Effect Of Endoscopic Sinus Surgery Research Articles

Effects of Endoscopic Sinus Surgery and Device on Irrigation

Objective 1) Assess the effect of endoscopic sinus surgery (ESS) on the distribution of topical solutions to the para-nasal sinuses. 2) Understand differences in topical solution distribution to the para-nasal sinuses using various delivery devices. Methods Ten cadaver sinus systems were irrigated with radio-opaque contrast prior to any surgery, after ESS, and following modified medial maxillectomy. Delivery of contrast was via pressurized spray, neti pot and squeeze bottle techniques for each surgical state. CT scans were performed before and after each irrigation using a portable CT machine. Blinded assessments were made for distribution of contrast within the sinuses. A semi-quantitative grading scale was used to assess contrast distribution to each of 5 sinus regions (maxillary, anterior ethmoid, posterior ethmoid, sphenoid and frontal). Results Total sinus distribution of contrast was significantly greater post-ESS as compared to the un-operated state (p<0.001). Sphenoid and frontal sinus distribution was most affected by surgery. Delivery device influenced contrast distribution, with neti pot and squeeze bottle techniques providing greater distribution than pressurized spray (p<0.001). Frontal sinus penetration was greater post-ESS (p=0.017) and neti pot delivery was the most effective frontal delivery device (p<0.001). Conclusions ESS greatly enhances the delivery of nasal solutions, regardless of delivery device. Limited distribution to the sinuses exists without concomitant ESS, especially for sprays. Squeeze bottle/neti pot use, post-ESS, offers a greatly enhanced ability to deliver solutions to the para-nasal sinuses.

Symptom Specific Outcomes of Endoscopic Sinus Surgery

Objective 1) Learn the relative effectiveness of endoscopic sinus surgery (ESS) regarding improving individual major chronic rhinosinusitis (CRS) symptoms and headache. 2) Be able to more effectively counsel patients undergoing ESS. Methods A literature search of MEDLINE, EMBASE, Web of Science, Cochrane databases, and other Web-based sources from 1980–2008 was performed. Additional articles were identified by reviewing relevant bibliographies. Studies with more than 10 adult CRS patients that used symptom severity scores to analyze at least 4 major criteria (facial pressure, congestion, nasal obstruction, nasal discharge, and hyposmia/anosmia) or 3 major criteria as well as headache were included. 265 studies were identified and reviewed. 22 of these met inclusion criteria and their data were analyzed. After conversion of the symptom severity scores used in each study to a relative percent value, symptom categories were averaged, and compared in aggregate. Results This analysis included 1641 CRS patients (average of 74 pts/study). The patients were followed an average of 19.4 months (range, 1 week to 76 months) postoperatively. All 6 evaluated symptoms showed non-weighted, relative improvements in symptom scores. Overall, symptoms improved synchronously with a relative improvement over preoperative levels ranging from 27% to 36%. ESS provided the greatest relief from nasal obstruction (relative improvement of 36%), which was a significantly larger change than with facial pain (p<0.034) or nasal discharge (p<0.034). Conclusions The relative improvement in major CRS symptoms and headache after surgery is similar. Nasal obstruction improves slightly more than facial pain and nasal discharge.

The Effects of Endoscopic Sinus Surgery on Level of Fatigue in Patients with Chronic Rhinosinusitis

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

Effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation

Assess paranasal sinus distribution of topical solutions following endoscopic sinus surgery (ESS) using various delivery devices. Experimental prospective study. Ten cadaver sinus systems were irrigated with Gastroview before surgery, after ESS, and after medial maxillectomy. Delivery was via pressurized spray (NasaMist), neti pot (NasaFlo), and squeeze bottle (Sinus Rinse). Scans were performed before and after each delivery with a portable CT machine (Xoran xCAT), and blinded assessments were made for distribution to individual sinuses. Total sinus distribution was greater post-ESS (P < 0.001). Additional distribution was gained with medial maxillectomy (P = 0.02). Influence of delivery device on distribution was significantly higher with neti pot > squeeze bottle > pressurized spray (P < 0.001). Frontal sinus penetration was greatest after surgery (P = 0.001). ESS greatly enhances the delivery of nasal solutions, regardless of delivery device. Pressurized spray solutions in un-operated sinuses provide little more than nasal cavity distribution. Use of squeeze bottle/neti pot post-ESS offers a greatly enhanced ability to deliver solutions to the paranasal sinuses.

