Mackay Score Research Articles

Comparison of Quality of Life and Lund Mackay Score in Subgroups of Rhinosinusitis

Comparison of Quality of Life and Lund Mackay Score in Subgroups of Rhinosinusitis

Prognostic value of sinus CT scans in hematopoietic stem cell transplantation

AbstractHematopoietic Stem Cell Transplant (HSCT) causes immunosuppression and predisposition to sinusitis. CT scans are complementary exams used in the diagnosis of sinusitis; however, its use in every patient is questionable. Aimto check the usefulness of ordering a CT scan prior to HSCT and to study the relationship between anatomical variations and sinusitis. Methodprospective study in which we performed paranasal CT scans before and after HSCT, using the Lund and Mackay score. Results77.5% and 61% of CT scans showed no evidence of sinus disease before and after HSCT. CT staging was not associated with sinusitis after HSCT. Anatomical variations were related to radiographic disease severity, but not to development of sinusitis after HSCT. There was no relation between pre-CT staging and sinusitis after BMT. ConclusionCT scans are not useful for all patients before HSCT. Anatomical variation is not a predictive feature to sinusitis but it can determine its severity.

Impact of osteitis and biofilm formation and correlation between both in diffuse sinonasal polyposis in Egyptian adults; a prospective clinical and histopathologic study

BackgroundThe pathogenesis of diffuse sinonasal polyposis is still not completely established, possible explanations are osteitis, aeroallergens, fungal sinusitis and biofilms. There are no reports in Egypt about osteitis and biofilms in those patients. PurposeTo study the incidence and impact of osteitis and biofilms in Egyptian patients on diffuse sinonasal polyposis patients. Patients and methodsFifty patients (22 males, mean age of 30.68±7.24years) submitted to surgery for diffuse sinonasal polyposis. Computerized scan on sinuses ordered and scored by Lund–Mackay staging protocol, severity of Osteitis using the Global Osteitis Scoring Scale. Tissue samples were taken from diseased sinuses to be analyzed histopathologically for osteitis, and with scanning electron microscopy to detect bacterial biofilms. Another ten patients as a control scheduled for septoplasty or turbinectomy with no evidence of sinusitis, and tissue specimens were obtained 1cm behind the anterior end of inferior turbinate and processed in the same manner for biofilm comparison. Study designContemporary prospective cross-sectional cohort study. ResultsIn 70% (35/50) of the polyposis patients, histopathology was positive for osteitis. Biofilms were detected by electron microscope in 39 (78%). Two of controls (20%) were biofilm positive with a significant difference (p=0.035). The mean Lund–Mackay was 19.08±3.67 and mean osteitis score was 18.68±11.99. There was a significant correlation between Lund–Mackay and osteitis score (p<0.001) and between both and histopathologically proven osteitis (p=0.049), biofilms (p=0.005) and postoperative endoscopic healing (p=0.046) where increased soft tissue disease and osteitis and biofilm were associated with bad healing and vice versa. ConclusionOsteitis and bacterial biofilms underlie the majority of Polypoidal chronic rhinosinusitis and both correlated significantly. Scanning electron microscope is a good tool for detecting bacterial biofilms. Sinus surgery with surgical ventilation, mechanical disruption of biofilms and osteitis is a mandatory therapeutic choice with prolonged treatment with antibiotics and nasal wash.

Understanding paediatric allergic fungal sinusitis: Is it more aggressive?

ObjectiveTo study and characterize the features of AFRS in children as compared to adults. Methods50 consecutive patients of AFRS attending our outpatient department were included in the study from July 2011 to December 2013. They were divided into two groups (A and B) according to age being ≤14 years and >14 years. Clinical history and examination included anterior rhinoscopy, SNOT 20 scores, CT of Nose and PNS (para nasal sinuses) (Lund Mackay scores), diagnostic nasal endoscopy (Kupferberg's grades), punch biopsy from nasal polyp, serum IgE, absolute eosinophil counts (AEC) and Aspergillus skin hypersensitivity test was done in all patients for conformation of AFRS. Bent and Kuhn's criteria were used for diagnosis. Sweat chloride levels were done in all patients of group A. ResultsGroup A had 12 patients and group B had 38. Mean duration of symptoms was significantly less in children as compared to adults (p<0.05). All patients of both groups had nasal polyposis at presentation. Unilateral disease and multisinus involvement was more common in children (6/12) as compared to adults. Proptosis (2/12) and telecanthus (4/12) was more common in children (group A) as compared to adults (group B). LM (Lund Mackay) scores and serum IgE were significantly high in children as compared to adults. Follow up CT scans showed early evidence of recurrence in children as compared to adults (p<0.05). ConclusionAFRS was seen to be more aggressive in children with increased fungal load when compared with adults. Typically, AFRS in children was less responsive to treatment with increased recurrence rates.

