Functional Endoscopic Sinus Surgery Research Articles (Page 1)

Background & objective: Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical technique used in some nasal conditions, refractory to medical treatment, for example chronic rhinosinusitis. The pain after the procedure is usually addressed with non-steroidal anti-inflammatory drugs (NDAIDs) or opioids, which are not without side effects. We conducted this study to assess the effect of bilateral sphenopalatine ganglion block with 0.5% bupivacaine injection at the end of the surgery in controlling postoperative pain. Methodology: We performed a double blinded randomized clinical trial on 70 patients undergoing FESS under general anesthesia. Sample size was calculated using PASS software version 15. Based on the findings of a previous study, using a two-sided two- sample equal-variance t-test with the population effect size at 0.7, the significance level (alpha) at 0.05 and the power (1- β) at 0.8, a sample size of at least 70 patients (35 per group) was produced. The patients were randomly assigned to one of the two groups; a control group, where normal saline was injected in the greater palatine foramen transorally, and the study group (SPG block group), where 0.5% bupivacaine was injected. Pain was then assessed postoperatively by the visual analogue scale (VAS); and the time to first need of inj. fentanyl as rescue analgesia and the total amount used were recorded. Results: Maximum intensity of the pain was at 2 hours post-operatively in the control group and 6 hours in the SPG block group, and pain intensity was lower in the SPG block group at 2, 6 and 12 hours post- operatively. In the SPG block group, less patients required rescue analgesia, time needed for the first dose of rescue analgesia was more, and the total 24-hour fentanyl consumption was lower. Conclusions: Sphenopalatine ganglion block using 0.5% bupivacaine results in better postoperative pain management, and a reduced need for analgesics in patients undergoing functional endoscopic sinus surgery. Keywords: Bupivacaine; Endoscopic Sinus Surgery; Fentanyl; Sphenopalatine Ganglion Block Citation: Albadry YAB, Saleh SHET, El-said AM, Naseef JN. The effect of sphenopalatine ganglion block with 0.5% bupivacaine on postoperative pain after functional endoscopic sinus surgery (FESS) under general anesthesia. Anaesth. pain intensive care 2025;29(4):356-62. DOI: 10.35975/apic.v29i4.2820 Received: April 02, 2025; Revised: June 06/ June 12, 2025; Accepted: June 12, 2025

Allergic fungal rhinosinusitis (AFRS) is a highly recurrent form of chronic allergic rhinosinusitis in immunocompetent patients. This study aims to compare the recurrence rates of AFRS between patients who received nasal steroid spray alone and patients who received a combination of nasal and oral steroids after endoscopic sinus surgery. This was a retrospective chart review of patients who underwent endoscopic sinus surgery for AFRS. The selection of the 39 participants has followed the 5 aspects of Bent and Kuhn criteria. Patients were divided into 2 groups: those discharged on both nasal and oral steroids (combination group) and those discharged on nasal steroids alone (local therapy group). All patients were followed for 3 years post operatively, and multiple assessments done for disease recurrence. One patient from 13 patients in the combination therapy group (7.7 %) and 9 patients from the 26 patients in the local therapy group (34.6 %) had recurrence of the condition and underwent functional endoscopic sinus surgery revision surgery (Fisher Exact Test = 3.30, P = .069). AFRS has recurred more frequently among patients who had bilateral disease (33.3%) compared to those who had unilateral disease (0%) (Fisher Exact Test = 4.03, P value = .045). In the postoperative medical management in ARFS, the combination of a short course of oral prednisolone and nasal steroid spray maybe effective to lower the recurrence rate of the disease when compared to nasal steroid spray alone.

Chronic maxillary atelectasis (CMA) describes the loss of maxillary sinus volume and has been well-described in the literature under many different names, creating inconsistency in reporting. A recent proposal has standardized the nomenclature but does not include disease of other paranasal sinuses. We describe a unique case of chronic ethmoid atelectasis, briefly review literature associated with CMA, and propose an expanded classification of chronic sinus atelectasis. A 70-year-old man presented to the emergency department with transient vision loss and was incidentally found to have sinus opacification on MRI. At his otolaryngology follow-up, he did not have any signs of sinonasal symptoms, hypoglobus, or enophthalmos. CT confirmed sinus opacification which was correlated with lateralized left middle turbinate and uncinate process. The patient underwent functional endoscopic sinus surgery to correct the anatomical changes. The spectrum of atelectasis affecting the ethmoids mirrors what has been described for CMA, potentially indicating a similar disease process affecting different areas. If this falls along the same spectrum of disease, the grading system applied to CMA may be applied to other paranasal sinuses.

