Efficacy Of Endoscopic Sinus Surgery Research Articles

Efficacy of endoscopic sinus surgery in management of odontogenic maxillary sinusitis after control of dental pathology

BackgroundOdontogenic sinusitis (ODS) has clinical features like rhinogenic sinusitis. Although it is usually unilateral, diagnostic overlap could happen. However, ODS necessitates different management which includes dental intervention to eliminate the dental infection source. In some patients, ODS may persist even after management of dental pathology. The aim of this study was to assess the clinical features, and diagnostic criteria of ODS that is persistent after management of dental pathology, and to evaluate the efficacy of endoscopic sinus surgery (ESS) as a therapeutic option of the disease.MethodsTwenty patients were included in this study. All patients were presented with ODS refractory to medical treatment after management of their dental problems. Clinical features of the patients were analyzed. Also, endoscopic nasal examination and computed tomography of paranasal sinuses (CT) were performed for all patients. ESS were used, with widening of the maxillary ostium for drainage. Follow-up was carried out for at least 6 months.ResultsAll patients had unilateral disease, with 3 main complaints: malodourous nasal discharge (90%), facial pain (75%), and nasal obstruction (45%). Endoscopic nasal examination showed either middle meatal purulence (70%) or polypoid mucosa (30%). CT showed either thickened maxillary sinus mucosa (50%), or complete maxillary opacity (50%) with retained foreign body in 2 patients (10%). After ESS, all patients reported relieve of their sinonasal symptoms, and nasal endoscopy showed patent middle meatus, with one patient demonstrated adhesions between the middle turbinate and lateral nasal wall which was asymptomatic.ConclusionPrior dental intervention is a suspicious diagnostic landmark for ODS, and unilateral foul nasal discharge is the main prevalent complaint. Nasal endoscopy usually shows purulence or polypoid mucosa in the middle meatus, and CT is a good diagnostic tool for ODS. ESS with good widening of the maxillary ostium is an effective therapeutic option for those patients.

Comparative short-term efficacy of endoscopic sinus surgery and biological therapies in chronic rhinosinusitis with nasal polyps: A network meta-analysis.

To compare the safety and efficacy between endoscopic sinus surgery and different biologics in treating chronic rhinosinusitis with nasal polyps in adults by reviewing the existing clinical trials. Data extraction and risk of bias assessment were conducted by 2 independent reviewers according to the PRISMA recommendations and any disagreement was resolved by a third investigator. Outcomes were measured through a random-effects model. We searched Embase, Web of Science, MEDLINE, Cochrane, and other relevant sources from its inception to April 30, 2022. We included randomized controlled trials(RCTs) involving endoscopic sinus surgery (ESS) or biologics in treating adult patients with chronic rhinosinusitis with nasal polyps. Studies involving other miscellaneous diseases, non-RCT design, and insufficient participants or follow-up were excluded. In this systematic review, five RCTs and 1748 patients were included. All the biologics, as well as ESS, could significantly improve key nasal outcomes in CRSwNP both at 6months and 1year. Dupilumab exhibited better efficacy than ESS in improving SNOT-22 scores at one year. However, ESS showed superiority over three biologics in improving nasal congestion scores (NCS) at two various time points, except for better efficacy of Dupilumab at 1year. For the loss of smell scores, a greater improvement was observed in the Dupilumab cohort compared with other biologics and even ESS counterparts. Safety analysis showed no significant difference between the ESS cohort and biologic treatment. In summary, ESS showed comparable improvement in quality of life and symptoms to Omalizumab, Mepolizumab, and Benralizumab. Dupilumab seems to be more effective than ESS in selected items, whereas head-to-head trials and real-world studies are urgent to compare their efficacy. Our findings also showed that biologics could be applied as alternative or adjuvant therapy for uncontrolled severe CRSwNP.

Endoscopic Sinus Surgery in Older Patients With Significant Medical Comorbidities.