Efficacy of Preoperative Itraconazole in Allergic Fungal Rhinosinusitis

Criterion standard treatment of allergic fungal sinusitis (AFS) is primary surgery followed by adjuvant therapy. Even after good surgery, recurrence rates vary from 10 to 79%. Antifungals, e.g., itraconazole, and steroids have shown varying success rates in delaying recurrences given after surgery. Itraconazole decreases the need for steroids given as a primary treatment in allergic bronchopulmonary aspergillosis. This study investigated the efficacy of itraconazole given preoperatively for allergic fungal rhinosinusitis. A prospective study was carried out from July 2011 to November 2013 with 27 patients with histologically proven AFS, who were given itraconazole for 1 month in the preoperative period and operated after completion of the course of itraconazole. They were compared with 25 matched controls of patients with AFS who were operated on directly without preoperative itraconazole. Both groups were given oral steroids in tapering doses for 6 weeks during the postoperative period and followed up at regular intervals. Evaluations were done by using symptomatic (Sino-Nasal Outcome Test [SNOT-20]), radiologic (Lund Mackay scores), and endoscopic (Kupferberg nasal endoscopic grades) parameters. Symptomatology scores (SNOT-20) decreased significantly (p = 0.000) with itraconazole. There was a decrease (p = 0.007) in the Lund Mackay scores that reached up to 0. There was complete resolution of disease in 15% of the patients. Reductions in hyperdensities were noted on computed tomography in all the patients after preoperative itraconazole. Polyp sizes decreased and nasal endoscopic grades improved after itraconazole. Postoperative fungal cultures were positive in 60% of the patients in the preoperative itraconazole group compared with 76% of the patients in the control group, which indicated a decreased fungal burden. We found improvements in clinical, radiologic, and endoscopic parameters in AFS after preoperative itraconazole administration, which decreased the disease load significantly and also reduced the extent of surgery in the short-term follow-up. It may prove to be a good preoperative adjunct that needs further research.

Lund–Mackay and modified Lund–Mackay score for sinus surgery in children with cystic fibrosis

ObjectivePatients with cystic fibrosis (CF) frequently present with severe sinonasal disease often requiring radiologic imaging and surgical intervention. Few studies have focused on the relationship between radiologic scoring systems and the need for sinus surgery in this population. The objective of this study is to evaluate the Lund–Mackay (LM) and modified Lund–Mackay (m-LM) scoring systems in predicting the need for sinus surgery or revision surgery in patients with CF. MethodsWe performed a retrospective chart review of CF patients undergoing computed tomography (CT) sinus imaging at a tertiary care pediatric hospital from 1995 to 2008. Patient scans were scored using both the LM and m-LM systems and compared to the rate of sinus surgery or revision surgery. Receiver–operator characteristics curves (ROC) were used to analyze the radiological scoring systems. ResultsA total of 41 children with CF were included in the study. The mean LM score for patients undergoing surgery was 17.3 (±3.1) compared to 11.5 (±6.2) for those treated medically (p<0.01). For the m-LM, the mean score of patients undergoing surgery was 20.3 (±3.5) and 13.5 (±7.3) for those medically treated (p<0.01). Using a ROC curve with a threshold score of 13 for the LM, the sensitivity was 89.3% (95% CI of 72–98) and specificity of 69.2% (95% CI of 39–91). At an optimal score of 19, the m-LM system produced a sensitivity of 67.7% (95% CI of 48–84) and specificity of 84.6% (95% CI of 55–98). ConclusionThe modified Lund–Mackay score provides a high specificity while the Lund–Mackay score a high sensitivity for CF patients who required sinus surgery. The combination of both radiologic scoring systems can potentially predict the need for surgery in this population.

