Lund-Mackay Computed Tomography Score Research Articles

Postoperative care for Samter's triad patients undergoing endoscopic sinus surgery: A double-blinded, randomized controlled trial

Evidence is lacking to guide the postoperative management of Samter's triad patients with chronic rhinosinusitis with polyposis (CRSwP) undergoing endoscopic sinus surgery (ESS). The purpose of this study was to compare three different standardized medication regimens prescribed to these patients after ESS. Three-arm, randomized, double-blinded, controlled trial. Patients with Samter's triad undergoing ESS were postoperatively randomized into three medication regimens, those being saline irrigation alone (control group A), saline irrigation plus separate budesonide nasal spray (group B), and saline irrigation mixed with budesonide nasal spray (group C). Outcome measures were Sino-Nasal Outcome Test scores, Lund-Mackay computed tomography scores, and Lund-Kennedy endoscopic scores taken at preoperative baseline, and then at 6 months and 1 year postoperatively. Side effect profiles were also measured (adrenocorticotropic hormone blood level ranges and intraocular pressure at the same interval points). Analysis of variance and χ(2) analyses were conducted using a Bonferroni correction method and routine descriptive statistics. Inter- and intragroup comparisons were made. Sixty subjects were recruited. All groups were equivalent at baseline in all outcomes. All intragroup analyses showed statistically and clinically significant improvement in disease status as compared to baseline (P < .0167), with a sustained but lessened improvement at 1 year. However, no statistically or clinically significant differences were observed between groups at any time point (P > .05). There was no treatment effect noted. In this study, nasal steroids did not confer any additional benefit over saline alone as post-ESS care for the Samter's triad CRSwP patient population.

Introduction to an office-based sinus surgery technique

The advent of balloon catheter dilation of the sinus ostia has advanced the ability of surgeons to manage chronic rhinosinusitis with tissue preservation and less-invasive techniques. This technology has provided the opportunity to perform endoscopic sinus surgery outside of the traditional operating room in a select patient population. This article describes the author's experience with a postmarket study assessing the feasibility of moving select endoscopic sinus surgeries with the use of balloon catheter dilation tools to the office setting. A discussion of anesthesia technique, patient selection, procedure room set-up, and equipment requirements is presented. The safety, tolerability, effectiveness, and cost of performing balloon catheter sinus dilation were evaluated in 10 patients in the author's practice. Effectiveness was assessed with both the sinonasal outcome test (SNOT-20) as well as change in Lund-Mackay computed tomography scan scores. Patient pain perception during the procedure was measured with a visual analogue scale. Patient outcomes were assessed at 1-, 4-, 24-, and 52-week follow-up to determine the durability of the surgical results. At 6 months, SNOT-20 symptom scores were significantly improved (0.89 vs 2.05 baseline), as were Lund-Mackay computed tomography scores, which decreased from a preoperative mean of 7.00 to 0.86. With respect to tolerability, 9 of 10 patients indicated that the procedure was well tolerated.

Chronic rhinosinusitis with nasal polyps: elevated serum immunoglobulin E is associated with Staphylococcus aureus on culture

Recent data has implicated Staphylococcus aureus (SA) superantigen as a potential disease modifier in patients with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP). The objective of this work was to compare total serum immunoglobulin E (IgE) and serum eosinophils in patients with CRSwNP and CRS without nasal polyps (CRSsNP) based on culture results of the 3 most commonly isolated bacteria. Retrospective review at a tertiary rhinology referral center of patients with CRS over a 4-year period. Bacterial cultures and immunologic data were obtained from 62 patients with CRSwNP and 34 patients with CRSsNP. SA was the most prevalent bacteria in the CRSwNP group, isolated in 19 patients (31%). Patients with elevated total serum IgE (>114 IU/mL) were more likely to have SA on culture (p = 0.04) in this population. The percent serum eosinophil levels in the SA+ group compared with the SA- group was not significant (6.0 vs 5.1, p = 0.17). Lund-Mackay computed tomography (CT) scores, but not Sino-Nasal Outcome Test 20 (SNOT-20) scores were significantly higher in the SA+ vs SA- group (p = 0.03) in patients with CRSwNP. The CRSsNP group demonstrated no difference in IgE or serum eosinophils between different bacterial groups. Our findings suggest that there is an association between SA sinonasal presence and elevated total serum IgE in patients with CRSwNP. In addition, SA+ patients had higher Lund-Mackay CT scores, indicating a higher objective burden of disease in this group of patients.