Comparison of three different loading doses of dexmedetomidine for controlled hypotension during functional endoscopic sinus surgery under general anaesthesia- A randomised controlled study

This case report describes a male patient with chronic invasive fungal sinusitis, mainly characterised by swelling of the eye. After a definitive diagnosis was made based on clinical symptoms and imaging studies, the patient received timely antimicrobial and symptomatic treatment, followed by functional endoscopic sinus surgery and orbital abscess drainage. The foci of infection in the sinuses were completely removed and adequate drainage of the sinuses was achieved, resulting in significant relief of the patient's symptoms. The follow-up examination 1 month after discharge showed a good recovery.

Pott’s Puffy Tumor (PPT) is a rare but potentially life-threatening complication of frontal sinusitis, characterized by subperiosteal abscess formation and frontal bone osteomyelitis. Although predominantly seen in adolescents, adult cases are increasingly recognized. Early diagnosis is essential to prevent severe orbital and intracranial sequelae. We present two patients with distinct clinical features: a 31-year-old female with chronic frontal sinusitis complicated by sequestrated bone extrusion through a cutaneous fistula, and a 16-year-old male with an acute presentation of subperiosteal abscess, nasal polyp-related obstruction of the osteomeatal complex (OMC), and orbital cellulitis. Both patients underwent combined surgical and medical management, including broad-spectrum intravenous antibiotics, functional endoscopic sinus surgery, and external drainage. In the adult, necrotic bone was excised, and the anterior frontal wall was reconstructed with titanium mesh to restore sinus anatomy and drainage, while in the adolescent, early abscess drainage and polyp removal ensured frontal recess patency and prevented osteomyelitis. Postoperative follow-up demonstrated complete resolution without recurrence. These cases highlight that PPT can occur in both acute and chronic settings of chronic rhinosinusitis with nasal polyps, emphasizing the importance of prompt imaging, multidisciplinary evaluation, and individualized surgical strategies to optimize outcomes and minimize life-threatening complications.

ABSTRACTBackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) significantly impairs the quality of life, and disease control is now considered the primary treatment goal. Although patient‐reported outcome measures (PROMs) such as the 22‐item Sinonasal Outcome Test (SNOT‐22) and CRS‐PRO are widely used, their utility in predicting long‐term postoperative disease control remains limited.MethodsThis prospective follow‐up study aimed to evaluate postoperative recovery and identify the predictors of suboptimal disease control in patients with CRSwNP by integrating preoperative PROMs with objective clinical features. A total of 102 patients with CRSwNP undergoing functional endoscopic sinus surgery (FESS) were enrolled, of whom 89 completed at least 12 months of follow‐up. Preoperative and postoperative PROMs were compared across disease control groups classified based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 criteria. Least absolute shrinkage and selection operator regression was applied to select objective clinical predictors, which were then combined with either CRS‐PRO or SNOT‐22 item scores to develop and compare the nine machine learning models. Model performance was assessed using area under the curve (AUC), decision curve analysis, sensitivity, specificity, and other metrics.ResultsEosinophil and neutrophil counts were identified as key objective predictors of suboptimal disease control after FESS. Among all models, logistic regression incorporating CRS‐PRO scores and selected clinical features achieved the best performance, yielding an AUC of 0.866, accuracy of 83.3%, sensitivity of 72.7%, specificity of 89.5%, and F1‐score of 76.2%. This model demonstrated a strong discriminatory ability and potential utility in individualized clinical decision‐making.ConclusionIntegrating preoperative CRS‐PRO item scores with selected objective clinical parameters enables the accurate prediction of suboptimal disease control in patients with CRSwNP following FESS. This approach supports personalized risk stratification and postoperative management strategies.

