Indications For Endoscopic Sinus Surgery Research Articles

Role of transnasal endoscopic surgery for the management of orbital diseases

Abstract BACKGROUND. Indications for endoscopic sinus surgery have been widely expanding since its introduction, to such an extent that it is now accepted as the ideal method for the treatment of some orbital conditions. Endoscopic approach to orbits provides excellent visualization with minimal cosmetic and functional morbidity. MATERIAL AND METHODS. This descriptive study has been conducted in the Department of Otolaryngology - Head and Neck Surgery, KMC, Manipal, during July 2010 and July 2014. We evaluated the role of endoscopic sinus surgery (ESS) as a surgical mode of treatment in different types of orbital diseases. RESULTS. 24 patients underwent ESS approach for various ophthalmologic conditions. CONCLUSION. Results from our studies showed that the endoscopic sinus surgery approach is effective and has better results than an open approach in the management of certain types of orbital pathology.

Endoscopic sinus surgery for foreign body extraction in an adult patient.

Foreign bodies are an unusual indication for endoscopic sinus surgery. If outpatient extraction is not possible and acute sinusitis ensues, thorough exploration and extended surgical dissection should be considered to clear the nasal cavities.

A Covered Lateral and Posterior Wall Flap of the Maxillary Sinus Prevents Reocclusion of the Postoperative Maxillary Cyst.

The online version contains supplementary material available at 10.1007/s12070-021-02658-x.

Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study.

Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS. The RAND/UCLA appropriateness methodology was performed. An international, multi-disciplinary panel of 10 experts in CRS was formed and completed two rounds of a modified Delphi ranking process along with a face-to-face meeting. A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score ≥ 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score ≥ 20. This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment option during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment option and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high quality, patient-centered care to patients with CRS.

Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study.

Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS. The RAND/UCLA appropriateness methodology was performed. An international, multi-disciplinary panel of 10 experts in CRS was formed and completed two rounds of a modified Delphi ranking process along with a face-to-face meeting. A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score ≥ 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score ≥ 20. This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment option during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment option and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high quality, patient-centered care to patients with CRS.

Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study.

Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS. The RAND/UCLA appropriateness methodology was performed. An international, multidisciplinary panel of 10 experts in CRS was formed and completed 2 rounds of a modified Delphi ranking process along with a face-to-face meeting. A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score ≥ 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score ≥ 20. This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment "option" during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment "option" and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high-quality, patient-centered care to patients with CRS.

Outcome of Endoscopic Sinus Surgery in Children With Allergic Rhinitis

Ramadan HH, Hinerman RA. Am J Rhinol. 2006;20:438–440 PURPOSE OF THE STUDY. To compare results of endoscopic sinus surgery for treatment of chronic rhinosinusitis in children with and without documented allergy. STUDY POPULATION. One hundred forty-one children (aged 3–13 years) with chronic rhinosinusitis who were followed for at least 12 months after endoscopic sinus surgery and had symptoms assessed by caregiver questionnaire were included in this study. All children were evaluated for allergy, immunoglobulin deficiency, and cystic fibrosis before surgery. A total of 77 children had documented allergy, and 64 had negative allergy evaluations. The allergic and nonallergic children were similar with regard to gender distribution, tobacco exposure, and disease severity, but asthma was more than twice as prevalent in the allergic group (56% vs 23%). Children with cystic fibrosis, immunodeficiency, fungal infection, or previous sinus surgery were excluded from the study. Surgery usually consisted of middle meatal antrostomy and anterior ethmoidectomy. METHODS. Symptoms were evaluated by the caregiver using a nonvalidated questionnaire before surgery and every 3 months for at least 12 months after surgery. The results of the questionnaire 12 months after surgery were used to create 2 groups: (1) cured or improved subjects were categorized as successful, and (2) subjects with unchanged or worsened symptoms and those who required additional surgery were categorized as treatment failures. Medical treatment for sinusitis included long-term antibiotics, intranasal steroids, decongestants, antireflux treatment, systemic steroids, and allergy management. Allergy management consisted of antihistamines and intranasal steroids in all allergic children and immunotherapy in 25%. One third of allergic patients underwent endoscopic sinus surgery before initiation of allergy treatment. RESULTS. The overall success rate for endoscopic sinus surgery was 80%. The allergic group had a 77% success rate after sinus surgery, whereas the nonallergic group had an 84% success rate, a difference that was not statistically significant. Multivariate analysis was performed, and the presence of allergy did not predict a poorer outcome. Allergic children who underwent sinus surgery without preoperative allergy treatment had a 62% success rate, compared with a success rate of 84% for children who were treated for allergy before surgery. CONCLUSIONS. The presence of allergy does not predict poorer outcomes after sinus surgery in children. Preoperative treatment of such allergy improves surgical results. REVIEWER COMMENTS. This article demonstrated that endoscopic sinus surgery can effectively treat refractory sinusitis in children even when allergy is documented. The standard practice of allergy evaluation and treatment before sinus surgery in children was also supported, although the details of such evaluation were not addressed in this article. Because this was a cohort study, not a randomized, controlled trial, we cannot assess the effects of allergy management alone on children with chronic sinusitis. It is curious that the group of children who had allergy treatment before surgery had better surgical results at a 12-month follow-up than the others with allergy, because we would suspect that all children diagnosed with allergy would be treated for allergy at some point before or after surgery. The indications for endoscopic sinus surgery in children, and the extent of such surgery, remain debated. This article adds to evidence that such surgery is effective for refractory sinusitis, even in allergic children.