Role of Depression in Outcomes of Endoscopic Sinus Surgery

To prospectively measure the prevalence and effect of symptomatic depression on chronic rhinosinusitis (CRS) patients' quality of life (QOL), disease severity, and outcomes of endoscopic sinus surgery (ESS). Prospective cohort study. Academic, tertiary care center. Seventy-six patients with CRS were enrolled prior to ESS and followed postoperatively for a mean (SD) of 13.3 (5.4) months. Lund-Mackay computed tomography score, Lund-Kennedy endoscopy score, Patient Health Questionnaire-9 (PHQ-9), 2 disease-specific QOL instruments (Rhinosinusitis Disability Index [RSDI] and Chronic Sinusitis Survey [CSS]), and 1 general QOL instrument (Medical Outcomes Study Short Form-36 [SF-36]) were measured. Differences in outcome scores were analyzed using univariate and multivariate analyses. Only 7 (9.2%) patients reported a history of depression, but 19 (25.0%) patients scored in the range of moderate or severe depression on the PHQ-9. Mean (SD) preoperative scores were significantly worse in depressed patients on the RSDI (62.7 [18.2] vs 45.3 [16.3]; P < .001) and 7 of 8 SF-36 domains (all P ≤ .011). Patients with depression significantly improved on both disease-specific QOL instruments (mean [SD] change; RSDI: 33.5 [24.7], P = .017; CSS: 25.0 [20.9], P = .012) and 3 SF-36 domains (all P ≤ .050). Postoperative change scores were not significantly different from patients without depression on the RSDI, CSS, or SF-36. Severity of depression significantly improved postoperatively in depressed patients (preoperative PHQ-9 scores: 13.4 [2.0] vs 6.1 [4.5], P = .017). CRS patients with depression had worse baseline QOL than other CRS patients but experienced comparable postoperative improvement in QOL after ESS. Interestingly, depression severity significantly improved after ESS.

Correlations Between Endoscopy Score and Quality of Life Changes After Sinus Surgery

To assess whether change in endoscopy score correlates with change in health-related quality of life (HRQOL) following endoscopic sinus surgery for chronic rhinosinusitis. Prospective open cohort. Tertiary rhinology clinic. One hundred two adult patients with and without nasal polyposis who elected to undergo endoscopic sinus surgery and were followed up for 12 +/- 2 months postoperatively. Patient characteristics and Lund-Mackay computed tomography scores were recorded preoperatively. Lund-Kennedy endoscopy scores and 2 HRQOL surveys, the Rhinosinusitis Disability Index and Chronic Sinusitis Survey, were examined before and after surgery. Postoperative changes in endoscopy score and HRQOL were examined using bivariate and multivariate analyses. Statistically significant improvements were found in endoscopy score (P < .001) and for all total and subscale HRQOL measures (P < .001). After controlling for baseline status and comorbid factors, improvement in endoscopy score significantly correlated with 12-month improvement on the total Rhinosinusitis Disability Index (P = .01), the physical (P = .01) and functional (P = .02) subscales of the Rhinosinusitis Disability Index, and the symptom subscale of the Chronic Sinusitis Survey (P = .003) but could explain only 25.5% to 36.6% of the linear variation for these HRQOL improvements. For most patients, endoscopy scores and disease-specific HRQOL significantly improve after endoscopic sinus surgery. Changes in endoscopy scores explain a portion of the improvement in HRQOL. For patients with chronic rhinosinusitis, improvements in disease-specific HRQOL outcomes are complex, multidimensional constructs that cannot be entirely explained by surgical changes measured by endoscopic examination. Trial Registration clinicaltrials.gov Identifier: NCT00799097.

Biofilms and Mucosal Healing in Postsurgical Patients with Chronic Rhinosinusitis