Microbiology of acute complicated sinus infections in children following the COVID-19 pandemic.

Examination of opioid prescribing guidelines on sinus surgery opioid prescription trends.

Background: Computed tomography (CT)-based image-guided surgery (IGS) is of great importance in functional endoscopic sinus surgery (FESS) and requires IGS-specific imaging protocols to ensure high intraoperative accuracy. This study aimed to compare photon-counting CT (PCCT), dual-energy dual-source CT (DECT), and spectral detector CT (SDCT) of the paranasal sinuses with respect to image quality, IGS accuracy and radiation dose. Methods: A formalin-fixed cadaver skull was examined using PCCT, DECT and SDCT at 100 kV tube voltage with descending tube currents (mAs). The setup of electromagnetic IGS was evaluated using a visual analog scale. Accuracy was analyzed endoscopically using defined anatomical landmarks. Diagnostic image quality as well as bone and soft tissue noise were assessed qualitatively using a 5-point Likert scale and quantitatively by determination of signal-to-noise ratio. Radiation dose was evaluated using the dose length product. Results: While PCCT datasets could be registered and navigated accurately down to 10 mAs (1.5 mm error at 10 mAs), both DECT and SDCT exhibited significantly increased inaccuracies below 40 mAs (4.35/5.15 mm for DECT/SDCT at 25 mAs). Using PCCT therefore enabled a 45% radiation dose reduction at the minimally required dose length product using PCCT. Quantitative and qualitative image quality were superior for PCCT compared to DECT and SDCT. Conclusions: PCCT provides excellent accuracy of anatomical landmarks in IGS with superior image quality of the paranasal sinuses in low-mA scans and substantially reduced radiation exposure.

Low-value care occurs when the harms or costs of care exceed the benefits. Such care includes when medical device-based procedures are favored over medical management, such as invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) for stable coronary artery disease; endovascular intervention for lower extremity peripheral arterial disease with intermittent claudication; and nasal endoscopy with balloon ostial dilation and functional endoscopic sinus surgeries (collectively, sinus procedures) for chronic rhinosinusitis. To evaluate the association of enacting evidence-based clinical coverage policies for these low-value procedures with their use in Louisiana's Medicaid program. Louisiana Medicaid partnered with academic investigators to develop and enact evidence-based policies between December 2021 and February 2022. This study used an interrupted time series approach to evaluate use of the 4 identified procedures 12 months before and 18 months after policy enactment. For each procedure, best-fit curves were constructed of prepolicy utilization trends, which were used to generate expected postpolicy trends. These expected trends were then compared to observed postpolicy utilization. Three-way analysis (time × intervention period [pre or post] × procedure) was used to assess changes in utilization slope for each procedure relative to colonoscopy (which had no policy changes and was expected to show baseline use of procedures in Louisiana Medicaid). Final follow-up was in September 2023. Monthly outpatient procedural utilization per 100 000 Louisiana Medicaid members of ICA, PCI, endovascular intervention, and sinus procedures. There were 1 396 629 Louisiana Medicaid members with data at 1 year before any policy enactment and 1 548 265 at final follow-up. Overall, 14 940 individuals (mean [SD] age, 43.5 [13.7] years; 53.0% female) underwent one of these procedures before policy enactment, and 20 882 (mean [SD] age, 43.3 [13.7] years; 52.6% female) after enactment. Differences in monthly outpatient procedure rates in the postenactment compared with the preenactment period per 100 000 members were as follows: ICA, 0.65 (95% CI, 0.06 to 1.23); PCI, 0.15 (95% CI, -0.01 to 0.31); endovascular intervention, -0.01 (95% CI, -0.12 to 0.10); and sinus procedures, -0.23 (95% CI, -1.61 to 1.15). There was no significant change in the 3-way time × intervention period × procedure vs colonoscopy interaction for any procedure. In this quality improvement study, enactment of evidence-based clinical coverage policies for 4 common medical device-based procedures was not associated with a reduction in their use in Louisiana Medicaid. These findings suggest a need for more comprehensive strategies to improve evidence-based care for Medicaid through multipronged efforts that include education, policymaking, and value-based coverage implementation.

