Effect Of Endoscopic Sinus Surgery Research Articles

Effect of endoscopic sinus surgery on clinical outcomes in DeltaF508 cystic fibrosis patients.

Chronic rhinosinusitis (CRS) is prevalent in the Cystic Fibrosis (CF) population. CRS exacerbations in CF are thought to contribute to pulmonary exacerbations. Literature regarding the impact of endoscopic sinus surgery (ESS) is inconclusive. This study examines rates of lung function decline and pulmonary exacerbation in CF patients who have undergone ESS. Retrospective review of medical records. Academic Hospital. 40 adult CF patients. Rate of lung function decline (% predicted Forced Expiratory Volume in 1second [ppFEV1 ]), number of pulmonary exacerbations (IV/oral antibiotic therapy±hospital admission) and total number days hospitalised 2-year postoperatively was collected. CRS patients undergoing ESS were matched to those without ESS by gender, age, and F508del genotype. Forty patients (mean age 37.4, 60% male) were reviewed. No significant difference was found between the surgical group and controls in baseline ppFEV1 (72.5% vs. 72.7%, P=.98), 2-year preoperative number of pulmonary exacerbations (3.05 vs. 1.65, P=.10), or Lund-Mackay scores (12.25 vs. 11.55, P=.71). No significant difference was found in 1-year (70.5% vs. 72.8%, P=.84) or 2-year (70.4% vs. 72.6% P=.80) postoperative ppFEV1 and 2-year postoperative pulmonary exacerbations (1.7 vs. 1.45, P=.87). A significant increase was identified in total number days hospitalised postoperatively (4.85, P=.02). In the surgical group, no significant difference was identified between preoperative and postoperative ppFEV1 , 1year (-2.51%, P=.32) and 2years after ESS (-3.10%, P=.51), postoperative rate of pulmonary exacerbations (-1.28, P=.11), or in total number days hospitalised (3.74, P=.14). In this study, ESS does not appear to significantly improve ppFEV1 or decrease the number of pulmonary exacerbations postoperatively.

Effectiveness of endoscopic sinus surgery and aspirin therapy in the management of aspirin-exacerbated respiratory disease.

Background: Aspirin therapy and/or type 2 (T2) biologics are used in the management of aspirin-exacerbated respiratory disease (AERD). Objective: To identify the number of patients with AERD who tolerated aspirin therapy, yet due to persistent symptoms, incorporated T2 biologic management. Methods: A retrospective review was performed between July 2016 and June 2019. Patients with AERD and who underwent endoscopic sinus surgery (ESS), aspirin desensitization (AD), and at least 6 months of aspirin therapy (ATAD) after AD, and who remained biologic-naive up through this timepoint were included in the study. Introduction of a T2 biologic while on ATAD was the primary outcome. The secondary outcome was a change in a validated patient-reported outcome measure for chronic rhinosinusitis score between the postoperative predesensitization timepoint, and the 6-month postdesensitization timepoint, presented as means and compared by using the Student's t-test. Results: A total of 103 patients met inclusion criteria. Two patients (1.9%) ultimately supplemented ATAD with a T2 biologic. The mean outcomes measure test score after 6 months of ATAD for patients who received biologics was 40.5 versus 15 in those who did not receive biologics (p = 0.02). The mean differences between the postoperative predesensitization test score and the 6-month postdesensitization test score for patients who went on to receive biologics was an increase of 13 versus a decrease of 10 for those patients who did not receive biologics (p = 0.12). Conclusion: ESS, coupled with AD and ATAD, was successful in the long-term management of the majority of the patients with AERD, which rarely required the incorporation of T2 biologics. Patient questionnaires, such as outcomes measure test score, may identify aspirin therapy failures and help guide the practitioner in deciding when to introduce T2 biologics into the patient's treatment regimen.

Endoscopic sinus surgery and aspirin desensitization improve otologic-specific SNOT-22 scores.