Incidence of neoplasia in patients with clinically suspicious nasal lesions and the value of computed tomography imaging in diagnosis.

There is no consensus as to whether all routine bilateral polypectomy specimens should be sent for formal histopathological diagnosis to exclude underlying neoplastic pathology. This study assessed the necessity for histopathological investigation as routine practice in cases of bilateral and unilateral nasal lesions by estimating the incidence of unexpected pathologies. It also evaluated the ability of computed tomography to predict histopathological diagnosis in patients with unilateral nasal lesions. A retrospective analysis was conducted of 98 patients undergoing nasal polypectomy over a 12-month period. Five of 23 patients with a unilateral lesion on nasendoscopy had inverted papillomas on histopathological examination. None of the 75 patients with clinically bilateral lesions on nasendoscopy showed evidence of neoplasia on histopathological examination. Patients with inverted papillomas had significantly lower total Lund-Mackay scores than those with bilateral polyps. Asymmetry scores of inverted papilloma patients were significantly higher compared to both bilateral and unilateral polyps patients. The results suggest that histopathological diagnosis is only necessary in unilateral lesion patients as no unexpected histopathological diagnoses were made in bilateral lesion patients. Computed tomography imaging may have a role in predicting histopathological diagnosis by demonstrating asymmetry and less overall sinus opacification in patients with neoplastic lesions.

Functional Endoscopic Sinus Surgery Versus Balloon Sinuplasty with Ethmoidectomy: A 2-year Analysis in Pediatric Chronic Rhinosinusitis.

To evaluate the 2-year post-operative outcomes of pediatric patients with chronic rhinosinusitis (CRS) treated with balloon catheter sinuplasty (BCS) and ethmoidectomy compared to functional endoscopic sinus surgery (FESS). Two-group, retrospective cohort study of 28 children with CRS was performed. Of these 28 participants, 15 were treated with traditional FESS (53.6%) and 13 (46.4%) underwent traditional ethmoidectomy with balloon sinuplasty. Pre-operative and 2-year postoperative total symptom scores and medications were compared. To examine the potential long-term differences in surgical outcomes and surgical procedure on symptom outcome, one-tailed Chi square analyses were employed. The mean age of the children examined was 9.3 (SD=SD=4.1; range 3-18) and 61.9% were male. Pre-operative symptomatology, medication and Lund Mackay scores were evaluated for both groups and no significant differences were identified. Overall, 73.3% of children that underwent traditional FESS and 76.9% of those who had BCS with ethmoidectomy reported significant long-term improvement in at least one of their pre-operative sinus complaints. Our data suggests that both BCS with ethmoidectomy and traditional FESS are effective treatment options for uncomplicated CRS and result in long-term alleviation of core sinus complaints, as well as decreased sinus related medication use. Larger prospective studies are needed to further evaluate these procedures.

Effectiveness of mucolytic agent treating with chronic rhinosinusitis:a randomized clinical research

Objective To investigate the effect of mucolytic agents during endoscopic sinus surgery. Methods 84 patients of chronic rhinosinusitis were employed in the study,which were randomly divided into the control group(41 subjects)and study group(43 subjects)according to the digital table. The patients in the control group adopted regular therapies, and study group were received regular therapies as well as mucolytic agents(eucalyptol- limonene- pinene soft capsule,300 mg,three times a day)application for 8 weeks. Followed visiting lasted for 6 months. The VAS scores, Lund- Mackay scores and efficient rate were compared. Results The VAS scores and Lund- Mackay scores in the control group after treatment were(3.63±1.71)points and (8.34±4.68)points, and which in study group were(2.03±1.67) points and(6.48±3.59) points, and the difference was statistic significant(t= 4.338 and t= 2.049,P< 0.05). According to CPOS- 2012,in the control group,19 cases were controlled,14 cases were partly controlled,and 8 cases were uncontrolled, the whole efficient rate was 80.5%i.n the study group, 24 cases were controlled,17 cases were partly controlled, and 2 cases were uncontrolled, the whole efficient rate was 95.3%. Compared to the control group,the efficient rate of the study group was higher,the result showed statistical significance(χ2= 4.420,P< 0.05). Conclusion Using mucolytic agent after surgery can improve the controlled rate and affect the success of treatment of chronic rhinosinusitis. Key words: Rhinitis; Agent Treat; eucalyptol-limonene- pinene soft capsule

Risk factors associated with severity of eosinophilic otitis media.