Endoscopic sinus surgery (ESS) offers excellent outcomes for patients with chronic rhinosinusitis (CRS) in the general population. It is unclear whether older patients with significant medical comorbidities experience similar benefits. The purpose of this study is to evaluate whether increasing medical comorbidity is associated with worse sinonasal quality of life outcomes after ESS in older patients. This is a retrospective study of CRS patients 55 years or older who underwent elective ESS at an academic institution from July 2017 to June 2019. 22-Item Sino-Nasal Outcomes Test (SNOT-22) scores were gathered at baseline as well as at 3 and 6 months following surgery. Data on demographics, medical comorbidities, preoperative Lund-Mackay (LM) scores, and postoperative complications were extracted from the medical record. The Charlson Comorbidity Index (CCI) was calculated for each patient. Multivariate linear regression was used to evaluate a potential association between CCI and change in SNOT-22 scores at 3 months postoperatively. A total of 205 patients met inclusion criteria with a mean (SD) CCI score of 2 (2.4) and a CCI score range of 0 to 11. The mean (SD) LM score was 8 (5.3). Rates of asthma and nasal polyposis were 28.3% and 36.6%, respectively. The mean (SD) improvement in SNOT-22 scores at 3 and 6 months compared to baseline was 17.9 (19.7) and 20.9 (18.1) points, respectively. After adjusting for covariates, there was no significant association between CCI and change in SNOT-22 scores. Greater medical comorbidity is not associated with worse SNOT-22 outcomes postoperatively, although future studies are needed to determine if comorbidities are associated with higher complication rates. A multidisciplinary approach to perioperative care is critical in maintaining the safety and efficacy of ESS in this patient population.

Efficacy of Endoscopic sinus surgery for associated with filling material of the maxillary sinus, simultaneous sinus-lifting and dental implantation

Objectives: Optimization of the sinus-lifting in patients with filling material in maxillary sinus cavity by a one-stage endonasal endoscopic elimination of the sinuspathology and carrying out a sinus-lifting. Materials and methods: A total of 28 patients (12 males and 16 females, the age was 31 to 64 years, from 2016 to 2022) with ridge defects in age group were selected for the study. All patients had a partially or totally edentulous atrophied posterior maxilla. All patients underwent a thorough clinical examination according to a generally accepted scheme.For sinus surgery, used endoscope is 4.0 mm diameter rigid endoscope (Karl Storz). The fungal material, and hypertrophic mucosa within the maxillary sinus were removed and sent for pathological analysis.Sinus lifting procedures were performed using a lateral window approach. A total of 34 sinus lifting procedures were performed, using a mixture of bovine bone, autogenous bone and PRP. According to our surgical procedure we performed in our patients 1 a 2 stage sinus lifting, 98 implants were inserted. Dental prosthetic rehabilitation was undertaken 5 months after implants insertion and submerged healing. Implant success was assessed clinically and radiographically. The height of the graft and bone density was measured 6th and 9th month after surgery using serial CT. The following parameters were assessed: failure of the augmentation procedure, implant failure, and vertical bone height. Results: Any intraoperative and postoperative complications, such asbleeding, membrane perforation, swelling, ecchymosis, pain, nasal bleeding, and infection, were recorded clinically and radiographically. Of the 98 implants placed in these 28 patients, 3 failed to osseointegrate. The CT examination showed the presence of dense bone around and above the implants. The implants appeared to be well integrated with no peri-implant bone loss. At 6 years follow up, excellent integration of grafted tissue, steady levels of bone around the implants and healthy peri-implant tissues were reported. Implants placed in the reconstructed areas were demonstrated to integrate normally, postoperative occlusal function and esthetics have been favorable. Conclusion: The method of simultaneous endonasal sanitation of the maxillary sinus, sinus-lifting, dental implantation, allows to reduce the probability of perforation of the membrane, significantly shortening the rehabilitation period of patients with insufficient bone tissue in the maxillary sinus. These methods led to simpler, more comfortable, lower risks of morbidity, more predictable compared to more invasive maxillary sinus augmentation

Local anaesthetic techniques in endoscopic sinonasal surgery: a contemporaneous review.