Drainage of retro-parapharyngeal abscess: an additional indication for endoscopic sinus surgery

Deep neck abscesses are life-threatening conditions, in early stages preferably treated by intravenous antibiotic therapy; in advanced stages, surgical drainage is mandatory. We report two cases of retro-parapharyngeal abscess with prevalent retronasopharyngeal extension in two men aged 60 and 82, both of whom underwent transnasal endoscopic drainage. The main surgical steps were incision of the posterior pharyngeal mucosal wall, widening of the incision, drainage of purulent collection and careful dissection and removal of the necrotic tissue. The first patient, with an abscess associated with chronic otitis media and presenting hypoglossal nerve palsy, quickly recovered from pharyngodinia, otalgia and trismus. Twenty-six months after surgery, he is symptom-free, with hemitongue atrophy due to denervation as the only residual sign. The second patient, affected by skull base osteomyelitis secondary to malignant external otitis, after a first successful drainage, underwent a second endoscopic procedure for the reoccurrence of an abscess in the contralateral retroparapharyngeal space. Twelve months after the first surgery, the patient reported an improvement of symptoms, except for persistent dysphonia related to vagal nerve palsy. At follow-up MR, another abscess was detected in the left retro-parapharyngeal space. In selected cases of abscess, transnasal endoscopic drainage may be an effective alternative to external approaches. Minimal morbidity, the absence of cervical or palatal scars and a short hospitalization time can be considered as important advantages in comparison to external approaches. Patients with abscess secondary to skull base osteomyelitis require close imaging surveillance because of the difficulty of definitive control of the disease.

Pediatric endoscopic sinus surgery—does it have a future?

In September 1996, an international consensus meeting [2,3], with a panel consisting of pediatric ENT specialists, a pediatrician and a microbiologist, provided definitions for different forms of pediatric sinusitis, with a numeration of the main symptoms and signs; indications for microbiological, allergic and immunological assessment, as well as for imaging studies; suggested standard medical management and finally, discussed the indications for surgery. The following indications for endoscopic sinus surgery were maintained:

Functional Endoscopic Sinus Surgery: University of Ottawa Experience and an Overview

The treatment of chronic rhinosinusitis resistant to medical therapy has been historically managed by a variety of external and internal surgical procedures. The pathophysiology of chronic sinus disease has been elucidated through the work of Professor Messerklinger. He observed that chronic sinusitis is usually due to stenosis of the anterior ethmoid region. 1,2 Infection can spread from the anterior ethmoid and the middle meatal regions, to secondarily affect the maxillary and the frontal sinuses. 2 He noted that the mucosal changes that occur secondary to obstruction of the ostiomeatal unit (OMU), resolve when normal ventilation and mucociliary clearance is restored.1,3-6 This knowledge has led to the acceptance of endoscopic sinus surgery as a valuable modality in the surgical management of sinus disorders. The important components of the OMU include the middle turbinate and meatus, maxillary ostium, infundibulum, uncinate process, ethmoid bullae, and hiatus semilunaris. 7 Functional endoscopic sinus surgery (FESS) was introduced in the 1960s by Professors Messerklinger and Wigand. It was popularized in Europe by Stammberger and subsequently in North America by Kennedy. 1,2,6,8 The use of this approach has become more popular with improvement in the understanding of the anatomy of the lateral nasal wall and surgical training. The indications for endoscopic sinus surgery have expanded to include not only the management of sinus infection resistant to medical therapy , but also the treatment of nasal polyposis, nasolacrimal duct obstruction, thyroid orbitopathy, CSF leaks, drainage of orbital abscess and hematoma, decompression of the optic nerve and globe, and surgical management of circumscribed benign and well -localized malignant neoplasms.1,8-12 It also remains an excellent modality for nasal examination. The objective of this study is to review our

Essentials of Functional Endoscopic Sinus Surgery

<i>Essentials of Functional Endoscopic Sinus Surgery</i>is a concise, readable volume that deals with the surgical treatment of sinus disease. Chapter 1 is an excellent review of sinus physiology and pathophysiology. It provides the theoretical basis for functional endoscopic sinus surgery originating with the work of Messerklinger. This is followed by a clear discussion of the surgical anatomy of the paranasal sinuses. This description of complex anatomy is well illustrated. A brief review of the roentgenographic anatomy of the area, via computed tomographic scanning, is also included. Chapter 4 gives a thorough description of the techniques and findings of diagnostic nasal endoscopy. Numerous photographs document normal anatomy as well as pathologic variations. The next chapter describes the procedure of maxillary sinus endoscopy through the canine fossa. Indications for this procedure and the technique are well described. The expected findings and potential complications are outlined. The indications for endoscopic sinus surgery

Indications for Endoscopic Sinus Surgery

Thus, if the patient has an appropriate history, appropriate physical findings, and appropriate CT, endoscopic sinus surgery typically will be indicated and beneficial. One should be especially wary of the patient who does not fit these criteria. Particularly worrisome is the patient whose symptoms fail to respond to antibiotics. A careful examination should be done for a non-infectious cause of the symptoms in this case. Another group of patients who should be cause for concern are those whose pain is out of proportion to the disease found. This is doubly true if their pain does not respond to antibiotics. These patients will usually not be helped by operative intervention. With careful adherence to the above criteria, the appropriate surgery will usually result in a very satisfied patient.

Extended Indications for Endoscopic Sinus Surgery

Extended Indications for Endoscopic Sinus Surgery