Background. The most common method for treating chronic polypous rhinosinusitis is functional endoscopic sinus surgery followed by the use of intranasal corticosteroids in the postoperative period. Considering the recurrent nature of the disease, with only about 50% effectiveness of medical therapy, and the increased risk of complications with multiple surgical interventions, there is a need to explore new treatment methods for chronic polypous rhinosinusitis. An important aspect is restoring the epithelial barrier of the nasal mucosa and reducing inflammatory processes within it to alleviate symptoms. Mesenchymal stem cells, which possess a wide range of immunomodulatory properties, may become a promising new therapeutic option for this condition. Results. The tolerability of immunotherapy with a biomedical cell product based on mesenchymal stem cells from the olfactory epithelium was good in all patients (n = 27). However, local reactions, such as nasal mucosa edema at the injection site and color change of the nasal mucosa to bluish-pink, without clinical manifestations at the site of suspension administration were observed in 5 patients (36%) in Group 1 and in 2 patients (15%) in Group 2. No systemic reactions (such as fever, changes in heart rate, blood pressure, or immediate allergic responses) were detected. In all patients of both the main and control groups, general, biochemical, and immunological blood parameters remained within normal ranges at all stages; no statistically significant differences or clinically relevant deviations were found. These data suggest that additional cell therapy alongside standard treatment for chronic polypous rhinosinusitis does not exert systemic effects on the body based on complete blood count data (p > 0.05). Conclusion. Cell therapy with a biomedical cell product based on mesenchymal stem cells from the olfactory epithelium is safe and well tolerated in patients with chronic polypous rhinosinusitis. The local application of mesenchymal stem cells from the olfactory epithelium does not produce systemic effects according to blood tests, biochemical analysis, or immunological studies. Local reactions at the injection site-such as mucosal color change or edema – may occur but without clinical significance.

BackgroundMany scientists are studying chronic rhinosinusitis (CRS) due to its high relapse incidence and drug resistance. We investigated the antibiofilm activity and sustained co-release of nitric oxide, silver nanoparticles, vancomycin, and ciprofloxacin in thermosensitive hydrogel (HyNSVC) for bacterial CRS.MethodsTo identify and isolate Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), samples were taken from 10 patients with CRS who underwent Functional Endoscopic Sinus Surgery (FESS), and then they were diagnosed using culture and molecular methods. The HyNSVC was synthesized, and its physicochemical characteristics were evaluated using different methods. The broth microdilution assay and the MTP (microtiter plate) method assessed the minimum inhibitory concentration (MIC) and antibiofilm effects. The inhibitory impact of HyNSVC on the expression of biofilm-associated genes was evaluated using real-time PCR. The cytotoxic effect of HyNSVC on the human epithelial cell line A549 was assessed.ResultsThe results of the SEM showed that the hydrogels have a porous structure and that the pores are interconnected. The molecular weights and polydispersity index (PDI) of the copolymer determined using gel permeation chromatography (GPC) were 5759 Daltons, 6270 Daltons, and 1.089, respectively. The anticipated molecular weight determined by H-NMR spectroscopy was around 5947 Daltons. Also, the porosity of the hydrogels was in the range of 80–90%. The HyNSVC MIC was 250 µg/ml for both bacteria. The 2 × MIC of HyNSVC reduced mature biofilm by 62% in P. aeruginosa and 68.1% in MRSA. The presence of HyNSVC did not significantly reduce gene expression. Finally, the MTT experiment showed no toxicity against A549 cells at the MIC concentration.ConclusionOur findings illustrated the efficacy of employing HyNSVC for drug release regulation and antibiofilm activity for bacterial infection, suggesting a promising treatment for CRS.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40001-025-03282-z.

