Endoscopic Paranasal Sinus Surgery Research Articles

The predicting role of postoperative changes in self-reported symptoms in patients with recurrence eosinophilic chronic sinusitis with nasal polyps

Objective:To investigate whether changes in postoperative symptoms and signs in patients can predict the recurrence of ECRS after nasal endoscopic sinus surgery. Methods:A total of 70 adult patients with ECRS were enrolled for ESS surgery from June 2020 to March 2022 in a single center. There were 50 males and 20 females, with an average age of （46.9±14.5） years. Follow-up after ESS was at least 52 weeks. Patients undergo peripheral blood tests, CT of the sinuses, olfactory T&T test, visual analogue scale of symptoms（VAS）, and endoscopic scoring. Results:VAS scores and endoscopic scores were analyzed at preoperative and 6th week, 12th week, 24th week and 52th week postoperative. After 12th week postoperatively, there was a clear correlation between symptom scores and endoscopic scores. Moreover, olfactory disorder and nasal discharge were the two most obvious symptoms. There were differences in the expression of multiple preoperative clinical inflammatory indicators between the symptom-controled group and the symptom-uncontrolled group（previous surgical history, concomitant asthma, nasal smear eosinophil, serum EOS%, total IgE, CT score, olfactory score, and symptom score, all with P<0.05）, while there was no difference in baseline endoscopic score（P>0.05）. At 12th week postoperative, the two groups of patients showed significant differences in both symptom scores and endoscopic scores. The symptoms and endoscopic score at the 12th week point of follow-up were used as predictive indicators for recurrence, with sensitivity and specificity of 62.5% and 83.3%, respectively. Conclusion:The changes in postoperative symptom score and endoscopic score in ECRSwNP patients indicated that the recurred ECRS. In the symptom-uncontrolled group, symptomatic and endoscopic scores showed consistent increased scores; In the symptom-controlled group, conflicting results between increased endoscopic scores and stable symptoms suggest that the presence of asymptomatic recurrence must be considered. The changes in symptoms and signs at the 12th week point of follow-up can serve as clinical indicators for preventing disease recurrence.

Cost–utility analysis of dupilumab compared with endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps. Evaluation in Colombia, a developing country

ABSTRACT Introduction Chronic rhinosinusitis with nasal polyps (CRSwNP) compromises respiratory function, sleep, concentration, work capacity, and quality of life, generating high costs for patients and health systems. The aim of the study was to analyze the cost utility of Dupilumab compared to endoscopic sinus surgery for patients with CRSwNP. Research design and methods We developed a model-based cost–utility analysis from the perspective of the Colombian health system to compare Dupilumab vs. endoscopic nasal surgery in patients with difficult-to-treat CRSwNP. Transition probabilities were extracted from the published literature about CRSwNP, and costing was based on local tariffs. We performed probabilistic sensitivity analysis for outcomes, probabilities, and costs (10.000 Monte Carlo simulations). Results The cost of dupilumab ($ 142.919) was 7.8 times higher than nasal endoscopic sinus surgery ($ 18.347). In terms of quality-adjusted life years (QALYs), surgery generates better results than Dupilumab: 11.78 vs. 9.05 QALYs. Conclusions From the perspective of the health system, endoscopic sinus surgery for the management of CRSwNP is a dominant alternative in all the analyzed scenarios compared to the use of Dupilumab. From a cost–utility point of view, the use of dupilumab should be considered when the patient requires multiple surgeries or when there is a contraindication for surgery performance.

OWN EXPERIENCES IN THE APPLICATION OF INTRAOPERATIVE 3D SPATIAL IMAGING IN THE ENDOSCOPIC SURGERY OF THE PARANASAL SINUSES