ObjectiveThere are few studies evaluating the impact of Aspirin-exacerbated respiratory disease (AERD) treatment on otologic symptoms. The aim of this study is to evaluate the effects of endoscopic sinus surgery (ESS) and aspirin desensitization (AD) on otologic symptoms in subjects with AERD.MethodsRetrospective chart review of adult patients diagnosed with AERD at our tertiary Care Academic Medical Center - Otorhinolaryngology Department. Charts of adult patients diagnosed with AERD who underwent ESS and ASA desensitization at our institution's AERD Center from 2016 to 2019 were reviewed. Sino-Nasal Outcomes Test 22-item survey (SNOT-22) scores were evaluated for patients at various time points including: pre-surgery, post-surgery/pre-aspirin desensitization, and various times post-desensitization up to >12 months. Within the SNOT-22, otologic-specific subdomain scores were evaluated at similar time points. Patients on immunomodulatory medications other than corticosteroids were excluded from analysis.ResultsSNOT-22 scores were analyzed for 121 patients. There was a significant improvement in overall SNOT scores from pre-surgery (44.62) to post surgery/pre-desensitization (23.34) (P < 0.0005). Similarly, SNOT-22 otologic-specific scores also improved after surgery prior to desensitization (3.19–2.04) (P = 0.005). Following AD, the improvement in the overall SNOT-22 continued to improve for up to 12 months (P < 0.005). While the otologic-specific SNOT-22 scores remained stable after surgery and ASA desensitization.ConclusionESS and AD reduce otologic-specific SNOT-22 scores and parallel trends in overall SNOT-22 scores. The effect of treatment is durable over the course of 12 months. Future work should aim to correlate otologic SNOT-22 scores with objective otologic data.

Effect of Endoscope Sinus Surgery on Pulmonary Function in Cystic Fibrosis Patients: A Meta-Analysis.

The objective of this study was to quantify the effect of endoscopic sinus surgery on pulmonary function in patients with cystic fibrosis and chronic rhinosinusitis. The PubMed, MEDLINE, Cochrane Library, and Embase databases were searched for studies published in English, without any language and time restrictions from their inception to March 1, 2020. Studies examining pulmonary function outcomes in patients with cystic fibrosis and chronic rhinosinusitis following endoscopic sinus surgery were included. Primary outcomes were pulmonary function tests, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF), and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75 ). A total of 12 studies with 570 patients were included for data extraction and meta-analysis. For FEV1 (%), the summarized mean difference (MD) was -6.92 (95% confidence interval [CI] = -19.67 to 5.83, P = .29) and 0.70 (95% CI = -3.81 to 5.21, P = .76) for the postoperative results after 6 months and 12 months, respectively. The pooled MDs for FVC (%) and FEV1/FVC ratio (%) for the postoperative results after 6 months were 0.60 (95% CI = -4.12 to 5.31, P = .80) and -1.29 (95% CI = -6.14 to 3.55, P = .60). Endoscopic sinus surgery in chronic rhinosinusitis patients with cystic fibrosis did not improve the pulmonary function in chronic rhinosinusitis patients with cystic fibrosis. More prospective studies and meta-analyses addressing the same topic are needed in the future. Laryngoscope, 131:720-725, 2021.

Effect of endoscopic sinus surgery on general health related quality of life domains in chronic rhino sinusitis patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic rhino sinusitis (CRS) is a common health problem affecting around 5-12% of the general population in a year. Treatment of CRS consist of medical and surgical management. Surgical management is considered when patient is not responding to maximal medical treatment or in case of complication. Sino nasal outcome test 22 (SNOT- 22) is considered as the most appropriate instrument in the evaluation of HRQOL impairment in CRS patients. This study evaluated general health related quality of life (QOL) domains of SNOT- 22 changes following endoscopic sinus surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted in 53 subjects who underwent endoscopic sinus surgery for chronic rhino sinusitis in Department of otorhinolaryngology, Government Medical College, Kottayam over a period of one year. Detailed history including SNOT-22 questionnaire enquired. Clinical, radiological and endoscopic examinations were performed. This patient followed up after 1 week, 1month and 3 months. SNOT-22 scores were recorded at each visit; data compiled and analysed with help of SPSS.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The baseline SNOT-22 score for study population was 37.51. General health related quality of life domains was assessed separately. The score for psychological dysfunction and sleep dysfunction decreased from 10.72, 6.00 to 1.58 and 1.02 respectively at the end of 3 months.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Chronic rhinosinusitis patients reported significant improvement in psychosocial dysfunction and sleep related symptoms after endoscopic sinus surgery. Chronic rhino sinusitis patient with anxiety and depressive disorders need special attention to improve health related quality of life (HRQOL).&lt;/p&gt;