Endoscopic endonasal surgery is a minimally invasive technique that has revolutionised the management of complex neurosurgical, otolaryngological, skull-base and craniofacial lesions. Traditionally performed under general anaesthetic, this study explores the growing role of local anaesthetic techniques. A contemporaneous review of modified dental techniques and intraoral anatomy provides a supportive guide for performing endoscopic sinus surgery under local anaesthetic. The practical procedures for four midfacial nerve blocks are described with relevance to endoscopic surgery under local anaesthetic. Anatomy, surgical technique and potential complications are discussed for the incisive foramen block, sphenopalatine ganglion block (via endonasal approach), maxillary nerve block (via the greater palatine foramen and the transoral lateral pterygoid plate approach) and transcutaneous approach to the pterygomaxillary fissure. Ultimately, such techniques may extend the safety and efficacy of endoscopic sinus surgery, limit surgical risk and increase satisfaction for patients, surgeons and healthcare managers alike.

Efficacy of endoscopic sinus surgery alone versus in combination with neurosurgical intervention for the treatment of pediatric subdural empyema

ObjectivesTo compare treatment outcomes for sinogenic subdural empyema (SE) between those managed with initial endoscopic sinus surgery (ESS) alone versus those treated with a combination of ESS and craniotomy over the last decade at our institution. To better characterize subdural empyema with regard to presentation, causative pathogens, and treatment course. MethodsRetrospective single-center chart review to identify and evaluate pediatric SE patients between 2009 and 2019. Patients meeting inclusion criteria were classified in one of two groups: those who initially underwent ESS or frontal trephination without concurrent neurosurgical procedure and those who underwent craniotomy or burr hole in addition to a sinus procedure. Presenting characteristics and treatment outcomes were compared between the two groups. ResultsEighteen patients met inclusion criteria. The ESS alone and the ESS + craniotomy subgroups each had 9 patients with similar baseline characteristics. The ESS + craniotomy group was more likely to present with neurological symptoms (p = 0.039) and have multiple intracranial fluid collections (p = 0.046). 74.1% of patients presented to the Emergency Department (ED) or to their primary medical doctor and were treated with outpatient management prior to hospitalization with definitive surgical management. The most common presenting symptoms were fever, headache and nausea/vomiting. There were no differences between treatment groups in rate of return to the operating room (OR) (p = 1.00), length of stay (LOS) (p = 0.553), or adverse neurological outcomes (p = 0.456). 44.4% of patients in the ESS alone group eventually required neurosurgical intervention. ConclusionsSurgical SE patients often present to medical professionals in the primary care setting or ED and are managed with outpatient treatment before admission with definitive treatment. In this small retrospective cohort patients who underwent sinus intervention alone had similar rates of return to OR, LOS and adverse neurological outcomes use as those who underwent a sinus procedure in coordination with a neurosurgical intervention. There may be a group of patients with SE who may be managed with endoscopic procedures alone and further studies should seek to determine the characteristics of this population.

Evaluation of Endoscopic Sinus Surgery Combined with Dexamethasone in the Treatment of Chronic Rhinosinusitis

The purpose of this study is to explore the efficacy of endoscopic sinus surgery combined with dexamethasone for treating chronic rhinosinusitis. A total of 123 chronic rhinosinusitis patients diagnosed by magnetic resonance imaging and cochlear implant in the otolaryngology department of the First Peopleâs Hospital of Chuzhou City from January 2018 to January 2019 were selected. They were randomly divided into the control group (n=61) and the experimental group (n=62). After endoscopic sinus surgery, the control group used only normal saline for nasal cleaning, while the experimental group added dexamethasone nasal spray for regular treatment. After outpatient follow-up every 3 mo, the sinonasal outcome test-20 scores, Lund-Kennedy scores, olfactory tests, and therapeutic effects were compared between the two groups. Before treatment, compared to the control group, there was no significant difference in the sinonasal outcome test-20 scores (38.78±5.42 vs 39.08±5.73) and Lund-Kennedy scores (17.35±3.21 vs 17.40±3.35) of the experimental group. After treatment, during the follow-up period of 3, 6, and 12 mo, the sinonasal outcome test-20 scores were (9.38±2.10 vs 2.10±0.45) and the Lund-Kennedy scores were (7.45±1.65 vs 2.23±0.73) between the control and the experimental groups, which were significantly different between the two groups(P<0.05). The olfactory test scores of the experimental group was significantly higher (P<0.05). After treatment for 12 mo, the cure rate of the experimental group was 95.16 %, which was significantly www.ijpsonline.com 127 Indian Journal of Pharmaceutical Sciences Special Issue 5, 2020 higher than that of the control group cure rate of 90.16 %. In terms of the recurrence rate after treatment, there was a statistically significant difference between the two groups in the follow-up period of 3 mo (22.95 vs 12.90 %) and 6 mo (14.75 vs 6.45%). However, there was no significant difference in the followup period of 12 mo (1.45 vs 0). Endoscopic sinus surgery combined with dexamethasone could ameliorate the clinical symptoms of chronic rhinosinusitis patients, improve their quality of life. It also has a better long-term effect, which is worth to consider.