Introduction: Intraoperative spatial imaging using a high-resolution 3D camera is a state-ofthe-art technique applied to endoscopic paranasal sinus surgery. It enables better visualization of the surgical site, improves depth perception and facilitates tissue identification. All 3D endoscopy capabilities are still under review. The purpose of this study is to compare analogous endoscopic surgeries performed with 3D technique and those performed with traditional 2D technique based on the analysis of length of surgery, blood loss, occurrence of intraoperative complications and hospital stay time. Material: The material included 346 patients who underwent endoscopic paranasal sinus surgery with unilateral or bilateral sinus opening. In case of 152 patients, corrective surgery of the nasal septum was additionally performed. The patients were divided into two groups (2D group and 3D group) comprising 173 patients each, who underwent paranasal sinus opening using 2D and 3D endoscopic visualization. Each group was divided into four subgroups: the first were patients after bilateral paranasal sinus surgery (PSS), the second were patients after bilateral endoscopic paranasal sinus surgery and nasal septal correction surgery (PSS+NS), the third were patients after unilateral paranasal sinus surgery (UPSS), and the fourth group was patients after unilateral endoscopic paranasal sinus surgery and nasal septum correction surgery (UPSS+NS). Methods: The surgery was carried out using a TipCam 3D endoscope from Storz (Germany), 18 mm in length, 4 mm in diameter, with 30° optics, with an integrated camera capable of transmitting 3D images, as well as classic 2D endoscopes, 16 mm in length, 4 mm in diameter and 30° optics, along with a video track and instrument set. Patients underwent unilateral or bilateral endoscopic surgery with opening of the maxillary sinuses, frontal sinuses, anterior and posterior ethmoid as well as corrective surgery of the nasal septum. Patients underwent unilateral or bilateral endoscopic surgery with opening of the maxillary sinuses, frontal sinuses, anterior and posterior ethmoid as well as corrective surgery of the nasal septum. Results: The length of surgery were as follows in the 2D group: 2D/PSS+NS group — 107 min. (±22); 2D/PSS group — 95 min (±24); 2D/UPSS+NS group — 68 min (±21); 2D/UPSS group — 53 min (±14); The length of surgery in the 3D group: 3D/PSS+NS group — 91 min. (±17); 3D/PSS group — 83 min (±20); 3D/UPSS+NS group — 69 min (±15); 2D/UPSS group — 49 min (±10); Among the complications were early and late postoperative bleeding, eyelid or orbital hematomas, and eyelid edema. There were 17 complications in the 2D group (9.82%), and 7 complications in the 3D group (4.05%). Conclusions: It was found that 3D endoscopic surgeries significantly reduced the length of surgery, especially in serious bilateral paranasal sinus surgeries. and influenced a decrease in perioperative complications. 3D endoscopic surgeries had no significant effect on the amount of blood loss and the length of the patient’s stay at the Clinic.

Machine-Learning Points at Endoscopic, Quality of Life, and Olfactory Parameters as Outcome Criteria for Endoscopic Paranasal Sinus Surgery in Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) is often treated by functional endoscopic paranasal sinus surgery, which improves endoscopic parameters and quality of life, while olfactory function was suggested as a further criterion of treatment success. In a prospective cohort study, 37 parameters from four categories were recorded from 60 men and 98 women before and four months after endoscopic sinus surgery, including endoscopic measures of nasal anatomy/pathology, assessments of olfactory function, quality of life, and socio-demographic or concomitant conditions. Parameters containing relevant information about changes associated with surgery were examined using unsupervised and supervised methods, including machine-learning techniques for feature selection. The analyzed cohort included 52 men and 38 women. Changes in the endoscopic Lildholdt score allowed separation of baseline from postoperative data with a cross-validated accuracy of 85%. Further relevant information included primary nasal symptoms from SNOT-20 assessments, and self-assessments of olfactory function. Overall improvement in these relevant parameters was observed in 95% of patients. A ranked list of criteria was developed as a proposal to assess the outcome of functional endoscopic sinus surgery in CRS patients with nasal polyposis. Three different facets were captured, including the Lildholdt score as an endoscopic measure and, in addition, disease-specific quality of life and subjectively perceived olfactory function.

