our review, there were no cases that required a cessation of therapy.

Inflammatory Sinonasal Polyposis-Causing Globe Perforation-With Response to Dupilumab Therapy.

A 75-year-old male patient with asthma presented with left eye vision loss for 1 year and progressive nasal obstruction, anosmia, and purulent eyelid and nasal discharge for several months. There was no light perception vision with an afferent pupillary defect in the left eye. Examination demonstrated nasal dorsum widening, sino-cutaneous fistulae, bilateral proptosis, and left eye chemosis with corneal keratinization in the setting of prior perforation (Fig. 1A). Nasal endoscopy showed severe, bilateral polyposis (Fig. 1B). MRI revealed an extensive sinonasal process with left globe disfigurement and severe, postobstructive, sinus mucocele formation (Fig. 2, top). The patient underwent bilateral functional endoscopic sinus surgery. Intraoperatively extensive sinonasal polyposis and inspissated mucinous debris were encountered. Histopathology demonstrated nasal polyps with dense eosinophilic infiltration and cultures grew polymicrobial bacteria. He underwent left eye evisceration, left lower eyelid ectropion repair, and second-stage sinus surgery. Postoperatively, there were improvements in pain, breathing, and smell. Nasal endoscopy displayed improved sinus patency, although with rapid polyp recurrence. Given concern for mucocele formation and potential impact on the right eye, bimonthly subcutaneous dupilumab was initiated. Following 5 doses, there was dramatic improvement, with symptom resolution, nasal bridge narrowing, sinonasal polyposis reduction, and fistulae closure (Fig. 1C). Subsequent CT showed dramatic polyposis involution and sinus clearing (Fig. 2, bottom). Severe chronic sinusitis with polyposis may exert mass effect on local structures including the brain, optic nerves, and globes. Among patients with severe, refractory, or recurrent polyposis, subcutaneous dupilumab may provide a dramatic clinical response.FIG. 1FIG. 2

Usefulness of post-operative endoscopic score for optimal treatment selection in recurrent eosinophilic chronic rhinosinusitis.

This study retrospectively analysed post-operative endoscopic scores to determine the optimal post-operative treatment in patients with eosinophilic chronic rhinosinusitis undergoing functional endoscopic sinus surgery. In total, 339 adults who underwent initial bilateral functional endoscopic sinus surgery for eosinophilic chronic rhinosinusitis were enrolled. Patients were divided into group A, which required no additional post-operative treatment; group B, which required local/systemic steroids post-operatively; and group C, which further required dupilumab and/or revision surgery. Sixty-five per cent of patients could be treated with initial functional endoscopic sinus surgery (group A). Post-operative steroids were required in 35 per cent of patients with a post-operative endoscopic score of 30 per cent (group B). Further advanced treatments with dupilumab and/or revision functional endoscopic sinus surgery were required in 10 per cent of patients with a post-operative endoscopic score of 65 per cent (group C). The post functional endoscopic sinus surgery endoscopic score can be used as an index to determine treatment at the time of eosinophilic chronic rhinosinusitis recurrence.

P266 A case of mixed fungal infection causing invasive fungal Rhinosinusitis in a post-COVID patient