Increased Serum Periostin Levels and Eosinophils in Nasal Polyps Are Associated with the Preventive Effect of Endoscopic Sinus Surgery for Asthma Exacerbations in Chronic Rhinosinusitis Patients

Background: Eosinophilic nasal polyps (NPs) are associated with the presence of asthma in chronic rhinosinusitis (CRS) patients. Serum periostin has been considered a relevant biomarker for unified airway diseases. Objective: To determine the utility of biomarkers including serum periostin that reflects reduction of exacerbations of comorbid asthma in CRS patients. Methods: We prospectively recruited 56 CRS patients who were subjected to undergo endoscopic sinus surgery (ESS) (20 with asthma) between October 2015 and December 2017 and followed them for 1 year after ESS. Blood eosinophil count, serum periostin, and fractional nitric oxide (FeNO) were measured at enrollment. How these type 2-driven biomarkers reflect comorbid asthma was determined using receiver operating characteristic (ROC) analysis. The frequency of asthma exacerbations during 1 year was counted both before and after ESS. Associations between preoperative biomarkers including eosinophils in NPs and asthma exacerbations were evaluated. Results: Blood eosinophil count, FeNO, and serum periostin levels were significantly higher in CRS patients with asthma than in those without (p < 0.01 for all) and discriminated comorbid asthma among CRS patients (p < 0.05; AUC > 0.80 for all). The increased preoperative serum periostin correlated with lower absolute number of postoperative exacerbations (ρ = −0.49, p = 0.03) and its relative reduction after ESS (ρ = 0.53, p = 0.03) in asthmatic patients. Increased eosinophils in NPs were also associated with reduced asthma exacerbations. Conclusion: Preoperative increased serum periostin and eosinophils in NPs are associated with the preventive effect of ESS for asthma exacerbations in CRS patients comorbid with asthma.

The Effect of Endoscopic Sinus Surgery on Eustachian Tube Dysfunction Symptoms.

We assessed how eustachian tube dysfunction (ETD) changed with endoscopic sinus surgery (ESS) and identified factors associated with improvement. Retrospective chart review. Academic center. Patients undergoing ESS for chronic rhinosinusitis with and without nasal polyposis (CRSwNP, CRSsNP) or recurrent acute rhinosinusitis (RARS) completed the Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months. Included in analyses were demographics, comorbidities, Sinonasal Outcome Test 22 (SNOT-22), radiographic score, endoscopy score, procedure, and medication use. Regression analysis identified factors associated with improvement, defined as ΔETDQ-7 >3.5. In total, 302 patients were studied. ETD prevalence was 68% in CRSsNP, 48% in CRSwNP, and 88% in RARS. Patients with ETD had a mean baseline ETDQ-7 of 25.8 ± 8.0 and improved postoperatively at 2 weeks (19.9 ± 8.1, P < .001), 6 weeks (17.8 ± 9.3, P < .001), 3 months (16.8 ± 8.5, P < .001), and 6 months (16.4 ± 7.9, P < .001). At 6 months, ETD improved in 89% of patients with CRSsNP, 68% with CRSwNP, and 78% with RARS. On multivariate analysis, ETD improvement was associated with higher preoperative ETDQ-7 score (adjusted odds ratio [aOR], 1.12; 95% confidence interval [CI], 1.04-1.22; P = .030), higher preoperative SNOT-22 score (aOR, 1.02; 95% CI, 1.02-1.08; P = .001), higher preoperative SNOT-22 ear subscore (aOR, 1.27; 95% CI, 1.02-1.65; P = .034), posterior ethmoidectomy (aOR, 1.59; 95% CI, 1.22-4.92; P = .025), and postoperative corticosteroid spray use (aOR, 1.57; 95% CI, 1.17-1.66; P = .008). ETD symptoms often improve following ESS. Factors associated with improvement include higher preoperative disease burden, posterior ethmoidectomy, and postoperative corticosteroid spray. 4.