The management of postoperative airway after nasal endoscopic sinus surgery

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nasal surgery followed by nasal packing can be vulnerable due to airway complications like, respiratory blockage and dyspnea. Thus the present study aimed to compare the nasal packing with nasal airway after the nasal surgery for the airway management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 120 patients for fibreoptic endoscopic sinus surgery were included in this study. All subjects were equally divided in to 3 groups; group 1, 40 patients with traditional bilateral nasal packing; group 2, 40 patients with 5 mm internal diameter uncuffed ETT in to one of the nostrils and bilaterally in group 3 40 patients. During postoperative period all data were recorded and analyzed by using statistical analysis software 20.0.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; In case of group 1 patients cardio-respiratory parameters reported significant variation. Pain and bleeding during removal of nasal airway and discomfort showed significant results among group 1 patients than in group 2 and group 3 patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study showed that the new intervention to manage the airway obstruction has benefits as compared to traditional nasal packing with ease of suctioning, oxygen supplementation.&lt;/p&gt;

Inhibitory Effects of S-carboxymethylcystein on Goblet Cell Proliferation in Cultured Epithelium.

The influence of S-carboxymethylcystein (S-CMC) on the proliferation ability of goblet cells in nasal polyp epithelium in response to inflammatory stimulation was examined. The subjects were patients with chronic paranasal sinusitis. An epithelial cell culture system was established using nasal polyp mucosa excised during endoscopic paranasal sinus surgery. The samples were divided into 4 groups (group a: control group, group b: 10 ng/mL tumor necrosis factor-α (TNF-α) treatment group, group c: 10-7 M S-CMC and 10 ng/mL TNF-α treatment group, group d: 10-5 M S-CMC and 10 ng/mL TNF-α treatment group). The total number of epithelial cells and number of goblet cells were measured under a microscope, and the ratio of goblet cells to the total number of epithelial cells was calculated. In group b, 10 ng/mL of TNF-α significantly increased the number of goblet cells compared with group a, suggesting involvement of TNF-α in goblet cell proliferation. In addition, the number of goblet cells significantly decreased in group d compared with that in group b, and it also decreased in group c compared with that in group b, although the difference was not significant, and the decrease was smaller than that in group d, suggesting that S-CMC inhibited goblet cell proliferation in a concentration-dependent manner. TNF-α promoted goblet cell proliferation in nasal polyps, suggesting its influence on nasal polyp formation. As S-CMC inhibited inflammatory stimulation-induced goblet cell proliferation in nasal polyp epithelium, it may be useful for the treatment of sinusitis.

Congenital Midline Nasal Mass: Four Cases with Review of Literature

Introduction&#x0D; Congenital midline nasal masses include nasal dermoids, gliomas, encephaloceles. Although rare, these disorders are clinically important because of their potential for connection to the central nervous system. Preoperative knowledge of an intracranial connection is a necessity to allow for neurosurgical consultation and possible planning for craniotomy. This study discusses the clinical presentation of congenital midline nasal mass and the role of imaging modalities like CT scan and MRI in diagnosis and the surgical management.&#x0D; Materials and Methods&#x0D; This prospective study is carried from March 2014 to March 2016, during which 4 cases presented to the Otorhinolaryngology department. Pre-operative evaluation of the patients included endoscopic evaluation along with haematological investigations, CT Scan and MRI. The masses were removed with nasal endoscopic sinus surgery or by external approaches and neurosurgical intervention.&#x0D; Result&#x0D; The age of the patients ranged from 3 years to 25 years. Three of them were male and one female. There was one case of nasoethmoidal encephalocele and the other three were dermoids (intranasal dermoid cyst, nasal dermoid cyst and nasal dermoid sinus cyst).&#x0D; Conclusion&#x0D; Congenital midline nasal masses are rare. These disorders are clinically important because of their intracranial connection which require proper evaluation with radiological imaging like CT scan and/or MRI before FNAC and any surgical intervention.

仮想の鏡「ハイパーミラー」を用いた内視鏡下鼻内手術の遠隔手技指導実験( 臨床現場のVR)

仮想の鏡「ハイパーミラー」を用いた内視鏡下鼻内手術の遠隔手技指導実験( 臨床現場のVR)

ICA Injury in Sphenoid Sinus during Nasal Endoscopic Sinus Surgery-A Case Report

Background:Injury to the cavernous portion of the Internal Carotid Artery (ICA) during nasal endoscopic sinus surgery is a rare complication, which is associated with high rates of morbidity and mortality. ICA is more vulnerable to iatrogenic injury inside the sphenoid lateral wall when it runs in a more medial course which although is uncommon but a normal variant and when the ICA runs only in sphenoid sinus mucosal cover.