Endoscopic Sinus Surgery for the Treatment of Organized Hematoma of the Maxillary Sinus

Organized hematoma is a benign and non-neoplastic lesion, however, differential diagnosis from neoplastic diseases is always problematic, and patients are often forced to sustain excessive surgical invasion. We retrospectively studied the characteristics of imaging findings of organized hematoma of the maxillary sinus, and estimated the validity and effectiveness of endoscopic sinus surgery for the treatment of this disease. Three patients (2 men and a woman, ranging in age from 50 to 62 years) with organized hematoma of the maxillary sinus who underwent endoscopic sinus surgery were retrospectively analyzed. The diagnosis was provisionally made based on the findings of preoperative computed tomography (CT) and magnetic resonance imaging (MRI), and was confirmed by histopathological examinations of surgical specimens. CT revealed a well-defined expansile mass in the unilateral sinus associated with thinning and expansion of the medial sinus wall in all the cases. On contrast-enhanced images, patchy heterogeneous enhancement was observed. Intermingled low/intermediate/high signal intensity was seen on both T1- and T2-weighted MRI. The lesions were curetted via an endoscopic middle meatal antrostomy with the assistance of a microdebrider. None of the patients received arterial embolization or blood transfusion. Histopathological findings were consistent with those of organized hematoma. Their postoperative courses were uneventful, and all the patients are currently free from disease. We conclude that organized hematoma of the maxillary sinus can be successfully treated by endoscopic sinus surgery under accurate preoperative diagnosis and careful surgical planning.

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.

Subjective Headache before and after Endoscopic Sinus Surgery

The aim of this study was to show the effect of endoscopic sinus surgery on subjective headache scores in patients diagnosed with chronic rhinosinusitis (CRS) with or without nasal polyps. We performed a retrospective analysis of prospectively collected data from 201 patients over a 2-year period. Headache and Sino-Nasal Outcomes Test (SNOT-20) mean scores were compared preoperatively and 2 years postoperatively on patients diagnosed with CRS with or without nasal polyps. Two hundred one patients underwent surgical management of CRS with or without nasal polyps over a 3-year period. One hundred four patients were men and 97 were women, with a mean age of 49 (range, 18-80 years) years. Polyps were present in 78 patients with CRS. The mean subjective headache score based on a 0-10 visual analog scale improved from 4.7 preoperatively to 0.8 2 years postoperatively (p < 0.0001). The mean headache score of 123 patients without polyps was larger compared with 78 patients with polyps (5.1 versus 4.1, respectively; p < 0.05). As previously reported, the mean overall preoperative and postoperative SNOT-20 scores were 28.7 and 6.7, respectively (p < 0.0001). Headache is a common symptom with CRS, present in 73.6% of our patients undergoing functional endoscopic sinus surgery for CRS with or without nasal polyps. An overall decrease in mean headache scores was noted at 2-year follow-up.

Mucosal healing and mucociliary transport change after endoscopic sinus surgery in children with chronic maxillary sinusitis