Evaluation of the Effect of Endoscopic Sinus Surgery with Medialization of Middle Turbinate

Background: The main goals and key points of endoscopic sinus surgery are providing a sufficient drainage and ventilation for the diseased paranasal sinus groups. Method: A total of 44 patients (males 22 & 22 females) were included in this study, all of them complaining of chronic rhinosinsitis with or without polyposis not responding to maximal medical treatment and were assigned for ESS. Patients were classified into three groups; Group A: ESS with bolgarization, Group B: ESS with suture medialization of middle turbinate, Group C: ESS without medialization Postoperatively, patients were followed up with subjective (nasal obstruction, nasal discharge, headache, fascial pressure and smell disturbance) and objective (endoscopic evaluation of middle meatal MM patency) parameters in 2 weeks, I month, 3 months, 6 months and 1 year. Result: There improvement in nasal obstruction was reported by patients in all the three groups. Improvement in other symptoms was significantly higher in group A as compared to other groups. MM patency was evaluated by endoscopy and showed improvement of 100% in group B.

Sleep disturbances in patient with chronic nasal obstruction due to nasal polyp: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nasal obstruction is thought to be a major cause of sleep impairment. Typical sleep-related problems seen with nasal polyp include snoring, sleep-disordered breathing and sleep apnoea. The impact of nasal polyposis on quality of life is well studied however its effects on sleep have been less well studied. In the current study, we aim to investigate sleep disturbances in Filipino patients with nasal polyposis using different sleep questionnaires VAS score for snoring, Epworth sleepiness scale (ESS) for daytime sleepiness and Pittsburgh sleep quality index (PSQI) for sleep quality and the effect of endoscopic sinus surgery on sleep quality.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective, non-randomized study was done in the Department of Otorhinolaryngology Head and Neck Surgery of Southern Philippines Medical Center from February 2014 to July 2014. Number of 18 patients with chronic nasal obstruction for more than 6months due to nasal polyps at least grade II on endoscopic examination were included in the study. Visual analogue scale (VAS) score for snoring, ESS for daytime somnolence and PSQI for quality of sleep was compared preoperatively and 1month postoperatively. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean value of VAS score for snoring, mean value of excessive daytime sleepiness measured by ESS and mean PSQI score for sleep quality improved significantly with p&amp;lt;0.001 after endoscopic sinus surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Nasal polyp patients mostly present with nasal obstruction, snoring and excessive daytime sleepiness. Correction of nasal obstruction significantly improves snoring and sleep quality. After endoscopic sinus surgery, patients may experience improvement in snoring and have better sleep quality with decreased daytime sleepiness.&lt;/p&gt;

Features and effectiveness of endoscopic sinus surgery in children

The concept of modern functional endonasal sinus surgery in the pediatric population is based on sparing, minimally invasive interventions within the middle nasal passage, mainly the ostiomeatal complex, performed taking into account modern knowledge of the physiology of the nasal cavity and paranasal sinuses, as a result of which normal can be restored as soon as possible aerodynamics in the nasal cavity; respiratory and other functions of the nasal cavity and paranasal sinus are restored. The article presents the history, modern principles and indications for pediatric sinus surgery. The features of preparation, management of the postoperative period and the effectiveness of sinus surgery in the age aspect are described.