Eosinophilic otitis media (EOM) is an intractable otitis media associated with bronchial asthma. Clinical characteristics of EOM are apparent, but severe EOM, which is unresponsive to ongoing treatments, can occur. The present study aimed to investigate potential risk factors associated with the severity of EOM. We scored the EOM severity of 26 patients according to quantity of middle ear effusion (MEE), thickness of the middle ear mucosa, use of topical and oral corticosteroids, and use of antibiotics, all measured over a 3-month period. The scores for four 3-month periods (1 year) were averaged. We analyzed the prevalence of clinical variables by partial regression: sex, age, body mass index (BMI), duration of bronchial asthma, association of aspirin-intolerant asthma, Lund-Mackay score for sinusitis, mastoid pneumatization, width of the bony Eustachian tube at the tympanic orifice, percentage of eosinophils and immunoglobulin E in peripheral blood, and association of allergic rhinitis. Duration of bronchial asthma was defined as the period from onset of bronchial asthma to the age of first consultation at our hospital. Samples of MEE were taken for bacterial culture. The average severity score was 6.6 (out of 16). The severity score in the pathogen-positive MEE group was significantly higher than that in the pathogen-negative MEE group (p<0.05). The score was not significantly different between the seasons. Linear multiple regression analysis showed that BMI and the duration of bronchial asthma significantly affected the EOM severity score (p<0.05). The presence of aspirin intolerant asthma tended to be correlated with the severity score. The Lund-Mackay score tended to be negatively correlated with it. There is a significant association between the severity of EOM and obesity, as well as with the duration of bronchial asthma.

The effect of smoking on CT score, bacterial colonization and distribution of inflammatory cells in the upper airways of patients with chronic rhinosinusitis

Objective: The study was designed to determine whether smoking affects CT score, bacterial colonization of the upper airways and distribution of inflammatory cells in nasal mucosa in patients with chronic rhinosinusitis.Material and methods: Sixty-four patients were enrolled in the prospective study. We characterized differences in CT score, rate of revision surgery, differences in bacterial colonization in the middle nasal meatus and distribution of inflammatory cells in nasal tissue in smoking and non-smoking patients with chronic rhinosinusitis with nasal polyps (CRSwNP), chronic rhinosinusitis without nasal polyps (CRSsNP) and control group.Results: Direct tobacco use was associated with significantly more severe form of the disease according to the preoperative CT investigation of paranasal sinuses using Lund–Mackay scoring system in both CRSwNP (p = 0.035) and CRSsNP (p = 0.023) groups. More intense colonization of upper-respiratory tract by the pathogenic bacteria in smokers compared to non-smokers was found. Non-pathogenic bacterial flora was more often present in non-smokers compared to smokers. Plasma cells and lymphocytes were the most numerous cells in nasal tissue in all three groups. In smokers with presence of pathogenic bacteria in middle nasal meatus there was stronger neutrophil (p = 0.002) and macrophage infiltration (p = 0.044) in CRSsNP group.Conclusion: Tobacco smoke exposure is related to higher Lund–Mackay score, increased colonization by pathogenic bacteria and lower incidence of commensals in middle nasal meatus, but does not influence cell distribution in nasal mucosa in patients with chronic rhinosinusitis.