Study on effects of early improved decubitus of general anesthesia downlink sinus endoscope operation

Objective To discuss the effects of early improved decubius of general anesthesia downlink sinus endoscope operation. Methods A total of 106 cases of patients who received nasal sinus open surgery in a certain hospital in Beijing from September 2014 to May 2015 were randomly divided into a control group and an experimental group according to the random number table method, 54 cases in the control group and 52 cases in the experimental group.The control group adopted recumbent position after general open nasal endoscopic sinus surgery of our hospital (changing to semirecumbent position after 4 hours' prostration without pillow). The experimental group adopted semirecumbent position at the early stage after surgery(the head of bed was elevated for 40 degrees after the postoperative evaluation for general anesthesia, patients with clear consciousness are able to correctly answer questions). The blood pressure, heart rate, breathing and blood oxygen saturation of the two groups 4 hours before and after the operation were compared.The nasal hemorrhagic secretions seepage quantity, wound pain and general discomfort of the two groups 4 hours after operation were compared. Results There were no statistical significances in terms of the comparison of the mean systolic pressure, diastolic blood pressure, heart rate, breathing and blood oxygen saturation of the two groups 4 hours after operation (t value respectively -1.834, -0.071, -0.144, -0.813, -0.818, P>0.05). There were no statistical significances in terms of the wound pain condition 4 hours after operation(Z=-0.572, P>0.05). The seepage quantity of nasal bloody secretions of the experimental group 4 hours after operation was better than that of the control group, and the difference was statistically significant(Z=-2.014, P<0.05). The discomfort of the experimental group's patients 4 hours after operation was obviously reduced compared with the control group, and the difference was statistically significant(Z=-2.270, P<0.05). Conclusions The early improved decubitus of general anesthesia downlink sinus endoscope operation proved no obvious effect on patients' systolic pressure, diastolic blood pressure, heart rate, breathing, blood oxygen saturation and nasal wound pain, but it is helpful for discharging the nasal secretions, reducing overall discomfort of patients, increasing patients' comfort and improving the quality of nursing. Key words: General anesthesia; Nasal endoscopy; Sinus operation; Recumbent position

Balloon catheter dilation technology combined with a fibrolaryngoscope to treat a maxillary sinus cyst.

A prospective randomized controlled study was conducted to investigate the effect of balloon catheter dilation technology combined with a fibrolaryngoscope in the treatment of a maxillary sinus cyst. The clinical data of 14 cases (19 maxillary sinuses) with balloon catheter dilation technology combined with a fibrolaryngoscope to remove sinus cysts (balloon group) and 16 cases (23 maxillary sinuses) with conventional nasal endoscopic sinus surgery to remove sinus cysts (conventional group) were analyzed. All cases have completed the preoperative and postoperative SNOT-20, nasal endoscopy and coronal sinus CT scan. Lund-Kennedy endoscopic and Lund-Mackay CT scan staging scores were recorded. All patients were followed up for 24 weeks after the operation. The SNOT-20 scores, Lund-Kennedy endoscopic and Lund-Mackay CT scan staging scores were lower in the balloon group than that in the control group. Balloon catheter dilation technology combined with a fibrolaryngoscope can effectively preserve the function and structures of the nasal cavity and sinus, making it a good choice in the treatment of a retention cyst of the maxillary sinus.

Latrogenic diplopia

Diplopia is a very disturbing condition that has been reported as a complication of several surgical procedures. The following review aims to identify the ocular and nonocular surgical techniques more often associated with this undesirable result. Diplopia is reported as an adverse outcome of some neurosurgical procedures, dental procedures, endoscopic paranasal sinus surgery, and several ophthalmic procedures. The most common patterns and some recommendations in order to prevent and treat this frustrating outcome are also given.

