Recurrent Polyposis Research Articles

Chronic rhinosinusitis with nasal polyposis : Aretrospective analysis of therapeutic approaches in 463patients

Chronic rhinosinusitis with nasal polyps (CRSwNP) is amultifactorial inflammatory disease, the treatment of which has undergone significant changes in recent years. In addition to surgical approaches, topical and systemic steroids, and adaptive acetylsalicylic acid (ASA) desensitization, three specific antibodies have complemented the therapeutic portfolio since 2019. Aretrospective evaluation of all patients who presented as outpatients for the first time due to CRSwNP in 2007 and 2008 (collectiveA) and 2017 and 2018 (collectiveB) was performed, up to and including June 2023. The clinical courses of 463patients (mean age 49.1years, range 5-82years; 65.9% male) were included in the analysis. Conservative treatment with nasal corticosteroids started before initial presentation was more frequent in collectiveB (collectiveA 43.9% vs. collectiveB 72.2%). In 278 of the 463 patients (60%; A:62%, B:58%), at least one operation on the nasal sinuses had been performed after initial presentation; in 101 of these patients (36.3%) recurrent polyposis (within mean follow-up of 2.4years) required further treatment. The indication for ASA provocation/desensitization was applied less frequently in collectiveB, also due to ahigh discontinuation rate (at least 38%) of the maintenance therapy. Of the total cohort, 16patients (3.5%; A:n = 8, B:n = 8) were meanwhile switched to antibody therapy at recurrence. Astep-by-step guideline-orientated approach is recommended in the treatment of CRSwNP. Systemic antibodies as an add-on to nasal corticosteroids are arelatively new therapeutic option for treatment-refractory CRSwNP, which reduces the indication for ASA desensitization, which is associated with a relatively high incidence of side effects and poor compliance.

The impact of middle meatal steroid-eluting implants on the postoperative outcomes of chronic rhinosinusitis: A systematic review and meta-analysis

Endoscopic sinus surgery (ESS) has become an established surgical option in refractory chronic rhinosinusitis (CRS). The goal of this review is to assess the impact of steroid-eluting middle meatal implants after ESS. Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, PUBMED, and GOOGLE SCHOLAR were searched from inception to November 2022. All randomised controlled trials (RCTs) involving adult patients receiving ESS for CRS utilising a steroid-eluting middle meatal implants were eligible. The primary outcome was adhesion or synechiae. The secondary outcomes were mucosal inflammation, polyp reformation, the need for oral steroids and additional surgery, postoperative bleeding, sinus pain and discomfort, postoperative sinus-related infection, and change in intraocular pressure. Fourteen full articles were examined out of 496 potential abstracts. Seven RCTs satisfied the criteria. At 30days, steroid-eluting implants reduced adhesion (OR: 0.28, 95% CI: 0.14 to 0.56; P<0.001), mucosal inflammation (MD: −13.09, 95% CI: −18.22 to −7.97; P<0.001), polyp reformation (OR: 0.31; 95% CI: 0.22 to 0.44; P<0.001), and requirement of additional oral steroid (OR: 0.44; 95% CI: 0.25 to 0.78; P=0.005) or surgery (OR: 0.25; 95% CI: 0.12 to 0.50; P<0.001). While their use for adhesion (OR: 0.24; 95% CI: 0.11 to 0.54; P<0.001) and polyp reformation (OR: 0.24; 95% CI: 0.12 to 0.51; P<0.001) were favourable, there was no difference in mucosal inflammation (MD: −5.68, 95% CI: −12.39 to 1.03; P=0.100) or the need for surgery (OR: 0.96; 95% CI: 0.07 to 12.37; P=0.980) when evaluated after 30days. Overall, the findings suggest that steroid-eluting middle meatal implants improve ESS outcomes by lowering rates of adhesion formation, postoperative medical and surgical interventions, recurrent polyposis, and inflammation, while having no significant negative impact in the immediate postoperative period. More research is needed into the long-term impacts.

Inflammatory Sinonasal Polyposis-Causing Globe Perforation-With Response to Dupilumab Therapy.

A 75-year-old male patient with asthma presented with left eye vision loss for 1 year and progressive nasal obstruction, anosmia, and purulent eyelid and nasal discharge for several months. There was no light perception vision with an afferent pupillary defect in the left eye. Examination demonstrated nasal dorsum widening, sino-cutaneous fistulae, bilateral proptosis, and left eye chemosis with corneal keratinization in the setting of prior perforation (Fig. 1A). Nasal endoscopy showed severe, bilateral polyposis (Fig. 1B). MRI revealed an extensive sinonasal process with left globe disfigurement and severe, postobstructive, sinus mucocele formation (Fig. 2, top). The patient underwent bilateral functional endoscopic sinus surgery. Intraoperatively extensive sinonasal polyposis and inspissated mucinous debris were encountered. Histopathology demonstrated nasal polyps with dense eosinophilic infiltration and cultures grew polymicrobial bacteria. He underwent left eye evisceration, left lower eyelid ectropion repair, and second-stage sinus surgery. Postoperatively, there were improvements in pain, breathing, and smell. Nasal endoscopy displayed improved sinus patency, although with rapid polyp recurrence. Given concern for mucocele formation and potential impact on the right eye, bimonthly subcutaneous dupilumab was initiated. Following 5 doses, there was dramatic improvement, with symptom resolution, nasal bridge narrowing, sinonasal polyposis reduction, and fistulae closure (Fig. 1C). Subsequent CT showed dramatic polyposis involution and sinus clearing (Fig. 2, bottom). Severe chronic sinusitis with polyposis may exert mass effect on local structures including the brain, optic nerves, and globes. Among patients with severe, refractory, or recurrent polyposis, subcutaneous dupilumab may provide a dramatic clinical response.FIG. 1FIG. 2