Effects of endoscopic sinus surgery on objective and subjective measures of cognitive dysfunction in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a common condition that has been associated with cognitive dysfunction. The purpose of this study was to evaluate the effect of endoscopic sinus surgery (ESS) on the subjective and objective measures of cognitive dysfunction and related quality-of-life measures in CRS. Thirty-five adults with CRS refractory to medical therapy were prospectively enrolled. Preoperatively and postoperatively (≥4 months), subjects completed objective neurocognitive evaluation with the Automated Neuropsychological Assessment Metrics (ANAM) platform and multiple questionnaires, including the Cognitive Failures Questionnaire (CFQ), a modified World Health Organization Health and Work Performance Questionnaire (ctHPQ), 22-item Sino-Nasal Outcomes Test (SNOT-22), Sinus Control Test (SCT), Questionnaire of Olfactory Disorders (QOD), Beck Depression Inventory-second edition (BDI-II), Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS). Thirty-three of 35 patients satisfactorily completed the study. Postsurgical improvement in the CFQ was 46.7 ± 18.4 to 31.9 ± 17.8 (p < 0.001). Neurocognitive testing revealed significant improvements in mathematical processing (p = 0.003) and matching to sample (p = 0.023), as well as a significant decline in simple reaction time (p = 0.026). In addition, improvements were noted for SNOT-22 (54.8 ± 21.4 to 24.8 ± 21.1, p < 0.001), SCT (9.3 ± 2.6 to 3.9 ± 3.8, p < 0.001), PSQI (10.7 ± 4.5 to 6.9 ± 4.0, p < 0.001), BDI-II (14.0 ± 9.9 to 8.9 ± 9.0, p < 0.001), QOD (17.6 ± 13.4 to 9.9 ± 12.3, p = 0.001), and FSS (4.6 ± 1.4 to 3.1 ± 1.5, p < 0.001). There was significant improvement in overall presenteeism (7.3 ± 1.4 to 8.4 ± 1.3, p = 0.029). Analysis by polyp status revealed significant improvement in mathematical processing and matching to sample in only CRS patients without polyps. ESS is associated with improvement in subjective and some aspects of objective cognition.

Effect of endoscopic sinus surgery on olfactory function in patients with chronic rhinosinusitis with nasal polyps

Objective:To evaluate the effect of surgery on olfactory function in patients with chronic rhinosinusitis with nasal polyps（CRSwNP） by subjective and objective olfactory tests. Method:This was a retrospective study. Forty patients with CRSwNP who underwent endoscopic sinus surgery（ESS） from 2015 to 2017 in Beijing Anzhen Hospital were enrolled. Postoperative time was 6-46 months. The patients were followed up in October 2018 and examined using Sniffin' sticks olfactory test and olfactory event-related potentials （oERP）. The polyps collected during surgery were performed to eosinophil count and percentage calculation. They were divided into eosinophilic CRSwNP（ECRS） and non-eosinophilic CRSwNP（NECRS）. The subjective and objective olfactory functions between the two groups were compared before and after surgery respectively and the paired T test was performed between the postoperative and the preoperative Sniffin' sticks olfactory test. Covariance analysis was used to adjust the effect of different postoperative time on postoperative olfactory recovery. Result:There were 21（52.5%） ECRS and 19（47.5%） NECRS patients of the 40 patients with nasal polyps. There was statistical difference in the posterior ethmoid score and the posterior olfactory cleft score of CT. According to the criterion of total TDI increased more than 5.5, olfactory function in 21（52.5%） patients had improved. In addition, there was a significant improvement in olfactory function in ECRS group either in unilateral T/TDI or bilateral T/D/TDI, but only unilateral T/TDI increased in NECRS group. There was no significant difference in Sniffin' sticks olfactory test between the two groups, but there was a statistically significant difference in the latency of oERP after surgery. Conclusion:ESS could improve olfactory function in patients with CRSwNP by more than 50%. Bilateral olfactory improvement in ECRS was better than that in NECRS, but olfactory function in postoperative ECRS was still lower than that in NECRS. oERP can more objectively and accurately reflect the severity of olfactory disorders associated with eosinophilic inflammation.