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesTo identify the fungal etiology of invasive nasal sinusitis in a patient of post-COVID.MethodsA 34-year-old non-diabetic man, who had mild coronavirus disease (COVID) infection 2 months back presented with left-sided nasal obstruction, headache accompanied by malodorous, thick, mucopurulent discharge for the last 2 weeks.A CT scan of sinuses revealed opacification of left posterior ethmoid and sphenoid sinus without bony erosion or calcification.The patient underwent unilateral functional endoscopic sinus surgery (FESS) and debridement of tissue from the affected sinuses.ResultsA KOH preparation of the debrided tissue showed thin septate hyphae. Gram-stained smear of the debrided material showed thin septate fungal hyphae with clamp-like connections (Fig. 1). Histopathological examination revealed features of the inflammatory polyp. In Sabouraud dextrose agar the fungal colony grew fast and its aerial mycelium is white and cotton-like. The fungus was phenotypically identified as Schizophyllum communae (identification was confirmed at the National Reference Centre).He continued to do well but about 2 months later he started experiencing headaches and pain behind the eyes. He also complained of nasal stuffiness (left greater than right) and yellowish nasal discharge. At this point, a CT scan revealed soft tissue density with interspersed hyperdensity in sphenoid sinus bilateral ethmoid, and bilateral maxillary sinuses with associated bony erosion and possible extension into the right cavernous sinus and extrachonal compartment of right orbit suggestive of invasive fungal sinusitis (Fig. 2).Bilateral FESS was done. Extensive fungal material was observed in the sphenoid sinus and thorough debridement was performed.Mycological studies of the debrided tissue showed thin septate hyphae. Schizophyllum communae was again isolated in culture.Histopathological section showed inflammatory cells and several slender, branching septate fungal hyphae.The invasive nature of the infection prompted reexamination of the histopathology slides and cultures for the presence of other fungi particularly of the Mucorales group but no other fungus could be identified.The patient was started on liposomal amphotericin B and the tissue blocks were sent for fungal identification to the National Reference Centre through sequencing following DNA extraction from the paraffin blocks. Amplification of the 18 S rDNA region (coding for the 18 S RNA) using ZM primers followed by sequencing revealed the presence of R. arrhizus.The patient was continued on amphotericin B. The patient was discharged after 2 weeks with oral isuvuconazole. At six months follow up he is doing well with no evidence of active infectionConclusionAs the novel COVID‐19 continues to rampage, an abrupt increase in the number of opportunistic fungal infections has been observed.Invasive and often fatal rhino-cerebral Mucormycosis is now been increasingly reported in patients who have had COVID-19 infection in the recent past. In this case, there was a dual fungal infection causing rhino-sinusitis which was established through conventional culture and PCR assays from paraffinized tissue sections. Increased awareness of the existence of dual mold infections in at-risk patients is necessary for optimum management. PCR methods in tissue sections increase the diagnosis of dual mold infections.

Role of mitomycin-C to reduce post FESS adhesion and ostial stenosis

The aim of this study is to determine adhesion formation rate and antrostomy closure rate after the use of Mitomycin-C in patients underwent FESS. This is a prospective case control study conducted at ENT Department Lyari General Hospital, Karachi, Pakistan. Fifty one patients included with diagnosis of bilateral chronic rhinosinusitis or allergic fungal sinusitis and were the surgical candidate, underwent bilateral Functional Endoscopic Sinus Surgery (FESS). The patients were evaluated using Lund-Mackay staging system prior to surgery. At the completion of surgery Mitomycin-c (MMC) was applied in one nasal cavity the other nasal cavity served as a control. Among fifty one patients both nostrils were used hence we have 51 cases and 51 controls. The patients were followed for a minimum period of three months after surgery. Subjective improvement of symptoms were recorded as well as rigid nasoendoscpic examination was also performed regularly. The adhesion formation rate in MMC applied nasal cavities was 11.7% as compared to 64.7% of controls. The middle meatal antrostomy closure rate was 41% and 5% in controls and MMC applied group respectively. Hence mitomycin-c application has shown benefit in reducing post FESS ostial stenosis and adhesion formation between middle turbinate and lateral nasal wall. Application of Mitomycin-C has impact on reducing post FESS adhesion formation and middle meatal antrostomy closure.

The effect of functional endoscopic sinus surgery on nasal resonance.

Background and objectiveFunctional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.MethodsThe nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.ResultsIn both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.ConclusionChanges in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.

Anaesthetic Management of a Case of Sinonasal Mucormycosis with Post Covid -19 Pulmonary Embolism for Endoscopic Debridement

Coronavirus disease (COVID)-19, especially the severe disease is associated with an increased risk and prevalence of venous thromboembolism [1]. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) binds to the angiotensin converting enzyme-2 (ACE-2) receptors on endothelial cells, especially within the kidneys, heart, lungs, etc. causing endothelial cell damage leading to thrombosis and thrombotic complications like deep vein thrombosis, pulmonary embolism, myocardial infarction, etc [2].We present here our experience of the anaesthetic management of a 40 year old male with post COVID-19 sinonasal mucormycosis and history of pulmonary embolism posted for bilateral functional endoscopic sinus surgery (FESS) and endoscopic debridement.