Efficacy of Steroid-Impregnated Spacers After Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

The aim of this study was to compare the effect of steroid-impregnated spacers to that of conventional management after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Six databases were searched from inception until November 2022. Sixteen studies were found that compared the improvement of chronic sinusitis-related symptoms and postoperative outcomes between a steroid-impregnated spacer group and a control group (non-steroid-impregnated spacers). The Cochrane risk of bias tool (for randomized controlled studies) and the Newcastle-Ottawa Scale (for non-randomized controlled studies) were used to assess the quality of the works included. Regarding the endoscopic findings, the degree of mucosal edema, ethmoid inflammation, crust formation at 2-3 months postoperatively, nasal discharge, polyposis, and scarring/synechia were significantly lower in the steroid-impregnated spacer group. The steroid-impregnated spacer group also showed significantly lower Lund-Kennedy scores and perioperative sinus endoscopy scores than the control group at 2-3 weeks postoperatively. Furthermore, the steroid-impregnated spacer group had lower rates of adhesions, middle turbinate lateralization, polypoid changes, the need for oral steroid use, the need for postoperative therapeutic interventions, and lysis of adhesions than controls. However, no significant between-group differences were found in short-term (2-3 weeks postoperatively) endoscopic findings regarding nasal discharge, postoperative crusting, polyposis, or scarring/synechia. Steroid-impregnated nasal packing reduced the rates of postoperative intervention and recurrent polyposis and inflammation in CRS patients undergoing ESS.

Evaluation of Computed Tomography Findings in Revision Endoscopic Sinus Surgery

Objective: To investigate computerized tomography (CT) data of patients who needed revision surgery for chronic rhinosinusitis. Material and Methods: 83 patients who underwent revision endoscopic sinus surgery by the senior author due to recurrent and/or persistent chronic rhinosinusitis were included in this study. The following data were obtained from preoperative CT scans and recorded for each side of every patient: recurrent polyposis, incomplete uncinectomy, retained agger nasi cell, lateralization of middle turbinate, recirculation phenomenon, maxillary antrostomy stenosis, incomplete anterior and posterior ethmoidectomy, scarring at the frontal recess, sphenoid ostium stenosis, or novel onset sphenoid disease. Results: Based on our findings, septal deviation caused inadequate posterior ethmoidectomy, while incomplete uncinectomy increased the risk of frontal sinus disease. Conclusions: We suggest that septum deviation may cause insufficient visualization, while incomplete uncinectomy may prevent adequate intervention to the frontal sinus and these subsequently play a role in ESS failure.

Use of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery

BackgroundChronic rhinosinusitis with nasal polyps recurs frequently after functional endoscopic sinus surgery (FESS), with resultant poor quality of life with persistence of nasal obstruction, sinus aches, and discharge as well anosmia and dysgysia; revision FESS is usually the treatment of choice referred to relief patients’ suffering, yet it is not always the case, patients preference as well as fitness for general hypotensive anesthesia, patients age, cardiopulmonary status, and concurrent bronchial asthma might render unfit for an elective procedure. The aim of this study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery.ResultsThirty patients suffering from recurrent sinonasal polyposis after single or multiple FESS procedures were selected; all patients were subjected to intranasal application of gelfoam soaked with triamcinolone as a conservative medical office procedure using triamcinolone-soaked absorbable gelatin foam (gelfoam) weekly for a period of 8 weeks followed by intranasal steroid nasal spray for maintenance and as anti-recurrence measure. Patients were followed up for 4 months post-intervention; Meltzer Clinical Scoring System was used to analyze the patients’ pre- and post-intervention via office endoscopy (0° 4-mm Hopkins endoscope). All patients tolerated the procedure well. The study group showed no statistical significance pre-intervention which comprised 17 (56.7%) patients with grade 4 sinonasal polyposis extent and 13 (43.3%) patients with grade 3 sinonasal polyposis extent (P=0.795), denoting no difference between patients pending treatment option. Post-treatment, both groups showed a significant reduction in the extent of polyposis (P<0.001) where post-treatment showed 21 (70%) patients with grades 0 no polyps and 9 (30%) patients with grade 1 sinonasal polyposis extent.ConclusionTriamcinolone-soaked gelfoam packing is an effective and safe method for managing recurrent sinonasal polyposis after FESS. Intervention contributed to a successful result, decreased the need for surgery in poor candidates for hypotensive anesthesia, and could be used as a sole treatment of recurrent sinonasal polypsis in elderly patients whose general condition could not tolerate invasive procedures.