Effect of the F508del genotype on outcomes of endoscopic sinus surgery in children with cystic fibrosis

ObjectiveNumerous authors have sought to describe genotype–phenotype correlations in cystic fibrosis (CF), notably to pancreatic insufficiency and lung disease. However, few studies have focused on the association between the F508del genotype and response to sinus surgery. The objective of this study is to assess the effect of the F508del genotype on sinonasal disease severity and outcomes following functional endoscopic sinus surgery (FESS) in a pediatric population. MethodsA retrospective chart review of 153 children with CF seen at a tertiary care pediatric hospital from 1995 to 2008 was performed. Patients were classified into one of three groups according to F508del genotype, either as homozygous, heterozygous or not carrying a F508del mutation. The sinonasal disease phenotype of the three groups was compared based on clinical and radiological findings, extent of endoscopic sinus surgery and rate of revision surgery. ResultsThe relationship between the F508del genotype and pancreatic insufficiency was confirmed (p<0.05). There was no association between the F508del genotype and increased need for FESS (p=0.75). Moreover, no association was established between F508del homozygosity and presence of nasal polyps, Lund–Mackay score, extent of surgery or length of postoperative hospitalization. The rates of revision surgery did not differ significantly among the three genotypes analyzed (p=0.59). ConclusionThere is no clear association between the F508del genotype and an increased need for FESS, extent of surgery, or revision surgery. Given the phenotypic variability of sinonasal disease in patients with CF, a prospective study is needed to better understand outcomes following FESS and the contribution of gene modifiers to this effect.

Efficacy of Preoperative Itraconazole in Allergic Fungal Rhinosinusitis

Objectives:Gold standard treatment of allergic fungal rhinosinusitis (AFS) is primary surgery followed by adjuvant therapy. Even after good surgery, recurrence rates vary from 10 to 79%. Antifungals like itraconazole and steroids have shown varying success rates in delaying recurrences given postoperatively. Itraconazole decreases need for steroids given as a primary treatment in allergic bronchopulmonary aspergillosis. This study investigates the efficacy of Itraconazole given preoperatively in AFS.Methods:A prospective study was carried out from July 2011 to December 2012 on twenty histologically proven patients of AFS, who were given Itraconazole preoperatively for 1 month, operated subsequently. They were compared with 20 matched controls of AFS cases, operated directly without preoperative itraconazole. Both groups were given oral steroids for 6 weeks postoperatively and followed for 3 months. Evaluations were done using symptomatic (SNOT score), radiologic (Lund Mackay scores) and endoscopic (Kupferberg Grades) parameters.Results:Symptomatology scores (SNOT20) decreased significantly (p=0.000) with Itraconazole. There was a significant decrease (p=0.005) in Lund Mackay scores reaching to 0 with complete resolution of disease in 15% cases with reduced hyper densities noted in all. Polyp sizes decreased and nasal endoscopic grades improved. Postoperative fungal cultures were positive in 45% compared to 79% cases among control group suggesting a decreased fungal burden. Total serum IgE decreased with itraconazole and had positive correlation (c.c=0.68) with postoperative fungal culture.Conclusions:We found improvements in clinical, radiologic, and endoscopic parameters in AFS after preoperative Itraconazole administration, decreasing the disease load significantly. It may prove to be a good preoperative adjunct needing further research.

Efficacy of controlling rhinosinusitis on the prevention of complications in pituitary surgery with transsphenoidal approach

The microscopic transcolumellar transseptal transsphenoidal approach (TSA) is the one of the most widely used methods for the surgical treatment of sellar and parasellar lesions. But nasal and paranasal sinus inflammation is the relative contraindications of TSA. This study was performed to investigate the results of pre TSA treatment options according to the degree of nasal and paranasal sinus inflammation on the paranasal sinus computed tomography scan (PNS CT). From January 2005 to September 2010, 145 consecutive patients underwent operation of pituitary lesions through the TSA. The preoperative CT images for these patients were reviewed, and 26 patients were identified with sinus opacification on PNS CT. We then analyzed presenting symptoms, physical and endoscopic examination, Lund-Mackay score on PNS CT and preoperative management of the sinus problem retrospectively. Twenty-six patients had sinus opacification on PNS CT. Eight patients had the symptoms of sinusitis corresponding to PNS CT finding, so they had therapeutic antibiotics, and had TSA after symptomatic improvement. Three patients had the symptoms of sinusitis and sinus opacification with mean Lund-Mackay score of 5.33, so they underwent endoscopic sinus surgery first, and they got TSA a few months after. One patient underwent endoscopic sinus surgery and TSA simultaneously. No patient had a serious complication including intracranial infection. TSA is a relatively safe technique, but intracranial complication after surgery may be fatal. Therefore rigorous evaluation and management is mandatory. It is especially important to treat rhinosinusitis issues preoperatively. Our preliminary data may be helpful to evaluate and manage the paranasal sinus inflammation before TSA.