Bioabsorbable dressing impregnated with betamethasone and ciprofloxacin after endoscopic sinus surgery: A randomized, double-blind, placebo-controlled study.

In addition to its hemostatic and stabilization role, biodegradable nasal packing can be used as a carrier for drugs after functional endoscopic sinus surgery (FESS). The aim of this study was to compare the influence of biodegradable synthetic polyurethane foam (NasoPore) soaked with ciprofloxacin, or betamethasone, or both to the same foam soaked with saline after FESS. 120 adults with chronic rhinosinusitis, with and without polyps, directed for bilateral full-house FESS were enrolled for the study. The patients were randomized and blinded into 3 groups, depending on the type of postoperative procedure applied. Thus, NasoPore soaked with antibiotic was provided to the first group; in the second group, the steroid was used; and the combination of both, in the third group. In each case, the aforementioned procedure was administered on one side of the nose, while NasoPore was soaked in saline on the other, at the end of the surgery, respectively. The patients were requested to complete a questionnaire during their postoperative visits at 2, 10, 30, 90, and 180 days, scoring the level of complaints on the VAS scale, separately for each side. The evaluation of the healing process was performed at each visit using rigid endoscopy and subsequently rated on numerical scales. Decreased mucosal edema and secretion; reduced Lund-Kennedy score; and favorable influences on facial pressure, nasal blockage, and smell were most evidently seen in the group receiving the antibioticsteroid combination. The application of biodegradable nasal packing with betamethasone and ciprofloxacin in sino-nasal surgery has positive effects not only on the healing process but also impacts patient's comfort. To optimize it, however, further research is needed.

Bilateral Involvement of Frontal Sinuses in a Pott's Puffy Tumor: A Case Report

ABSTRACT Aim and objective A case report with review of the literature. Background Pott's puffy tumor is an uncommon complication of frontal sinusitis. Nevertheless, an increase in the frequency of cases has been reported over the last 10 years. The presence of both frontal sinuses in the production of Pott's puffy tumor has never been described before. Case description A 15-year-old boy was evaluated in the emergency department by tumor and pruritus at the right frontal level. A computed tomography (CT) scan revealed a disruption of the right frontal sinus with a subperiosteal abscess. During surgery, it was discovered the involvement of both frontal sinuses. A combined bilateral functional endoscopic sinus surgery and external approach were used. Conclusion This pathology must be kept in mind in the case of an adolescent patient with a frontal tumor. Surgery is the most important factor in the treatment of this pathology together with a targeted antibiotic treatment. How to cite this article Palacios-García JM, Moreno-Luna R, Molina-Fernandez E, et al. Bilateral Involvement of Frontal Sinuses in a Pott's Puffy Tumor: A Case Report. Int J Otorhinolaryngol Clin 2019;11(3):67–69.

Serum eosinophil cationic protein: a prognostic factor for early postoperative recurrence of nasal polyps

The objective of this work was to assess the efficacy of serum eosinophil cationic protein (ECP) concentration in predicting early postoperative recurrence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). We prospectively enrolled CRSwNP patients to receive bilateral functional endoscopic sinus surgery (FESS) and followed them for 1 year. Serum ECP level was measured within 1 week before surgery. Demographics and associated medical factors were analyzed with the surgical outcome, and nasal polyp histology was microscopically examined. Overall, 58 patients met the inclusion criteria and underwent FESS. After at least a 1-year follow-up period, 9 patients had postoperative recurrence, with significantly higher serum ECP levels (p = 0.030). Receiver operating characteristic curve analysis showed the optimal cutoff level of serum ECP concentration for predicting the postoperative recurrence of nasal polyps was 21.8 µg/L (p = 0.030). Regardless of atopy status and histology type, logistic regression analysis showed that a higher ECP level was the sole significant factor related to early postoperative recurrence of nasal polyps (odds ratio, 54.8; p = 0.014). Cox proportional hazard regression analysis revealed that the hazard ratio of CRSwNP patients with an ECP level of >21.8 µg/L resulting in early postoperative recurrence was 7.6 (p = 0.011). Serum ECP appears to be a feasible predictor for early postoperative recurrence of nasal polyps. CRSwNP patients with preoperative serum ECP levels of ≥21.8 µg/L had an approximately 55-fold increased risk of early recurrence. CRSwNP patients with higher preoperative serum ECP levels should be closely monitored within the first year after surgery.