Effect of endoscopic sinus surgery on postoperative cognitive performance, quality of life and psychological status in patients with sinusitis and nasal polyps

Objective To explore the influence of endoscopic sinus surgery on postoperative cognitive performance, quality of life and psychological status of patients with sinusitis and nasal polyps. Methods From January 2017 to January 2018, 300 patients with sinusitis and nasal polyps who underwent endoscopic sinus surgery in the Fifth Hospital of Shaoxing were selected.The quality of life, psychological status and cognitive performance of patients before and after surgery were compared. Results After operation, 190 cases were cured, 90 cases were effective, and 20 cases were ineffective.The total effective rate was 93.33% (280/300 cases). After operation, the patients′ nasal endoscopy score was (3.23±0.34) points, which was significantly lower than before operation [(8.53±1.63)points] (t=43.875, P<0.05). After surgery, the clinical main symptoms such as nasal congestion, nasal secretions, headache, facial pain and olfactory disturbance were significantly improved (t=13.070, 12.252, 6.501, 8.954, 5.503, all P<0.05). After operation, the patients' anxiety scale (HAMA) and depression self-rating scale (SDS) scores were significantly lower (t=115.012, 45.203, all P<0.05). After surgery, the scores of physiological function, social function, physiological role, physical pain, mental health, emotional color and vitality were significantly increased (t=5.231, 5.579, 10.360, 8.580, 9.23, 11.336, 1.993, all P<0.05), and the total score of the Medical Outcome Study Simplified Scale-36 (SF-36) score was also significantly improved (t=8.942, P<0.05). After surgery, the 20 and 5 items of the patient-stomach-sinus test-20 (SNOT-20) entry score gradually decreased from 1 month after surgery (t=16.029, 18.041, all P<0.05). After operation, the cognitive performance of the patients was significantly improved.The awareness of sinusitis and nasal polyps related diseases was (70.94±2.85)points, and the knowledge of nasal endoscopy was (95.23±3.84)points, the differences were statistically significant (t=16.474, 58.484, all P<0.05). Conclusion Endoscopic sinus surgery can improve the cognitive performance of patients with sinusitis and nasal polyps, reduce negative emotions such as anxiety and depression, and improve the quality of life of patients.It is worthy of widespread promotion in clinic. Key words: Sinusitis; Nasal polyps; Endoscopic surgery; Quality of life

The Effects of Endoscopic Sinus Surgery on Voice Characteristics in Chronic Rhinosinusitis Patients.

Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed. Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms. 18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p = .005) and VHI (10-4.7, p < .001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p < .001). Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality.

Clarithromycin and endoscopic sinus surgery for adults with chronic rhinosinusitis with and without nasal polyps: study protocol for the MACRO randomised controlled trial

BackgroundChronic rhinosinusitis (CRS) is a common source of ill health; 11% of UK adults reported CRS symptoms in a worldwide population study. Guidelines are conflicting regarding whether antibiotics should be included in primary medical management, reflecting the lack of evidence in systematic reviews. Insufficient evidence to inform the role of surgery contributes to a fivefold variation in UK intervention rates. The objective of this trial is to establish the comparative effectiveness of endoscopic sinus surgery (ESS) or a prolonged course of antibiotics (clarithromycin) in adult patients with CRS in terms of symptomatic improvement and costs to the National Health Service compared with standard medical care (intranasal medication) at 6 months.Methods/designA three-arm parallel-group trial will be conducted with patients who remain symptomatic after receiving appropriate medical therapy (either in primary or secondary care). They will be randomised to receive: (1) intranasal medication plus ESS, (2) intranasal medication plus clarithromycin (250 mg) or (3) intranasal medication plus a placebo. Intranasal medication (current standard medical care) is defined as a spray or drops of intranasal corticosteroids and saline irrigations. The primary outcome measure is the SNOT-22 questionnaire, which assesses disease-specific health-related quality of life. The study sample size is 600. Principal analyses will be according to the randomised groups irrespective of compliance. The trial will be conducted in at least 16 secondary or tertiary care centres with an internal pilot at six sites for 6 months.DiscussionThe potential cardiovascular side effects of macrolide antibiotics have been recently highlighted. The effectiveness of antibiotics will be established through this trial, which may help to reduce unnecessary usage and potential morbidity. If ESS is shown to be clinically effective and cost-effective, the trial may encourage earlier intervention. In contrast, if it is shown to be ineffective, then there should be a significant reduction in surgery rates. The trial results will feed into the other components of the MACRO research programme to establish best practice for the management of adults with CRS and design the ideal patient pathway across primary and secondary care.Trial registrationISRCTN36962030. Registered on 17 October 2018.