The influence of bacterial biofilm on the clinical outcome of chronic rhinosinusitis: a prospective, double-blind, scanning electron microscopy study

The aim of this study was to assess the influence of bacterial biofilms in chronic rhinosinusitis (CRS) patients on the clinical outcomes following endoscopic sinus surgery (ESS). This was a prospective, double-blind study. Patients undergoing ESS, because of CRS, were recruited. Overall 80 patients were qualified. For each of these demographic, clinical and radiologic characteristics were recorded. During surgery each patient had at least 7 mucosal specimens taken to assess, using scanning electron microscopy, the possible presence of bacterial biofilms. Prior to mucosa specimen excision, swabs for bacteriological and fungal analyses were taken. Each patient underwent perioperative and follow-up assessment at 3 and 6 months post-ESS. Biofilms were found in 33 (41.3%) patients (study group). From among the 47 patients without the presence of biofilms, 33 (control group) were taken to match the study group in age, gender and clinical characteristics. The intensity of subjective and objective CRS symptoms, as well as patient quality-of-life, did not correlate with the Lund and Mackay score (p > 0.05). Analysis of variance showed that, in the control group or the group as a whole, the intensity of subjective and objective symptoms decreased (p < 0.05), and the quality-of-life increased with time (p < 0.05). In conclusion, biofilm-positive patients tend to have a greater severity of disease preoperatively and continue to have persistent and more severe symptoms post-ESS. This study supports the role of biofilms in maintaining the chronic and recalcitrant nature of CRS. The lack of planktonic bacteria in post-operative sinus swabs does not rule out the presence of bacterial biofilms.

Sinonasal bony changes in nasal polyposis: prevalence and relationship to disease severity

Nasal polyposis is characterised by opacification of the nasal cavities, paranasal sinuses and ostiomeatal complexes on computed tomography scanning. Sinonasal bony changes have been reported as disease sequelae. To assess the prevalence of sinonasal bone expansion, erosion and thickening in patients with nasal polyposis, and to correlate disease severity with the prevalence of bony changes. A retrospective radiological study was conducted comprising pre-operative computed tomography scans of 104 patients with nasal polyposis and scans of 44 age- and gender-matched individuals (control group) without sinonasal disease. Lund–Mackay scores and bony changes were quantified. Ninety-three per cent of the study group scans showed sinonasal bony change, with no changes in the control group. Radiological severity of nasal polyposis correlated positively with the prevalence of bony changes (rs = 0.31; p < 0.01). Sinonasal bony changes were common in the study group. This highlights the importance of pre- and intra-operative imaging, which can help to prevent intra-operative complications. As bony changes may mimic invasive disease, the importance of histological assessment of polyps is emphasised.

Chronic rhinosinusitis assessment using the Adelaide Disease Severity Score

This study aimed to validate the use of the Adelaide Disease Severity Score for the assessment of chronic rhinosinusitis. A prospective cohort study supplying level 2b evidence. Forty-eight patients, scheduled for endoscopic sinus surgery for failed management of chronic rhinosinusitis, completed the Sino-Nasal Outcome Test 22 and the Adelaide Disease Severity Score tool (the latter assessing symptoms (i.e. nasal obstruction, rhinorrhoea, post-nasal drip, headache or facial pain, and olfaction) and quality of life). Lund-Mackay computed tomography scores and Lund-Kennedy endoscopic scores were also recorded. The Adelaide Disease Severity Score results were then compared with those of the other three tools to assess correlation. Mean scores (95 per cent confidence intervals) were 22.31 (21.47-24.15) for the Adelaide Disease Severity Score and 30.6 (27.15-34.05) for the Sino-Nasal Outcome Test 22; there was a statistically significant correlation (Spearman coefficient = 0.45; p = 0.0015). A statistically significant correlation was also noted with the Lund-Mackay score (p = 0.04) and with the Lund-Kennedy score (p = 0.03). The Adelaide Disease Severity Score is a simple, valid tool for clinical assessment of chronic rhinosinusitis, which correlates well with the Sino-Nasal Outcome Test 22, Lund-Mackay and Lund-Kennedy tools.