COMPARATIVE STUDY BETWEEN NASAL PACKING WITH CARBOXY METHYL CELLULOSE AND LATEX GLOVED MEROCEL IN THE SAME PATIENT AFTER FUNCTIONAL ENDOSCOPIC SINONASAL SURGERY

Background: Nasal packing after functional endoscopic sinus surgery (FESS) is used as a standard procedure to control the postoperative bleeding, promote the mucosal healing and to prevent synechiae formation, but traditional non-resorbable packs have several disadvantages. The optimum solution to minimize these disadvantages may be accomplished using the new biodegradable packs. Objectives: This study was done to compare between the effect of carboxy methyl cellulose (CMC) foam nasal pack and latex gloved merocel (LGM) nasal pack in the same patient after FESS regarding the prevention of postoperative bleeding, pain and synechiae formation. Patients and Methods: A prospective, randomized, single-blinded controlled study was performed in 35 patients with bilateral chronic rhinosinusitis who were collected from ENT outpatient clinic of Al-HusseinUniversityHospital from Feb. 2019 to Nov. 2019. All patients underwent bilateral FESS by a single surgeon. At the end of the operation, each patient was packed with dissolvable CMC foam nasal pack in one nasal cavity and latex gloved merocel nasal pack in the other side. The hemostatic effect of the CMC foam and latex gloved merocel was assessed during the recovery period. Pain levels were recorded by the patients on a visual analogue scale 2, 6, 12 and 24 hours after surgery and at the time of packing removal. The effectiveness of prevention of synechiae formation was assessed endoscopically 4 and 8 weeks after surgery. Results: There was no statistically significant difference between CMC group and LGM group as regard their effect on control the postoperative bleeding. Only five (14.3%) of the CMC group had primary postoperative bleeding, and it occurred in three (8.6 %) of gloved merocel group. The mean level of patient pain was 0.98 (Range: 0-2) in CMC group, but was 1.65 (Range: 1-3) in latex gloved merocel group which is statistically significant. As regarding synechiae formation, the difference between both groups was statistically insignificant at the 4 weeks period] Two (5.7%) of CMC group and five (14.3 %) of LGM group developed a synechiae [and statistically significant at the 8 weeks period] three (8.6%) of CMC group and nine (25.7 %) of gloved merocel group developed synechiae]. Conclusion: Dissolvable CMC foam nasal pack was associated with very low levels of localized pain, and with low levels of postoperative bleeding and synechia formation.

Avoiding repeated surgery in patients with acute invasive fungal sinusitis.

We aimed to ascertain whether using an aggressive initial surgical protocol would reduce the need for repeated sinus surgery in patients with acute invasive fungal sinusitis (AIFS). Patients with AIFS prospectively underwent clinicoradiological assessment followed by bilateral functional endoscopic sinus surgery (FESS) and debridement of affected tissue. Antifungal therapy was also administered. Postoperative endoscopic debridement of crusts was performed weekly in the clinic. Outcomes were compared with a historical control group who underwent multiple surgeries. There were 42 male and 9 female patients aged 9-68years (mean: 42.5years). Forty (78.4%) patients were diabetic and 17.6% had hematological malignancies. The majority (60.8%) had stage 2 or 3 disease. Partial/total maxillectomy (29.4%), orbital exenteration (7.8%) and craniotomy (2%) were also performed at a single session in 20 patients. Intra-operative sampling of all sinuses was performed. Six patients who appeared to have unilateral disease based on clinicoradiological assessment were found to have bilateral disease. Only 2 patients required revision surgery. Follow-up ranged from 3 to 24months. The survival rate was 68.2% overall and 73.5% for diabetics alone. The difference in outcomes with a single surgery versus multiple surgeries was not significant (p = 0.09) CONCLUSION: A surgical protocol involving bilateral FESS along with debridement of visibly affected areas and antifungal therapy avoids repeated surgery in patients with AIFS with no change in outcomes. The absence of clinicoradiological involvement of the paranasal sinuses does not preclude the presence of invasive fungal disease in these sinuses.