Two Cases of Epiphora Following Le Fort I Osteotomy

Several conditions can cause acquired nasolacrimal duct (NLD) obstruction. These conditions include involutional stenosis of the NLD that presumably results from unidentified infection or autoimmune disease, dacryolith, sinus disease, naso-orbital fractures following trauma, inflammatory diseases, such as Wegener’s granulomatosis, neoplasm or iatrogenic injuries during endoscopic paranasal sinus surgery. The two jaw surgery (TJS) (i.e., maxillary and mandibular osteotomies) has recently become popular for cosmetic purposes and has become an increasing cause of concern regarding NLD obstruction. However, there have been no previously reported cases of NLD obstruction associated with TJS. The NLD can be damaged by excessively high maxillary osteotomies during TJSs, which can result in epiphora. Furthermore, in the absence of direct damage to the NLD or excessive mobilization of the maxillary bone during TJS, the soft tissues surrounding the Hasner’s valve can cause NLD obstruction. Recently, the authors experienced two cases of NLD obstruction following TJS and report those cases here.

The Influence of Selected Preoperative Factors on the Course of Endoscopic Surgery in Patients with Chronic Rhinosinusitis

Epidemiological data shows the increasing prevalence of chronic rhinosinusitis which poses significant health, social and economic problems in today's world. Endoscopic paranasal sinus surgery is currently the method of choice in the treatment of chronic rhinosinusitis when conservative treatment methods fail. Therefore, maintaining a high percentage of therapeutic success with a constantly growing number of surgical procedures poses the major challenge to otolaryngologists. Appropriate surgical conditions have a great influence on the course of surgical procedure, the risk of complications and postoperative outcomes. The aim of this study was to analyse the influence of selected perioperative factors on the course of endoscopic surgery in patients with chronic rhinosinusitis. A group of 212 patients (105 women and 107 men) aged 19 to 74 (mean age 46.5) diagnosed with chronic rhinosinusitis were enrolled in the retrospective study. All patients underwent endoscopic sinus surgery. The analysis was concerned with the impact of such factors and clinical parameters as gender and age of patients, disease progression, previous (conservative and surgical) treatment, comorbidities, detrimental external factors, the scope of surgical treatment influencing the duration of surgery, bleeding in the surgical field and the total blood loss during surgery. It was found that the mean duration of surgery in the study group was 40.2 min, the mean blood loss was 312.17 mL and the mean degree of intraoperative bleeding scale reached 2.15. The intraoperative conditions deteriorate together with the increasing age of patients. Selected factors and clinical parameters, such as impaired nasal patency, olfactory disorders, the occurrence of nasal polyps, prior surgical treatment, the presence of aspirin-induced asthma and cardiovascular diseases, intranasal glucocorticoid therapy, a high degree of inflammatory changes in the sinuses and a large extent of surgery substantially influence the deterioration in intraoperative conditions. Knowledge of these factors and their impact on surgery enables more thorough, multidisciplinary preparation of patients for surgery, and thus enables the optimisation of surgical conditions.

Postoperative airway management after nasal endoscopic sinus surgery: A comparison of traditional nasal packing with nasal airway.

Background:Nasal packing after the nasal surgery can be extremely hazardous and can lead to airway complications such as dyspnea and respiratory obstruction.Objective:The present study aimed at comparing the traditional nasal packing with nasal airway during the immediate postoperative period in patients undergoing fibreoptic endoscopic sinus surgery (FESS) under general anaesthesia (GA) with regards to airway management.Materials and Methods:The study groups consisted of 90 ASA grade I and II patients aged 16 to 58 years who underwent FESS under GA. Patients were randomly assigned into three groups: Group NP, UA and Group BA of 30 patients each. At the end of surgery, Group NP patients were managed with traditional bilateral nasal packing while a presterilized 5 mm ID uncuffed ETT was cut to an appropriate size and inserted into one of the nostrils in UA and bilaterally in BA group patients. During postoperative period following parameters and variables were observed over the next 24 hours: Any respiratory distress or obstruction, pain and discomfort, oxygen saturation, heart rate, blood pressure, bleeding episode, ease of suctioning through nasal airway, anaesthesiologists and surgeons satisfaction during postoperative period, discomfort during removal of nasal airway and any fresh bleeding episode during removal of nasal airway. The data was compiled and analyzed using Chi-square test and ANOVA with post-hoc significance. Value of P < 0.05 was considered significant and P < 0.0001 as highly significant.Results:The post-op mean cardio-respiratory parameters showed significant variations among NP group (P < 0.05) and the patient of UA and BA groups while intergroup comparison between UA and BA was non-significant (P > 0.05). Pain and discomfort, bleeding episode, ease of suctioning through nasal airway, pain and bleeding during removal of nasal airway (P < 0.0001) as well as surgeons and anaesthesiologists satisfaction criteria showed significant results among the NP group as compared to UA and BA groups (P < 0.05).Conclusion:The present intervention to maintain airway patency can be termed as excellent with additional benefits like ease of suctioning; oxygen supplementation and a possible haemostatic effect due to pressure on the operated site. The low cost of the modified nasal airway and easily replicable design were the standout observations of the present study.

Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery

The aim of the study was to assess the effect of three different types of anaesthesia on perioperative bleeding control and to analyse the mean arterial blood pressure and heart rate in patients undergoing endoscopic paranasal sinus surgery. Ninety patients (30 women and 60 men, aged 18–85 years) scheduled to undergo functional endoscopic sinus surgery in the years 2008–2010 were identified as candidates for inclusion in the study. Patients were randomly assigned to one of three groups (30 patients each) according to the type of general anaesthesia to be administered. Groups I and II both received inhalation anaesthesia (sevoflurane for sedation) and intravenous anaesthesia (fentanyl in group I, remifentanil in group II). Anaesthesia was delivered solely via intravenous route (TIVA) in group III, with propofol used for sedation and remifentanil for analgesia. Blood pressure and heart rate were monitored during surgery and post-surgically for 4 h. Mean anaesthesia duration in groups I, II and III was 108.7 ± 20.8, 112.6 ± 22.2 and 103.7 ± 17.5 min and the surgery duration was 71.3 ± 16.7, 78.8 ± 24.2 and 66.5 ± 15.5 min, respectively. Mean blood loss during surgery was 365.0 ± 176.2, 340.0 ± 150.5 and 225.0 ± 91.7 ml, with a mean blood loss rate of 5.1 ± 2.4, 4.5 ± 2.2 and 3.4 ± 1.1 ml/min in groups I, II and III, respectively. Technologically advanced control of the drug dose with the TIVA technique allows for better control of perioperative bleeding.

Application of Piezoelectric Device in Endoscopic Sinus Surgery

New applications of piezoelectric device have been already documented from otologic and ophthalmic endoscopic studies. The authors describe a first experience in endoscopic sinus surgery with piezosurgery to approach the paranasal sinus. Patients involved in this study presented for rhinogenous headache, rhinorrhea, nasal obstruction, and sinusitis. Radiological studies such as computed tomography of paranasal sinus and a correct clinical examination with a rigid endoscope 0 degrees were carried out, to exclude from the procedure patients with polyposis or other soft-tissue diseases. In fact, because of piezosurgery properties of micrometric and selected cutting on mineralized tissues, it has been used only to treat bone or cartilage anomalies of nasal sinus. The main advantages of the technique include soft-tissue protection and optimal visibility in the surgical field with decreased blood loss. From this preliminary report, the stability of mucous membrane previously cut has been documented by endoscopic follow-up, and the resolution of the main symptom of headache was referred. The main indications for piezosurgery shown in literature are in oral surgery, such as sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, and periodontal surgery. Other applications have been shown in otology, neurosurgery, ophthalmology, and orthopedics. Authors describe as a promising technique the piezoelectric device use in functional endoscopic paranasal sinus surgery in selected cases, with a minimal mucosal approach and thus the preservation of ventilation.