The aim of the study was to evaluate the effects of endoscopic sinus surgery for chronic maxillary sinusitis in children by investigating ultrastructure element changes in the sinus mucosa and nasal mucociliary clearance before and after operation. Twenty-five children with chronic maxillary sinusitis scheduled to undergo functional endoscopic sinus surgery and another five controls were enrolled. A saccharin transit test was performed before and after the operation for each subject. Forty specimens of diseased maxillary sinus mucosa were classified into edematous and polypoid types, with 20 specimens in each type. The mucosal specimens were taken from the superolateral wall of each maxillary sinus during surgery and at post-operative follow-up when the mucosal recovery had begun and the symptoms had subsided. The specimens were examined with a scanning electron microscope. A significant increase in number of the submucosal gland openings (GO) was noted for the sinusitis group, of both edematous and polypoid types. In post-operative cases, the number of gland openings decreased, however, it remained higher than for the control group. The number of goblet cells (GC) decreased in the sinusitis cases, and significant difference was not demonstrated compared to postoperative and control groups. After endoscopic sinus surgery, the cilia in both types of antral mucosa were significantly regenerated compared to preoperative variants. Significant differences in postoperative saccharin transit time were demonstrated for both types of antral mucosa compared to the preoperative values. After endoscopic sinus surgery for chronic pediatric sinusitis, the antral mucosa recovered and mucociliary clearance improved for both types of antral mucosa, with improved ventilation and drainage demonstrated for our patients. Based on our specimens, the edematous mucosa appear to regenerate sooner than the polypoid variant, with close post-operative follow-up for more than 2 and 4 months for the edematous and polypoid types of antral mucosa, respectively, necessary to prevent sinusitis relapse.

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

The symptom of eustachian tube dysfunction has been categorized as a "minor" symptom in chronic rhinosinusitis. The aim of this pilot study was to determine the frequency of otologic symptoms in patients with confirmed rhinosinusitis and the likelihood of its resolution in those patients undergoing endoscopic sinus surgery (ESS). Questionnaires were obtained from 168 patients who had undergone prior ESS over a 5-year period. Patients were asked to evaluate if they suffered from several different potential symptoms of eustachian tube dysfunction before ESS and whether that symptom changed postoperatively. Using the binomial test, 95% confidence intervals were determined for the following otologic symptoms of tubal dysfunction: "earfullness and congestion," "ear cracking and popping," "dizziness," and "ear pain. "ESS was found to have a significant treatment effect for the indicated otologic symptoms of tubal dysfunction. Tubal dysfunction, as manifested by otologic symptoms, is common in patients with chronic rhinosinusitis undergoing ESS. The classification of this as a "minor" symptom of rhinosinusitis needs to be reevaluated. These symptoms improve or resolve in the majority of patients undergoing ESS.

アスピリン喘息に対する内視鏡下鼻副鼻腔手術の効果

アスピリン喘息に対する内視鏡下鼻副鼻腔手術の効果

Treatment Outcomes and Acoustic Rhinometric Results in Endoscopic Sinus Surgery of Adult Chronic Paranasal Sinusitis

Background: Chronic paranasal sinusitis is one of the most common disease in the otorhinolaryngologic field. Endoscopic sinus surgery is treatment of choice in chronic paranasal sinusitis. The aim of this study was to evaluate objective and subjective treatment outcomes of endoscopic sinus surgery in adult chronic paranasal sinusitis with or without polyp. Materials and Methods: We reviewed 84 adult patients underwent endoscopic sinus surgery by one surgeon from June 1999 to June 2000, prospectively. We analyzed preoperative and postoperative subjective symptom scores and acoustic rhinometric results. Results: Fifty cases were male and thirty four cases female. The average age was of 33 year-old (range: 17 to 66 years). There was significantly improvement of symptom scores in postoperative 3 months and 6 months compared with preoperative symptom scores. There was significantly increased postoperative total volume of nasal cavity. When we compared high score group with low score group, there was statistically significant improvement of symptom scores between preoperative stage and postoperative 3 months in radiologic grading group. Conclusions: Endoscopic sinus surgery is considered to be effective for the treatment of chronic paranasal sinusitis. It seems to be helpful to employ subjective symptom score system and objective total volume change of nasal cavity through acoustic rhinometric test to analyze effectiveness of endoscopic sinus surgery. In this study, the most important preoperative factor of sinus surgery outcomes is radiologic grading system.

Endoscopic sinus surgery in cystic fibrosis: do patients benefit from surgery?