Treatment of Chronic Rhinosinusitis with Pressure-Pulsed Corticosteroid Inhalation

Chronic rhinosinusitis may cause olfactory dysfunction and affects quality of life in patients. In a prospective study we investigated the effect of topical application of corticosteroids through pressure-pulsed inhalation as treatment option of chronic rhinosinusitis with olfactory disorder. Patients with sinonasal olfactory disorder according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) were allocated to the new nasal inhalation therapy or a systemic corticosteroid therapy, each receiving a corticosteroid course of 12days. 18 patients received topical corticosteroid pressure-pulsed inhalation (AMSA, Schumacher, Dausenau) and 15 systemic corticosteroid. Olfactory function was measured before and after treatment using the Threshold Discrimination Identification score (TDI score) and visual analogue scales. Lund Mackay score (LMS) was measured before starting treatment. Olfactory function (OF) increased from 17.5±6.4 to 21±7.9 TDI points (p<0.0005) after 2months. OF decreased again to 19.5±6.0 after 6months (p=0.007). OF increased from 17.0±8.9 to 22.0±9.5 points (p=0.002) with systemic treatment after 2months. In the follow-up period of 6months, the mean TDI score dropped to 20.0±9.2 points (p=0.01). There was no correlation between LMS and TDI. Treatment of chronic rhinosinusitis with pressure-pulsed inhalation was demonstrated to be effective. Multicenter investigations with large participant numbers are needed.

Meticulous endoscopic sinus surgery to prevent recurrence of massive nasal polyposis

To evaluate the effect of meticulous endoscopic surgery, including opening of all involved sinus cells, on the subsequent symptoms and endoscopic findings of patients with massive nasal polyposis. One hundred patients with massive nasal polyposis resistant to medical treatment were selected. We documented each patient's demographic data, associated diseases, endoscopic findings, Lund-Mackay score and Sino-Nasal Outcome Test 22 (SNOT22) symptom score. All patients were followed up for at least two years to evaluate any recurrence. Of the 100 patients, 20 per cent had a history of asthma and 27 per cent had undergone previous surgery. All underwent endoscopic sinus surgery. After two years of follow up, 8 per cent had recurrence requiring surgery. Recurrence was significantly associated with a history of asthma (p < 0.001) and the histopathological presence of eosinophilia (p = 0.014). Meticulous endoscopic opening of all involved sinus cells can be a safe and effective means of controlling massive nasal polyposis, with an acceptable recurrence rate.

Canine fossa trephine is a beneficial procedure in patients with Samter`s triad

Canine fossa trephine (CFT) is an adjunctive technique to sinus surgery in patients with recalcitrant maxillary sinusitis. CFT allows for disease clearance in areas of the maxillary sinus that are hard to reach with standard endoscopic techniques. The objective of this study was to compare the surgical outcome of CFT to standard middle meatal antrostomy (MMA) in matched patients with the severely diseased maxillary sinus. Prospective clinical study Patients undergoing sinus surgery were enrolled in either the CFT or MMA group. All patients had nasal polyps, Lund Mackay score of 2 in the maxillary sinus, and nasal endoscopy showing the maxillary sinus full of polyps. The patients were followed and the maxillary sinus was graded endoscopically at 3, 6 and 12 months after the surgery. Length of surgery, disease recurrence and need for revision surgery was documented. Forty-two CFTs and MMA were performed in each group. At 6 and 12 months the CFT group demonstrated statistically significant improvement in nasal endoscopy scores. Six patients recurred by the one year mark in the MMA group, 4 of which underwent revision surgery. In the CFT group 2 patients recurred, one who underwent a unilateral revision CFT. Furthermore the CFT did not prolong the surgical time and was often faster than performing a MMA. CFT allows for clearance of all gross disease in the maxillary sinus and appears to improve postoperative outcome at 6 and 12 months and decrease the need for revision surgery.