Role of Endoscopic Sinus Surgery in Pediatric Chronic Rhinosinusitis

In children with chronic rhinosinusitis (CRS) refractory to medical therapy, both adenoidectomy and endoscopic sinus surgery (ESS) are considered to be surgical options. This review presents the current literature regarding the role of ESS in management of CRS in the pediatric population. Adenoidectomy has a success rate of 40–69% with a complication rate of 3.2%. Similarly, ESS has a reported success rate of 71–100% with a complication rate of 0.6–3%. ESS does not appear to have long-term adverse effects on facial growth based on recent longitudinal human studies. Age appears to be a factor in the efficacy of endoscopic sinus surgery. Patients older than 6 years have been shown to have better success rates for both ESS and adenoidectomy than those under six. In addition, ESS may be more effective than adenoidectomy in children older than 6 years. However, in children younger than 6 years, the difference in success rates has not been found to be statistically significant between the two procedures. ESS is an effective surgical treatment for pediatric patients with CRS and is best performed when medical therapy, adenoidectomy, or both have failed.

Surgical treatment of chronic rhinosinusitis after sinus lift.

The sinus lift (or sinus augmentation) is a common procedure to improve maxillary bone stock before dental implantation. Chronic rhinosinusitis (CRS) is a potential complication of this procedure and may be refractory to medical treatment. Functional endoscopic sinus surgery has previously been used to address CRS, however, results of previous studies indicated that implant removal is required. There are limited follow-up data available. The purpose of this study was to characterize the long-term outcomes and efficacy of endoscopic sinus surgery for refractory CRS after sinus lift, including the ability to salvage dental implants. This was a retrospective case series that described nine patients who, between June 2011 and September 2016, underwent endoscopic sinus surgery for CRS after a sinus lift procedure. The presenting symptoms of the patients, medical management, imaging results, operative procedures, and outcomes were reviewed. The majority of patients developed symptoms (mucopurulent nasal drainage, facial pain and/or pressure, nasal congestion, and foul smell) within 3 months of implant placement and were treated with at least three courses of antibiotics before referral to an otolaryngologist. All the patients underwent wide endoscopic maxillary antrostomy, with no surgical complications or postoperative reports of infection. There was a statistically significant improvement in 22-item Sino-Nasal Outcome Test scores (t(8) = -2.908; p = 0.02) and discharge, inflammation, and polyps/edema endoscopic scores ([z = -2.539; p = 0.011) between pre- and postsurgical treatment. Four patients had their dental implants removed before presentation. Among the five patients who presented with intact dental implants, none required removal before or after functional endoscopic sinus surgery. Functional endoscopic sinus surgery was a reasonable and efficacious treatment option for patients who presented with paranasal sinus disease after a sinus lift. Dental implant removal may not be a requirement for successful treatment of CRS associated with sinus lift procedures.

Minimally Invasive Surgery for Pott's Puffy Tumor: Is It Time for a Paradigm Shift in Managing a 250-Year-Old Problem?