The effects of endoscopic sinus surgery on pulmonary function in chronic rhinosinusitis patients with asthma: a systematic review and meta-analysis.

Evidences showed improvements in clinical asthma outcomes following endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) patients with asthma. However, pulmonary function benefits have remained controversial up to date. The goal of this study was to conduct a systematic review and meta-analysis to investigate the effects of ESS on pulmonary function tests in CRS patients with asthma. Pubmed, Embase and Cochrane Library were searched up to March 2018 to obtain relevant studies. The researches that evaluated the effects of ESS on pulmonary function in CRS patients with asthma and had at least one parameter of pulmonary function tests before and after surgery were included in the study. A total of 13 studies containing 421 patients satisfied the eligibility after judgment by 2 reviewers. These included three RCTs and ten case series. The heterogeneity in parameters of spirometry and difference in data presented forms across studies along with the lack of standard deviation of some data make it difficult to synthesize results. If data were unavailable for meta-analyses, descriptive statistics were used to report study outcomes. After qualitative and quantitative analysis, the weighted mean change after ESS in forced expiratory flow between 25% and 75% of vital capacity (FEF25-75%) was 0.21L/s (95% CI 0.12-0.30); eight of ten studies supported that forced expiratory volume at 1s (FEV1) improved after ESS; five of six studies supported that peak expiratory flow (PEF) improved after ESS. However, strength of evidence is generally low to insufficient. A generally low-quality evidence supports the association between ESS and improvements in FEF25-75%, FEV1 and PEF. A few studies met inclusion criteria for meta-analysis, which indicates the need for more high-quality studies to determine the effect of ESS.

Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease

Nasal polyps influence the burden of aspirin-exacerbated respiratory disease (AERD) by contributing to eicosanoid production. AERD is diagnosed through graded aspirin challenges. It is not known how sinus surgery affects aspirin challenge outcomes. To investigate the effects of endoscopic sinus surgery (ESS) on aspirin-induced reaction severity and on the levels of eicosanoids associated with these reactions. Twenty-eight patients with AERD were challenged with aspirin before and 3 to 4 weeks after ESS. Respiratory parameters and plasma and urine levels of eicosanoids were compared before and after challenges. Before ESS, AERD diagnosis was confirmed in all study patients by aspirin challenges that resulted in hypersensitivity reactions. After ESS, reactions to aspirin were less severe in all patients and 12 of 28 patients (43%, P < .001) had no detectable reaction. A lack of clinical reaction to aspirin was associated with lower peripheral blood eosinophilia (0.1 K/μL [interquartile range (IQR) 0.1-0.3] vs 0.4 K/μL [IQR 0.2-0.8]; P= .006), lower urinary leukotriene E4 levels after aspirin challenge (98 pg/mg creatinine [IQR 61-239] vs 459 pg/mg creatinine [IQR 141-1344]; P= .02), and lower plasma prostaglandin D2 to prostaglandin E2 ratio (0[±0] vs 0.43 [±0.2]; P= .03), compared with those who reacted. Sinus surgery results in decreased aspirin sensitivity and a decrease in several plasma and urine eicosanoid levels in patients with AERD. Diagnostic aspirin challenges should be offered to patients with suspected AERD before ESS to increase diagnostic accuracy. Patients with established AERD could undergo aspirin desensitizations after ESS as the severity of their aspirin-induced hypersensitivity reactions lessens.