Objective: To evaluate the effectiveness of FESS in ameliorating preoperative nasal symptoms attributable to CRS when compared with the postoperative period, particularly within a 30-day timeframe.Methodology: A prospective observational study was conducted at the Department of Otorhinolaryngology, Dow University of Health Sciences/Civil Hospital Karachi, from January 1st, 2022, to June 30th, 2022. A cohort of 149 eligible patients participated in the study, completing the SNOT-22 questionnaire 48 hours preoperatively and 30 days postoperatively. Efficacy was assessed through improvements in postoperative nasal symptoms, quantified using SNOT-22 scores.Results: Of the 149 patients enrolled, 121 were male and 28 were female. Significant associations were observed between preoperative and postoperative SNOT-22 scores (p-value 0.036), with notable correlations found regarding unemployment, positive family history of allergy, and patients aged 15-35 years, all demonstrating significant reduction in nasal symptoms postoperatively.Conclusion: FESS emerged as highly efficacious in managing CRSwNP symptoms, with notable enhancements in postoperative nasal symptoms and overall quality of life. Furthermore, positive outcomes were particularly pronounced among patients with a family history of nasal allergy, individuals within the younger age group, and those unemployed.Key words: Chronic rhinosinusitis, Functional endoscopic sinus surgery, Nasal polyps, Nasal symptoms, Rhinosinusitis.

Dexmedetomidine versus Esmolol Efficacy for Bloodless Field and Outcome during Functional Endoscopic Sinus Surgery: A Prospective Randomized Trial

Background Fungal ball has been known as a noninvasive subtype of chronic rhinosinusitis (CRS). Recently, other endotypes of sinonasal bioballs, which we reported as bacterial balls and mixed balls. Objectives This study aimed to investigate the pseudoball as a distinct endotype of sinonassal bioballs. Methods This study included 41 CRS patients with suspected fungal balls who underwent functional endoscopic sinus surgery (FESS) from January 2020 to November 2022. All fungus-like biomaterials were stained with Hematoxylin-Eosin, Gomori-Methenamine-Silver (GMS), and Gram stains. Diagnosis of pseudoballs was made when both GMS and Gram staining were negative. Clinical and computed tomography (CT) findings were compared between fungal balls and pseudoballs. Results Four endotypes of sinonasal bioballs were identified: fungal balls (56.1%), mixed balls (26.8%), pseudoballs (12.2%), and bacterial balls (4.9%). During FESS, the pseudoballs had heterogeneous gross features with a gel-like or semi-solid consistency and yellow-to-gray colors. Histopathology of the pseudoballs showed a matrix with thick acellular mucous material without any fungi or bacteria. When compared with fungal balls, all pseudoballs cases were immunocompetent (100%) and prone to involvement of the posterior ethmoid sinus (60%, p = 0.01) in CT scans. Conclusions The pseudoballs were dual-negative in GMS and Gram staining and showed distinct clinical and radiological characteristics as a different endotype.

Background: The variations of the olfactory fossa/ethmoid roof are common. These variations are important to be acknowledged when dealing with endoscopic sinonasal and skull base surgeries due to possibilities of injuries to the vital structures. The depth of the olfactory fossa is classified as Keros type I, II, or III (Depth 1-3mm, 4-7mm, and 8-16mm, respectively). Keros type III is consider the most venerable type to iatrogenic injury followed by type II. The variations can be similar or dissimilar among countries, geographies, and ethnicities. Functional endoscopic sinus surgery (FESS) is currently the preferred surgical option worldwide when dealing with nasal or sinonasal diseases. Awareness of the anatomical landmarks, Variations in the depth of the olfactory fossa, assist the surgeon in avoiding CSF leaking, brain herniation, and hemorrhage. For a few decades, it was introduced in Africa (Egypt, Nigeria, South Africa, Kenya, etc.). FESS was introduced at the Muhimbili National Hospital, Tanzania in 2010 and is currently becoming widely practiced in the country. Only a single study done in Kenya on anatomical variations of the ethmoid roof was found in east Africa. No data was found in Tanzania and due to the scarcity of data in Africa especially in east Africa, this study was necessary.