Predictors of disease progression after endoscopic sinus surgery in patients with chronic rhinosinusitis.

This study aimed to determine the predictors of disease progression after functional endoscopic sinus surgery in patients with chronic rhinosinusitis. A total of 281 adult chronic rhinosinusitis patients who underwent primary bilateral functional endoscopic sinus surgery between 2007 and 2017 and had at least 12 months of follow-up endoscopic evaluation were examined. Patients were divided into eosinophilic (n = 205) and non-eosinophilic chronic rhinosinusitis groups (n = 76). In order to determine adverse factors, post-operative endoscopic appearance scores were analysed in relation to the pre- and intra-operative findings using multiple regression analyses. The post-operative course of eosinophilic cases deteriorated over time, like the early period for non-eosinophilic cases. Frontal sinus polyps recurred early in eosinophilic chronic rhinosinusitis. Multivariate analyses indicated young adulthood, asthma, high computed tomography score and frontal sinus polyps as significant adverse predictors. Early, appropriate estimation of sinonasal conditions appears to be crucial for successful surgical management of chronic rhinosinusitis.

Effect of biodegradable versus nondegradable nasal packings in the outcome of functional endoscopic sinus surgery: clinical and histopathological study

BackgroundNasal packing has been used to prevent bleeding and formation of adhesions between the middle turbinate and lateral nasal wall. There has been a debate whether biodegradable packing might improve the outcome, or could a nondegradable dressing offer a better course after endoscopic sinus surgery.ObjectiveTo compare the effect of biodegradable versus nondegradable nasal packings on the outcome of endoscopic sinus surgery on clinical, endoscopic, and histopathologic basis.Patients and MethodsFifty patients with bilateral chronic rhinosinusitis of the same extent of sinus affection were enrolled in this study. None of them was a revision case. All patients had bilateral functional endoscopic sinus surgery by the same surgeon using the same technique of powered microdebrider utilization. At the end of the procedure, the operative cavity of each patient was randomly packed with Merocel as a nondegradable material on one side and a biodegradable material on the other side. We assessed the patients regarding immediate postoperative symptoms and endoscopic follow-up after 1- and 3-month postoperatively including biopsy taking for histopathological examination.ResultsPostoperative bleeding and patient discomfort were significantly higher in the nondegradable packing side, while biodegradable packing has caused significantly more edema. Merocel packed sides showed better epithelial restoration with marked epithelial hyperplastic changes and more goblet cells than the biodegradable sides. This difference was statistically significant 1-month postoperatively, but turned nonsignificant 3-month postoperatively.ConclusionsBiodegradable nasal packing can offer patients a good quality of life during the early recovery period without beneficial or detrimental effects on postoperative mucosal healing. Nondegradable packs offer less post-functional endoscopic sinus surgery edema providing better aeration and rapid wound healing.

Potential risk factors associated with the development of synechiae following functional endoscopic sinus surgery.

Synechiae formation in the middle meatus is the most common complication of functional endoscopic sinus surgery (FESS). Our objectives were to determine the incidence of synechiae occurring in a cohort of patients that have undergone FESS and identify characteristics associated with the development of synechiae postoperatively. A retrospective chart review was conducted of CRS patients, with or without nasal polyposis, that had undergone bilateral FESS in the past. All patients had received non-absorbable spacers intraoperatively that were left in situ for 6 days. Demographic and preoperative variables were analyzed to identify synechiae risk factors. A multivariable logistic regression model was constructed to estimate the probability of developing synechiae, given demographic and preoperative variables. Two hundred cases of bilateral FESS were retrospectively reviewed. Thirty-eight (19.0%, 95% CI 13.6-24.4%) patients developed synechiae. Individuals receiving primary FESS and nasal septal reconstruction (NSR) were strongly associated with the development of synechiae (OR 3.5, 95% CI 1.5-8.5; OR 3.0, 95% CI 1.3-6.9). A multivariable logistic regression model adjusting for NSR, recurrent FESS, concha bullosa, requirement of anterior and posterior ethmoidectomy, Lund-Mackay CT score and gender, identified the likelihood of developing synechiae with a sensitivity of 68%, specificity of 73%, positive predictive value of 38% and likelihood ratio of 2.5. Patients undergoing primary FESS and NSR are at greatest odds of developing postoperative synechiae. Methods of assessing risk factors and preventing synechiae formation in this population should be evaluated in future prospective investigations.