Impact of blood eosinophils on clinical effect of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

Objective: To investigate the effect of blood eosinophils on clinical effect of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: From March 2011 to March 2016, 72 cases with CRSwNP were treated by endoscopic sinus surgery in Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital. The clinical records were retrospectively reviewed, and the cases were divided into eosinophilia elevated and non-elevated group according to blood eosinophils, and nasal polyps were evaluated for histopathology eosinophil count. Statistical analysis was performed to compare two groups' pre- and post-operative symptoms of VAS score, sinus computed tomography (CT) scans scores according to the Lund-Mackay system and the outcome of surgery. Both groups' factors that might have affected their outcome were analyzed by t-test, Chi square, Pearson Correlation Coefficient and Willcoxon rank sum test. Results: Seventy two cases were followed up from 24 to 78 months.The average follow-up time was 56 months. The VAS score in the eosinophilia elevated group (n=16) was higher than that in the non-elevated group(n=56), and the difference was statistically significant (11.44±7.13 vs 4.98±5.64, t=3.726, P<0.05). The control of symptoms in the peripheral blood eosinophilia elevated group was less than that in the non-elevated group, and the difference was statistically significant (Z=-1.979, P<0.05). There was a positive correlation between eosinophil counts in peripheral blood and tissues of 72 cases (r=0.429, P<0.05). Conclusion: There is a significant correlation between tissue and blood eosinophil counts, and eosinophilia group has poorer outcomes.

A cost-effectiveness analysis of the up-front use of balloon catheter dilation in the treatment of pediatric chronic rhinosinusitis

BackgroundThe treatment of pediatric sinusitis continues to be a controversial topic. It has been recommended to treat pediatric chronic rhinosinusitis (CRS) with adenoidectomy before proceeding to more invasive techniques. There are concerns regarding side effects of endoscopic sinus surgery in pediatric patients. With the advent of balloon catheter dilation (BCD) as a minimally invasive technique, some authors are recommending up front adenoidectomy with BCD in order to maximize disease resolution while minimizing risk. PurposeOur study examines the cost effectiveness of adenoidectomy alone versus adenoidectomy and upfront BCD for the management of pediatric CRS. MethodsA decision tree analysis was created to determine the cost effectiveness of treating a pediatric patient who has failed medical management, using adenoidectomy versus adenoidectomy with up-front BCD. Three separate decision trees were made. The incremental cost effectiveness ratio (ICER) was calculated for each scenario and a sensitivity analysis was done to determine how different values impacted our results. ResultsAdenoidectomy as the sole first procedure was found to be more cost effective in all three decision trees. For tree 1, the adenoidectomy plus BCD arm was 0.03% more effective in the end, but with an $81, 431 incremental cost. ConclusionsCosts in addition to outcomes must be considered when comparing treatment modalities in our current health care environment. This study found that adenoidectomy as a first intervention before proceeding to more advanced techniques is nearly as effective and is a much more cost-effective algorithm for the treatment of pediatric CRS. However, the physician must advocate the best treatment for his or her own patients.

Quality of Life in Patients with Chronic Rhinosinusitis with Nasal Polyposis Before and After Functional Endoscopic Sinus Surgery: A Study Based on SINO-NASAL OUTCOME TEST

Background: Chronic rhinosinusitis is one of the most common diseases in the world. The high prevalence and chronicity of disease increasing burden of disease. Burden of this disease, productivity and the quality of life of patients decreased. The aim of this study was to evaluate the effect of endoscopic sinus surgery on the quality of life of patients with chronic rhinosinusitis with nasal polyposis.Method: This prospective study was performed on 59 patients suffering chronic rhinosinusitis with nasal polyposis referring to ENT clinic of educational hospital of Tabriz University of medical sciences during 2015 to 2017. These patients underwent Endoscopic Sinus Surgery as treatment. For all patients, SINO-NASAL OUTCOME (TEST) (SNOT-22) was completed before and twelve months after surgery.Results: Fifty-nine patients were enrolled in this study. 21 were female (35.6%) and 38 were male (64.40%). The mean age of the studied population was 40.88 ± 16.11 years. The mean score of the preoperative score was 59.38 ± 5.84 and the mean score of the postoperative score was 24.01 ± 10.48. The results of the statistical analysis showed that endoscopic surgery reduced The SNOT-22 questionnaire score is significant. (P &lt; 0.000). The results of the test showed that the increase in preoperative score increases the gain after surgery. (Spearman correlation coefficient: 0.419 and P: 0.001)Conclusion: Endoscopic sinus surgery seems to improve the symptoms and quality of Life in patients with chronic rhinosinusitis.