Objective: To examine the effects of endoscopic sinus surgery on the pulmonary status of cystic fibrosis (CF) patients through the objective parameters of steroid use, pulmonary function tests (PFTs), and inpatient hospital days (IHDs). Methods: Retrospective chart review of all patients with CF who underwent endoscopic sinus surgery from 1993 to 1999 at a tertiary care children's hospital. Preoperative pulmonary function, inhaler and steroid use, and IHDs were compared to postoperative parameters within a 1-year period. Results: Sixty-six patients, including eight lung transplant patients, underwent a total of 112 endoscopic sinus surgery procedures; 25 patients underwent more than one procedure. Patients were taking oral steroids preoperatively in 28% of procedures and inhaled steroids in 40%. Postoperatively, there was no statistically significant change in oral or inhaled steroid use, or in postoperative pulmonary function. If the index hospitalization, which was often for reasons not related to sinus disease, was considered part of the preoperative time period, endoscopic sinus surgery (ESS) was noted to result in a marked reduction (9.5 days (adjusted), P=0.001) in hospital days during the subsequent 6 months. If the date of the procedure alone was used to define pre- and postoperative time periods, the reduction in postoperative days was more modest and not statistically significant (3.5 days (adjusted), P=0.21). Conclusions: Although we found no statistically significant difference in PFTs, or steroid requirements following ESS, ESS may have resulted in a reduced need for hospitalization in the 6 months following the procedure. Future prospective studies in a larger number of patients and using more detailed outcome measures are needed to better evaluate the effects of endoscopic sinus surgery in pediatric patients with CF.

The effects of endoscopic sinus surgery on the nasal cycle as assessed by acoustic rhinometry.

Previous studies have demonstrated that acoustic rhinometry (AR) has a considerable utility in measuring nasal patency and in detecting the nasal cycle. This study was performed in 10 patients with chronic rhinosinusitis who were submitted to endoscopic sinus surgery. AR was used to determine minimum nasal cross-sectional area and volume as the indices of the nasal patency in all patients on the day before the surgery and 3 months postoperatively. We did not find any significant alteration when comparing the pattern of fluctuation, the periodicity, and the amplitude of the nasal cycle demonstrated by patients in the pre and postoperative periods, confirming that this surgery does not have any adverse effect on this physiologic cycle.

Effect of endoscopic sinus surgery on asthmatic patients with chronic rhinosinusitis

There have been several reports on the effectiveness of endoscopic sinus surgery (ESS) in asthmatic patients with chronic rhinosinusitis. Whether ESS has a positive effect on the clinical course of asthma still remains controversial. There have been several subjective evaluations but few objective results. We performed a study to evaluate the effectiveness of ESS in 19 patients with asthma who underwent ESS for rhinosinusitis. The use of antiasthma medication and postoperative asthma symptoms was analyzed. Objective changes of pulmonary function tests were evaluated. There was a significant improvement in diurnal and nocturnal asthma symptoms. Improvements in asthma medication scores were also confirmed, and individual asthma symptoms (dyspnea, cough, wheezing, and sputum production) improved significantly. Despite a reduction in use of antiasthma medication after ESS, the parameters of the pulmonary function tests did not change. Both subjectively and objectively, it seems that ESS, when used to treat asthmatic patients with chronic rhinosinusitis, can play a significant role in the clinical improvement of asthma. (Otolaryngol Head Neck Surg 2001;124:99-104.)

The effect of endoscopic sinus surgery on mucociliary clearance in patients with chronic sinusitis

The saccharin test was used to measure mucociliary clearance in 50 patients with symptoms of chronic sinusitis. Samples of the nasal mucosa were also examined under transmission electron microscopy before and after functional endoscopic sinus surgery (FESS). Before surgery, the mean saccharin clearance (ST) was 37.0 +/- 15.7 min, with nasal mucosa exhibiting ciliary loss as well as other ultrastructural changes. Three months after surgery, the mean ST had improved to 20.3 +/- 7.5 min and significant regeneration of cilia was observed. It was therefore concluded that FESS had successfully corrected mucociliary dysfunction in these patients.