Bilateral silent sinus syndrome: A rare case and review of literature.

Objective:In this report, we presented a rare case of bilateral silent sinus syndrome (SSS) in an otherwise healthy 57-year-old man treated with functional endoscopic sinus surgery (FESS). A systematic review of the literature regarding bilateral SSS was performed.Case Report:A 57-year-old man with well-controlled allergic rhinitis in the absence of previous surgery or trauma presented with bilateral SSS, which was successfully managed with bilateral FESS.Methods:A medical literature data base search of the terms “silent sinus syndrome” “maxillary atelectasis,” “imploding antrum syndrome,” and “bilateral silent sinus syndrome” was performed. The results were then narrowed to include only relevant articles.Results:Relevant articles included three case reports and two articles that describe or mention bilateral SSS. Of the three case reports found, two patients presented with bilateral SSS, whereas the third patient presented metachronously, with the contralateral SSS manifesting 4 months after presentation of the initial ipsilateral SSS.Conclusion:The present literature regarding bilateral SSS is likely incomplete, and further investigation is required to provide greater insight into the prevalence of this disease. In this report, bilateral FESS was successful in resolving symptoms and preventing disease progression.

Effects of mobile phone WeChat services improve adherence to corticosteroid nasal spray treatment for chronic rhinosinusitis after functional endoscopic sinus surgery: a 3-month follow-up study.

The objective of the study is to investigate the impact of receiving daily WeChat services on one's cell phone on adherence to corticosteroid nasal spray treatment in chronic rhinosinusitis (CRS) patients after functional endoscopic sinus surgery (FESS). This study was a two-arm, randomized, follow-up investigation. Patients with chronic rhinosinusitis with/without nasal polyps following bilateral FESS were randomised to receive, or to not receive, daily WeChat service on their cell phone to take corticosteroid nasal spray treatment. A prescription of budesonide aqueous nasal spray 128µg bid was given to all the subjects. Then they returned to the clinic after 30, 60, 90days. The primary study outcome was adherence to nasal spray treatment, whereas secondary outcomes were change in endoscopic findings and SinoNasal Outcome Test-20 (SNOT-20). On the whole, there was a significant inter-group difference in the change of adherence rate (F=90.88, p=0.000). The WeChat group had much higher adherence rate than the control group during the follow-up. In terms of postoperative endoscopic scores and SNOT-20, except granulation score, no significant differences were observed between the two randomization groups. WeChat services are already after a short period of observation associated with improved adherence to corticosteroid nasal spray treatment in CRS patients after FESS.

Evaluation of the effect of Nasopore on nasal packing in functional endoscopic sinus surgery

Objective:To investigate the effect of Nasopore on nasal packing in functional endoscopic sinus surgery.Method:A total of 117 chronic rhinosiunsitis with or without nasal polyps patients undergone bilateral functional endoscopic sinus surgery and finished follow up visit were recruited. In accordance with various nasal packing materials in operation, patients were divided into Nasopore group, Sorbalgon group, Merocel group and Sorbalgon combined Mercel group. The VAS score was measured and differences were observed in patients of four groups in terms of subjective symptoms,post-operation adverse reaction and recovery of mucosa of operative nasal cavity in 2,4,8 and 12 weeks.Result:①The postoperative VAS symptoms score regarding nasal obstruction, nasal pain, head pressure feeling and discomfort in removal of the nasal packing in Nasopore group were significantly better than those in the other groups(P<0.05).②In Nasopore group,incidences of adverse reactions in epiphora, dysphagia, bleeding after removal nasal packing,surrounding mucosa scratches, nasal packing incarceration were significantly lower than that in the other groups(P<0.05). The incidences of fever,sneezing,bleeding in operation day and faint when removing nasal packing in four groups had no statistical differences(P> 0.05).③The postoperative Lund-Kennedy endoscopic mucosa morphology score in 2,4,8 and 12 weeks in four groups had no statistical differences(P> 0.05), and in each group the score was significantly lower as time changes(P<0.05).Conclusion:The Nasopore packing has definite hemostatic efficacy,little postoperative discomfort and nice mucosal healing outcome as well in patients after functional endoscopic sinus surgery.It indicates that Nasopore is an effective and reliable packing material in FESS.

Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre.

RationaleThe European Position Paper on Sinusitis (EPOS) guidelines provide composite criteria to evaluate chronic rhinosinusitis (CRS) control, taking into consideration the severity of patients’ symptoms, aspect of nasal mucosa and medical intake as parameters of CRS control.ObjectivesTo study the degree of CRS control using novel EPOS control criteria at 3–5 years after a functional endoscopic sinus surgery (FESS) and correlate these data to symptoms scores.MethodsAdult CRS patients (n = 560) who had undergone bilateral FESS for chronic inflammatory sinonasal disease 3–5 years prior to the study were included. Patients received a postal questionnaire asking for control items according to EPOS control criteria, visual analogue scale (VAS) scores for total and individual sinonasal symptoms, sinonasal outcome test (SNOT)‐22 and Short Form (SF)‐36 questionnaires.Measurements and main resultsAbout 19.5% of CRS patients were well controlled, with 36.8% of patients being partly controlled and 43.7% uncontrolled. The levels of control corresponded to mean total VAS, SNOT‐22 and SF‐36 scores. Subgroup analysis revealed that female gender, aspirin intolerance and revision FESS were associated with higher prevalence of uncontrolled CRS, whereas allergy, asthma and smoking status did not alter the percentage of patients in each category of control. In 81 patients attending the outpatient clinic, nasal endoscopy changed classification in only four patients (4.9%).ConclusionsBased on the novel EPOS control criteria, at least 40% of CRS patients are uncontrolled at 3–5 years after FESS. Therefore, better treatment strategies leading to higher disease control are warranted in CRS care.

Omalizumab therapy for refractory allergic fungal rhinosinusitis patients with moderate or severe asthma

Purpose1. To assess the efficacy of omalizumab therapy in improving sinonasal outcomes in refractory allergic fungal rhinosinusitis (AFRS) patients with moderate or severe asthma. 2. To determine if omalizumab therapy reduces the usage of corticosteroids or antifungal therapy in AFRS patients Method: DesignThe clinical charts of patients with AFRS with moderate or severe asthma who received at least three subcutaneous injections of omalizumab therapy between 1st January 2012 and 1st May 2014 were retrospectively reviewed. These patients had undergone bilateral functional endoscopic sinus surgery (FESS) and failed adjunct medical treatments (oral or topical corticosteroids and/or antifungal therapy) prior to omalizumab therapy. ResultsSeven patients met the inclusion criteria and were included in this study. The mean age of the patients was 48.14. The average number of subcutaneous omalizumab injections was 7.57 (range 6–11) with a mean dosage of 287mg (range 225–375mg). The mean pre-omalizumab treatment Sino-Nasal Outcome Test-22 (SNOT-22) score was 52.14 while the mean post-omalizumab treatment SNOT-22 score was 35.86 (31% improvement). The mean pre-omalizumab therapy Phillpott–Javer endoscopic score (over the last one year before omalizumab therapy) was 36 while the mean post-omalizumab therapy endoscopic score (from the last clinic visit) was 14 (61% improvement). Omalizumab therapy reduced the dependence of AFRS patients on corticosteroid and antifungal treatments. ConclusionOmalizumab therapy can be considered as a potential adjunct for the treatment for patients with refractory AFRS with moderate or severe asthma. However, larger prospective studies to confirm the findings of this study will be required.