Obesity is an established risk factor for asthma, which shares common inflammatory pathways with chronic rhinosinusitis (CRS). However, the link between obesity and CRS remains poorly understood. By identifying trends in the structured histopathology (SHP) of obese patients with CRS, we aim to better understand how changes in the tissue architecture of obese patients may contribute to CRS. Retrospective chart review was conducted on 476 patients with CRS with and without nasal polyps who underwent functional endoscopic sinus surgery. Data were collected on SHP, demographics, and comorbidities. Chi-squared, logistic analyses, and multivariate analysis were performed. The patient cohort was 53.8% female. Mean age was 52.01 years and mean BMI was 29.74. A total of 290 (60.9%) patients were nonobese (BMI < 30), 100 (21.0%) were Class I obese (BMI 30-34.9), 40 (8.4%) were Class II obese (BMI 35-39.9), and 46 (9.7%) were Class III obese (BMI ≥ 40). It was found that class III obesity was associated with statistically significant increases in several histopathological markers, including hyperplastic/papillary changes (17.4% vs. 5.6%, p < 0.026), Charcot-Leyden crystals (17.4% vs. 6.6%, p < 0.037), and squamous metaplasia (26.1% vs. 17.6%, p < 0.028). Multivariate analysis was performed, controlling for asthma, smoking, CRS subtype, and diabetes mellitus status. None of the variables were identified as confounders. Several SHP variables are significantly more prevalent in obese patients who underwent functional endoscopic sinus surgery. This may serve as a predictor of CRS severity and suggests CRS in Class III obese patients follows a non-type 2 inflammatory pathway. ClinicalTrials.gov Identifier: NCT03816891.

Background and Aims: Chronic rhinosinusitis with nasal polyps (CRSwNP) is prone to postoperative recurrence. This study aimed to investigate the association between serum mammalian Ste20-like kinase 1 (MST1) and prognosis in CRSwNP patients after functional endoscopic sinus surgery (FESS). Methods: This prospective observational study included 100 CRSwNP patients undergoing FESS and 100 patients with nasal septal deviation or maxillary sinus cysts as controls. Serum levels of MST1, IFN-γ, and IL-5 were measured using Enzyme-linked immunosorbent assay (ELISA). MST1 mRNA expression in nasal polyps and inferior turbinate samples was quantified by qRT-PCR. Sinus lesions and quality of life were assessed using the Lund–Mackay, Lund–Kennedy, and SNOT-22 scoring systems. The 1-year recurrence-free survival was analyzed using Kaplan–Meier (K-M) curve, and the diagnostic value of MST1 for CRSwNP was evaluated by Receiver operating characteristic (ROC) curve. Results: Serum MST1 levels and MST1 mRNA expression were significantly elevated in CRSwNP patients. High MST1 expression positively correlated with increased eosinophils percentage and elevated IL-5 levels. Moreover, patients with lower MST1 expression exhibited better clinical outcomes and a lower recurrence rate. Logistic regression analysis identified MST1 and allergic rhinitis as independent predictors of recurrence. Furthermore, MST1 demonstrated a strong predictive value for recurrence in CRSwNP patients. Conclusion: Elevated serum MST1 levels were strongly associated with inflammation, disease severity, and recurrence risk in CRSwNP. These findings suggest that MST1 could serve as a valuable prognostic biomarker for postoperative outcomes in CRSwNP patients.

Chronic rhinosinusitis (CRS), functional respiratory disorders, and nasal aesthetic disorders are very common disorders. The development of endoscopic sinus surgery (FESS) raises the question of the safety and effectiveness of combined surgery. This clinical case series included 50 patients: 30 females, 20 males over 18 years of age, whose main complaints were nasal septum deviation, chronic hypertrophic rhinitis combined with atrophy of the maxillary sinus mucosa, cysts, and very few ethmoidal polyps that did not respond to drug treatment for at least 3 consecutive months.Surgical treatment was combined with functional endoscopic sinus surgery (FESS) and rhinoplasty.The incidence of postoperative complications, patient satisfaction with cosmetic and functional outcomes were analyzed. Simultaneous rhinoseptoplasty and endoscopic sinus surgery are possible without reducing the effectiveness of each of these operations. However, there are no generally accepted guidelines for the procedure, the extent of surgical intervention, and there is no generally accepted standard for assessing surgical risk. The combination of endoscopic sinus surgery and rhinoplasty is an effective and safe method that allows solving both functional and aesthetic problems of the nose during a single procedure. Further large-scale, controlled studies will help to definitively define its advantages and limitations.