Methacholine Bronchial Hyperresponsiveness inChronic Sinusitis

The coexistence of chronic sinusitis (CS) may deteriorate the clinical condition of lower airway diseases such as bronchial asthma (BA) or chronic bronchitis (CB). However, the bronchial hyperresponsiveness (BH) in CS without any apparent lower airway disease is not fully understood nor are the effects of treatment. We examined lower airway hyperresponsiveness to methacholine (MCh) in 42 subjects with CS but without allergic rhinitis (AR) who had normal lung functions without any pulmonary symptoms, comparing it with that of 50 subjects with stable BA, 50 subjects with simple CB and 40 subjects with AR, and further examined the effect of endoscopic sinus surgery in 7 CS subjects with BH. The BH to MCh was measured in terms of the minimum dose (Dmin), defined as the cumulative dose at the point where respiratory conductance began to decrease. A Dmin <50 units was defined as BH. Seventy-one percent of CS subjects showed BH without relation to the severity or duration of CS, or atopic status. BH in CS subjects, which was less than that in BA subjects, was similar to that in simple CB or AR in both its prevalence and degree. After the surgical treatment of CS, BH significantly decreased (p < 0.01) with improvements in both nasal symptoms and sinus lesions. These findings suggest that CS itself induces BH to a degree similar to simple CB and AR without any relationship to the clinical background, and that adequate treatment of CS reduces BH.

Management of chronic sinusitis in the adult cystic fibrosis patient.

Cystic fibrosis (CF) is an autosomal recessive disorder affecting exocrine gland function. Although CF was formerly a deadly disease of infants and children, recent improvements in antibiotics, nutritional therapy, and supportive care have extended the median survival to adulthood. Patients with CF often present with sinusitis and nasal polyposis in addition to recurrent pulmonary infections. Although the effectiveness of endoscopic sinus surgery in children with CF has been documented, the treatment guidelines and efficacy in the adult CF patient are unknown. We present a series of 16 adult patients with CF and chronic sinusitis. The majority of patients presented with nasal polyposis and concomitant pulmonary complications. Endoscopic findings are reviewed, with an emphasis on improving pulmonary function following endoscopic sinus surgery. Preliminary findings suggest that endoscopic sinus surgery improves symptoms of sinusitis and exercise tolerance and may delay the progressive respiratory failure that often affects the adult CF patient.

Nasal and sinus polyposis in children.

Nasal and sinus polyposis in the pediatric population is uncommon and its etiology is unclear. In this 11-year retrospective study, the authors describe the etiologic features and evaluate the effectiveness of endoscopic sinus surgery in 46 children. Patients were divided into three groups according to whether nasal and sinus polyposis was isolated (n = 14), or associated with either asthma (n = 5) or cystic fibrosis (n = 27). An allergy was present in 10% of patients with isolated polyposis, 80% of patients with polyposis associated with asthma, and 22% of patients with polyposis associated with cystic fibrosis. The indications for surgery were disabling symptoms, especially chronic nasal obstruction, rhinorrhea, and mouth breathing, and failure to respond to medical treatment. No surgical complications were encountered. Most patients reported improvement in quality of life with reduction of nasal obstruction in 83% of cases and rhinorrhea in 61%. Minor asymptomatic recurrence (i.e., a few micropolyps localized on the roof of the ethmoid cavity) was observed in 24% of the cases in this series, and major recurrence with the same functional symptoms as before surgery in 12%. However, recurrences were higher in patients with cystic fibrosis, because minor recurrence with no clinical manifestation was observed in 32% of these cases and major recurrence in 16%. Endoscopic sinus surgery must be decided in collaboration with the pediatric and pulmonary physicians, and must be performed skillfully. With a mean follow-up of 3.7 years, results in this series are encouraging.

副鼻腔内視鏡手術の術後成績 アンケート調査結果

副鼻腔内視鏡手術の術後成績 アンケート調査結果