The aim of this study was to review the clinical outcomes and efficacy of endoscopic sinus surgery (ESS) in the management of Pott's puffy tumor (PPT). Literature PubMed review using a combination of MeSH terms and keywords was undertaken, combined with a single surgeon case series of 3 patients. A total of 29 (20 males, median age 25 years) cases were reviewed. The most common etiology was acute frontal sinusitis (62%), followed by a history of chronic rhinosinusitis (28%). Two patients presented with concomitant preseptal cellulitis and cutaneous fistula each, while another had pneumocephalus. The majority of cases (59%) had Draf 1 procedure. Three cases had Draf 3 procedure. Five cases were successfully treated by sinus balloon sinuplasty. Postoperatively, most patients had either oral or intravenous antibiotics of varying duration. There were no further complications following ESS. Both fistulas healed without requiring surgical debridement or closure. Some PPT cases can be managed endoscopically. The availability of powered angled instruments, high-definition video, and image guidance systems have provided the modern otolaryngologists with a credible alternative to traditional techniques. Furthermore, improved bioavailability of modern antibiotics may obviate the need for craniotomy and external drains.

Outcomes in endoscopic sinus surgery: olfaction, nose scale and quality of life in a prospective cohort study.

To determine the efficacy of endoscopic sinus surgery (ESS) on olfactory function in chronic rhinosinusitis patients with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) and to compare the nasal obstruction and symptom evaluation (NOSE) scale before and after surgery. A prospective cohort study SETTING: Royal National Throat and Nose and Ear Hospital, London UK. One hundred and thirteen patients with CRS; 60 CRSwNP and 53 CRSsNP. Olfaction was measured using both the University of Pennsylvania Smell Investigation Test (UPSIT) and the 'sense of smell' visual analogue scale (VAS). The NOSE scale, the sinonasal outcome test (SNOT 22) and the Lund-Kennedy (LK) surgeon reported scores were also measured pre- and postoperatively at 6 months. The UPSIT psychophysical measurement significantly improved following ESS in the CRSwNP subgroup as did the patients perceived VAS sense of smell. However, in the CRSsNP subgroup, the improved VAS and UPSIT measurements were not significant. The NOSE, SNOT 22 and LK scores all improved significantly. The olfactory improvement as measured by the UPSIT correlated to the SNOT-22, but a correlation between the NOSE score and UPSIT was not found. Endoscopic sinus surgery significantly improved the patient's perceived and measured sense of smell in the CRSwNP subgroup which is the most surgically responsive CRS subgroup. Additionally, improved olfaction in the CRSwNP subgroup is most likely to improve the patient's quality of life. Endoscopic sinus surgery significantly improved the NOSE scale in both CRS subgroups at 6 months following surgery.

Recurrent sinonasal polyposis after the endoscopic sinus surgery

Article type Review article Article history Nasal polyposis is one of the chronic airway diseases, which affects the patient's quality of life in different ways. There are various complications along with nasal polyposis, which might be cured by drug administration. Due to failure of pharmacotherapy effects, various surgical approaches might be useful to resect the polyps with the possibility of polyposis re- currence after the surgery. In this study, we aimed to review different stud- ies about the etiology and prevalence of recurrent nasal polyposis and the efficacy of endoscopic sinus surgery in reducing the incidence of recur - rent nasal polyposis. We searched the PubMed and google scholar for the relevant articles. Based on the studied articles, there are various factors including the history of inflammatory diseases, the severity of polyposis, etc., which affect the long-term efficacy of surgical intervention.

Evidence-based Surgery for Chronic Rhinosinusitis with and without Nasal Polyps

Meta-analysis of both large outcome studies as well as cohort studies support the safety and efficacy of Endoscopic Sinus Surgery for Chronic Rhinosinusitis. The efficacy of endoscopic sinus surgery is demonstrated in the improvement of both disease-specific and generic QOL as well as objective measures. However, this must be interpreted together with a well-recognized long-term 15-20% revision rate, seen more often in patients with ASA trias and cystic fibrosis as well as osteitis and previous surgery. The effect of surgery is higher in managing nasal obstruction (effect size 1.7) and less so hyposmia (effect size 0.8). Allergy has an additive role on the symptomatology of CRS; however, its role if any on the outcome of ESS for CRS is unclear. The concurrent presence of aspiring sensitivity and asthma is associated with increased disease burden and more revision surgeries. Improved phenotyping of CRS may lead in the future to better tailoring of surgical treatments.