Analiza oceny histopatologicznej zmian patologicznych usuniętych w endoskopowych operacjach nosa i zatok przynosowych w materiale własnym

The work aimed at evaluating results of histopathological examination of postoperative material in endoscopic paranasal sinus surgery in the own material. The analysis covered 3,896 results of histopathological examination of routine postoperative material from the Department of Clinical Pathomorphology and Cytopathology Military Medical Academy University Clinical Hospital in Lodz. The study was conducted in hematoxylin and eosin staining according to the principles of this method. The postoperative material included pathological lesions removed by endoscopic surgery of the nose and paranasal sinuses in patients who were treated at Department of Otolaryngology and Laryngological Oncology between 2006 and 2010. The treatment included 1,118 patients, 509 women at the age of 15–79 and 609 men aged 17–77. The material for histopathological examination was sent from merely 1,176 operations because 57 patients were operated twice and one patient was operated three times. Polyps within the nose and paranasal sinuses were confirmed by histopathological examination in 705 patients, including 289 women and 416 men. Hypertrophic changes were diagnosed in 404 patients, including 218 women and 186 men. Inverted papilloma was recognised in histopathological examination in 9 patients, including 2 women and 7 men. Hypertrophies were slightly more common in women than in men. Both in men and women unilateral hypertrophic changes within the ostiomeatal complex were predominant, 42.66% in women and 40.86% in men. Histopathological examination of postoperative material in patients under endoscopic treatment due to paranasal sinusitis is considerably important for complex evaluation of inflammation type and confirmation of indications for appropriate anti-inflammatory therapy.

Feasibility of routine paranasal sinus CT-scans in preoperative transplant patients

Paranasal Sinus (PNS) CT- scans are routinely performed for screening of sinusitis in patients scheduled for organ transplant at the University Hospital Graz. This study was performed to evaluate whether routine PNS CT-scans are necessary in every transplant patient or in selected cases only, because clear evidence is missing in literature. 142 patients (113 male, 29 female) were included in this retrospective patient chart study. The majority of patients (n=142) were scheduled for liver transplant (n=79). Of all patients (n=142), 50 (35.2%) had normal PNS CT-scans and 92 (64.8%) had a pathologically changed PNS-scan. Seventy-one out of these 92 (77.2%) patients did not show clinical symptoms of sinusitis nor changes in diagnostic endoscopy, 21 (22.8%) patients did have symptoms of sinusitis and diseased PNS CT-scans. Three out of 71 (4.2%) without symptoms but pathologic CT-scans compared to 7/21 (33.3%) patients with symptoms and pathological CT-scans underwent endoscopic paranasal sinus surgery (FESS). All patients operated suffered from chronic sinusitis, none had mycotic or neoplastic disease in definite histology. Since there was a high rate (77.2%) of pathological CT scans unrelated to sinusitis symptoms these findings should be considered as accidental. In our opinion routine paranasal sinus CT scans are not feasible in patients scheduled for organ transplant according to high rate of false positive results.

Analysis of syndecan-1 and TGF-β expression in the nasal mucosa and nasal polyps

Objective Increased understanding of cytokines and their associated proteoglycans will contribute to the investigation of the formation of nasal polyps. Recently, some studies have suggested that syndecan-1 ectodomains are shed in response to low respiratory infection, but no studies regarding nasal and paranasal diseases have been reported. Transforming growth factor-beta (TGF-β) is involved in the regulation of nasal polyps, especially in processes crucial to the initiation, maintenance, and resolution of inflammatory responses. In the nasal mucosa and nasal polyps, we analyzed the expression of syndecan-1, which readily promotes infection, and TGF-β, which plays a role in syndecan-1 activity. Methods Fifteen patients who underwent turbinectomy for the treatment of nasal obstruction and seventeen patients with nasal polyps who underwent nasal endoscopic sinus surgery were included in this study. The localization of syndecan-1 and TGF-β in the nasal mucosa and nasal polyps was investigated by immunohistochemistry, and mRNA transcript levels of syndecan-1 and TGF-β were examined using quantitative real-time PCR. Results Immunohistochemical staining revealed that the expression of syndecan-1 in the nasal mucosa and nasal polyps was co-localized with TGF-β. The mean mRNA expression values for syndecan-1 and TGF-β were higher in nasal polyps compared to the nasal mucosa. Conclusions This is the first report showing expression of syndecan-1 in the nasal mucosa and nasal polyps. In nasal polyps, syndecan-1 expression may be increased by an unknown mechanism, permitting infection and inducing larger nasal polyps. We hypothesize that the accumulation of TGF-β, which is involved in the pathophysiological development of nasal polyps, may result in a change in the binding properties of syndecan-1 at inflammatory sites.