Patients with chronic rhinosinusitis (CRS) often remain symptomatic after technically proficient functional endoscopic sinus surgery. Current hypothesis indicates biofilms may contribute to the persistence of infection. However, few studies showed biofilms in postoperative patients. This study was designed to identify bacterial biofilms on postoperative mucosa, as well as to investigate the healing of sinus mucosa after surgery. After intraoperative mucosa was obtained for assessment of biofilms, 27 patients were followed up for 6 months. Postoperative medications and symptoms were recorded. As indicated by endoscopic evaluation, biopsy specimens of postoperative edema, scar, or adhesion were obtained. Samples were prepared for scanning electron microscopy (SEM) and hematoxylin and eosin (H&E) staining. Fifteen postoperative samples were taken from the 20 patients with intraoperative biofilms. Under SEM, postoperative biofilms were identified in 4/6 scar samples and 5/9 edema samples. There was no significant difference in biofilm presence between samples of scar and edema. Microcolonies were also identified on postoperative scar under H&E staining. The presence of intraoperative and postoperative biofilms was correlated with the severity of preoperative Lund-MacKay computed tomography score and postoperative Lund-Kennedy endoscopic score. Compared with intraoperative samples, postoperative samples from the same nine patients significantly recovered from ciliary damage, metaplasia, and basement membrane thickness. Postoperative cultures were positive in samples with and without postoperative biofilms. Biofilms persist after treatment, and may cause the unfavorable outcomes of surgery for CRS. The mucosa with biofilms can recover after surgery. Apparent bacterial plaque can be identified by H&E staining.

Correlation between SN‐5 and computed tomography in children with chronic rhinosinusitis

Symptom score questionnaires for evaluation of chronic rhinosinusitis (CRS) in adults does not correlate with computed tomography (CT) scan scores of paranasal sinuses. The SN-5 is a validated symptom score questionnaire for the evaluation of CRS in children. The purpose of this study is to evaluate the correlation of the SN-5 with the CT score in children. Retrospective review of prospectively collected data. Thirty-two children between the ages of 2 years and 12 years were seen prospectively for symptoms of CRS. The mean age was 7.7 years (range, 3.6-11.5; SD = 2.4). The caretakers completed the SN-5 during their visit when a CT scan of the paranasal sinuses was obtained. The mean SN-5 score was 4.1 (SD = 1.03) and the mean Lund-Mackay CT score was 6.8 (SD = 4.3). There was a significant correlation between the SN-5 score and Lund-MacKay CT score (rho = 0.68; P < .0001) for all children in the study. Twelve (38%) children had asthma, and for those children the correlation was poorer and did not reach statistical significance (rho = 0 .57; P = .057). For nonasthmatics the correlation was stronger (rho = 0.73; P = .0003). Symptom score questionnaire (SN-5) correlated to the disease severity as measured by the Lund-MacKay CT scan score. This is different from what has been found in adults. These findings have positive implications for the follow-up of treatment of CRS in children because the frequent use of CT scans in children is discouraged due to concern for radiation exposure.

Olfactory Function and Disease Severity in Chronic Rhinosinusitis

Olfactory dysfunction is deemed to be a significant contributor to poor quality of life (QOL). However, little is known about the relationship of olfactory testing to other measures of disease burden in patients with chronic rhinosinusitis (CRS). In this study, we examine the relationship of olfactory function to computed tomography (CT) scores, endoscopy scores, and QOL measures in patients with CRS. A multi-institutional, cross-sectional analysis of 367 patients was performed. Several objective measures were collected: the Smell Identification Test, Lund-MacKay CT score, Lund-Kennedy endoscopy score, two validated disease-specific QOL instruments, the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey, and a general health-related QOL instrument, the Medical Short Form-36. Analysis of variance was performed. Correlation coefficients were calculated. Patients with olfactory dysfunction had significantly worse mean endoscopy scores (normosmics, 4.16 [+/- 3.97]; hyposmics, 6.26 [+/- 4.21]; anosmics, 9.61 [+/- 4.48]; p < 0.001) and significantly worse CT scores (normosmics, 9.11 [+/- 5.40]; hyposmics, 11.16 [+/- 5.96]; anosmics, 17.62 [+/- 5.37]; p < 0.001). Endoscopy scores were moderately correlated with olfactory scores (r = -0.46; 95% CI, -0.38, -0.54; p < 0.001). CT scores were moderately correlated with olfactory scores (r = -0.53; 95% CI, -0.45, -0.60; p < 0.001). Olfactory function was not correlated with disease-specific or general health-related QOL measures. Although previous studies have suggested that olfactory impairment is associated with poor QOL, this study found no such correlation. In contrast, olfaction scores correlated well with other objective measures of CRS, namely, endoscopy and CT scores.

The Effect of the Total Intravenous Anesthesia Compared with Inhalational Anesthesia on the Surgical Field during Endoscopic Sinus Surgery

Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed. Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses of fentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system. The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001). In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.