The long-term efficacy of endoscopic sinus surgery for sinusitis and nasal polyps

Objective To improve the efficacy of endoscopic sinus surgery ( ESS ) by assessing its long-term curative effect.Methods ESS was performed on 86 patients with chronic sinusitis or nasal polyps.All the patients were then followed up for two years.Results In a 2-year follow-up,76patients ( 88.4％ ) were cured,while 10 ( 11.6％ ) failed to respond to the procedure.5 patients developed blood extravasation blood in the eyelid,and 6 developed nasal synechia.Conclusions Endoscopic sinus surgery is efficacious in the treatment of chronic sisusitis and nasal polyps.It can increase the cure rate effectively,achieve a long-term efficacy,and reduce complications. Key words: Endoscopic sinus surgery; Chronic sinusitis; Nasal polyps; Long-term efficacy

Uncinectomy Through the Anterior Nasal Fontanelle in Endoscopic Sinus Surgery

In functional endoscopic sinus surgery, the resection of the uncinate process is an important step. The traditional method of performing uncinectomy is associated with the risk of penetrating the lamina papyracea and orbital fat exposure. Without timely detection and appropriate treatment, uncinectomy may lead to serious consequences such as blindness. In our study, we used the novel approach of performing uncinectomy through the anterior nasal fontanelle. Orbital complications were observed in 4 of the 112 patients who underwent the traditional method; however, no complication was observed in patients who underwent surgeries with the new approach (P < 0.01). No nasolacrimal duct injury or eye movement disorder was observed in the 2 groups. The percentage of opening of the maxillary sinus ostia by using the new method was significantly greater than that achieved by using the traditional method (97.93% and 70.53%, respectively). The mean score in the visual analog scale, which is used to measure the efficacy of the procedure, for the new method was lower than that for the traditional method, and the difference was statically significant (t = 4.17, P < 0.01). Six and 12 months after the operations, the Lund-Kennedy endoscopy scores obtained when the new method was used were lower than those obtained when the traditional method was used (t = 3.27 and t = 4.40, respectively; P < 0.05). Therefore, uncinectomy through the anterior nasal fontanelle was a convenient and safe procedure and ensured good exposure of the maxillary sinus ostia. This procedure effectively improved the efficacy of endoscopic sinus surgery.

The Efficacy of Endoscopic Sinus Surgery in the Management of Silent Sinus Syndrome

Objective: Evaluate the efficacy of endoscopic sinus surgery (ESS) without orbital floor augmentation in restoring maxillary sinus volume and resolving enophthalmos in patients with silent sinus syndrome. Method: A retrospective chart review was conducted in all patients with silent sinus syndrome managed with endoscopic sinus surgery at St Paul’s Hospital from 2005 to 2010. A comparison of pre- and postoperative ophthalmometric and CT scan maxillary sinus volumetric measurements were performed. Results: In total, there were 25 patients aged 24 to 71 years who were managed with ESS. All patients underwent ESS with maxillary sinus antrostomy. All patients had a significant improvement in postoperative maxillary sinus volumetric measurements, with a mean increase of 22.7%. Conclusion: ESS without orbital floor augmentation can be used to improve enophthalmos and reverse maxillary sinus atelectasis in most patients with silent sinus syndrome.

Curative effect of endoscopic sinus surgery on treatment of non-invasive fungal maxillary sinusitis

Objective To explore the clinical efficacy of endoscopic sinus surgery on the treatment of noninvasive fungal the maxillary sinusitis. Methods 21 patients with non-invasive fungal maxillary sinusitis patients were given endoscopic sinus surgery. Completely remove of the nasal cavity and sinus disease, fully open, washing sinuses and give nasal endoscopy on a regular tine. Results Follow-up of 6 months to 4 years, 18 cases of cure, 1 case of loss of information. 2 case of relapse. Cases of recurrence were cured by endoscopic sinus dressing. Conclusion Endoscopic sinus surgery is an effective measure on trentment of non-invasive fungal maxillary sinuses. Key words: Endoscopy; Mycoses ; Maxillary sinusitis

Correlation of histopathology and symptoms in allergic and non-allergic patients with chronic rhinosinusitis

The aim of this study was to estimate and compare some histopathologic predictors of efficacy of endoscopic sinus surgery (ESS) in allergic and non-allergic patients with chronic rhinosinusitis (CRS). Symptomatology was rated in 50 allergic and 50 non-allergic patients prior to as well as 12 and 24 months after surgery. Specimens taken during the procedure were scored for goblet cells, subepithelial thickening, mast cells and eosinophils. The correlation between histopathology and symptoms was evaluated. Goblet cells and subepithelial thickening were the best predictors in both groups of patients. These parameters are significant global outcome predictors for allergic, but not for non-allergic patients. It is concluded that certain histopathologic parameters in CRS correlate with certain symptoms. Certain histopathologic changes are predictable for persistence of some bothersome symptoms after ESS. Pathologic evaluation might give prediction of response to ESS in allergic and non-allegic patients with CRS.

Paranasal mucoceles in children with cystic fibrosis

Sinus mucocele is rare in the paediatric age, and so far no prevalence data have been reported in children with Cystic Fibrosis (CF). Moreover, safety and efficacy of endoscopic management of sinus mucoceles has been widely proven but only in the adult population. The aim of our study was to evaluate the prevalence of this complication and the efficacy of endoscopic sinus surgery in CF patients during the initial years of life. Among the 242 CF patients born in the period between 1990 and 2001 and in regular follow up at our CF Centre, 90 patients with possible symptoms of chronic upper airways disease (CUAD) underwent a comprehensive ENT examination including rhinofibroscopy. In selected cases a CT scan of the paranasal sinuses was also performed. CUAD was diagnosed in 55/90 because of the consistent presence of nasal obstruction, combined with at least two other nasal symptoms such as chronic nasal discharge, snoring, epiphora. Diagnosis of mucoceles (five maxillary bilateral mucoceles, one maxillary unilateral, three maxillary and etmoidal mucoceles) was done by means of CT scan in 9/15 who performed the examination. Median age at the diagnosis was 4+/-0.5 years, ranging from 0.5+/-7 years, showing a prevalence of 16.4% (9/55) among patients with symptoms. Endoscopic sinus surgery was performed in all the cases. The follow-up period ranged from 3 months to 6 years with no recurrence observed. Sinus mucocele in CF population is less unusual than expected and a high degree of suspicion is needed. Endoscopic sinus surgery seems to be a safe and efficient treatment of this complication also in a paediatric population at a high risk as for the CF patients.

Prolonged visual disturbance secondary to isolated sphenoid sinus disease.

The objective was to evaluate the efficacy of endoscopic sinus surgery in patients with isolated sphenoid sinus disease with visual disturbances of more than 72 hours' duration. Retrospective review. A sequential series of patients with isolated sphenoid sinus disease with visual disturbances who underwent endoscopic surgery performed by the same surgeon between 1995 and 2002 were reviewed. Patients with malignant tumors were excluded from the study. Patients were evaluated preoperatively and postoperatively to record the effects of this approach on visual acuity and diplopia. The study population included six women and seven men with a mean age of 56.2 years (age range, 31-75 y). Eight eyes had vision loss attributable to compressive optic neuropathy (27%) and optic neuritis (27%); seven eyes with diplopia had abducens palsy (40%) and oculomotor nerve palsy (7%). Sphenoid sinus lesions included sinusitis (38%), mucocele (31%), and aspergillosis (31%). The mean interval between the onset of visual disturbances and surgery was 6.6 months (range, 3 d-3.5 y). Visual disturbances improved in 60% of the patients (P <.01). There was better improvement in diplopia than in vision loss (P <.01). The results of endoscopic sinus surgery for patients with abducens palsy and aspergillosis were excellent (83% and 80%, respectively). Optic neuritis and visual disturbances lasting for more than 6 months were regarded as poor prognostic factors. The study supports the treatment of visual disturbances resulting from isolated sphenoid sinus disease by endoscopic sinus surgery. A timely operation may prevent permanent sequelae.