The role of Staphylococcus aureus in the course of polyposis sinusitis

Introduction. Today, there are lot of theories of pathogenesis of polypoid sinusitis. The contribution of Starchylocossus aureus (S. aureus) to the occurrence of this pathogenetic reaction is being actively discussed.Objective: to improve the effectiveness of treatment of polypoid sinusitis using the results of the study of the effect of persistent staphylococcal infection on the onset and course of the disease.Materials and methods. The authors examined 105 patients with recurrent polyposis sinusitis aged 20 to 65 years. All patients underwent FESS surgery for recurrent polypous sinusitis at the initial visit. In the postoperative period, all patients received treatment according to one of two schemes. The first scheme included antihistamines and topical steroids, the second additionally included clarithromycin. The patients underwent bacteriological examination of smears for flora and fungi from the cavity; cytological examination of smears-prints from the mucous membrane of the nasal cavity (we counted neutrophils, eosinophils and lymphocytes in the preparation); immunological and allergic examination (skin tests, serum specific IgE levels).Results and discussion. It has been established that the presence of a carriage and sensitization to S. aureus in a patient, especially in combination with atopy, results in a more severe course of polyposis sinusitis severe nasal obstruction (91% versus 69.5%, respectively) and is characterized by more pronounced eosinophilic inflammation than Polypoid Sinusitis associated with infection with other microorganisms (the number of eosinophils in the blood: 7.5% and 4.3%, respectively; the level of eosinophils in smears from the nasal mucosa is 13 and 4.8%, respectively; the average ECP level is 17.6 and 8.1 ug / ml, respectively).Conclusions. The use of topical GCS remains one of the leading methods for preventing recurrence of PS. However, in addition to the backbone therapy with topical GCS and antihistamines, it is advisable to complete a course of antibiotics during nasal colonization with S. aureus.

Predictors of sinonasal disease onset, progression, and severity in pediatric cystic fibrosis patients

PurposePediatric cystic fibrosis (CF) patients have a variable onset, severity, and progression of sinonasal disease. The objective of this study was to identify genotypic and phenotypic factors associated with CF that are predictive of sinonasal disease, recurrent nasal polyposis, and failure to respond to standard treatment. MethodsA retrospective case series was conducted of 30 pediatric patients with CF chronic rhinosinusitis with and without polyps. Patient specific mutations were divided by class and categorized into high risk (Class I-III) and low risk (Class IV-V). Severity of pulmonary and pancreatic manifestations of CF, number of sinus surgeries, nasal polyposis and recurrence, age at presentation to Otolaryngology, and Pediatric Sinonasal Symptom Survey (SN-5)/Sinonasal Outcome Test (SNOT-22) scores were examined. Results27/30 patients (90%) had high risk mutations (Class I-III). 21/30 (70.0%) patients had nasal polyposis and 10/30 (33.3%) had recurrent nasal polyposis. Dependence on pancreatic enzymes (23/27, 85.2% vs 0/3, 0.0%, p = 0.009) and worse forced expiratory volumes (FEV1%) (mean 79, SD 15 vs mean 105, SD 12, p = 0.009) were more common in patients with high risk mutations. Insulin-dependence was more common in those with recurrent polyposis (5/10, 50% vs 2/20, 10%, p = 0.026). There was no statistical difference in ages at presentation, first polyps, or sinus surgery, or in polyposis presence, recurrence, or extent of sinus surgery based on high risk vs. low risk classification. ConclusionCF-related diabetes was associated with nasal polyposis recurrence. Patients with more severe extra-pulmonary manifestations of CF may also be at increased risk of sinonasal disease.

Frontální sinotomie Draf 3 jako součást revizních výkonů pro chronickou rinosinusitidu s polypy

Introduction: The prevalence of chronic rhinosinusitis with nasal polyps (CRSwNP) in the population is estimated at 4%. If adequate conservative treatment fails to improve the quality of life, patients are indicated for surgical therapy, which is represented by a functional endonasal surgery. The recurrence of polyps after surgery is reported by up to 60% in some studies. At the moment, available data does not indicate the optimal extent of surgery, especially in the case of revision procedures. The aim of the presented study was to find out whether a more radical revision surgery, including Draf 3-type (D3) frontal sinotomy, could be beneficial for patients with recurrent disease. Material and methods: Forty-two patients with recurrent polyposis were included in a retrospective case-control study. Half of the patients had undergone a more radical procedure including D3, while the control group had a standard operation. In both groups, the quality of life was assessed using the Czech version of the SNOT-22 questionnaire, the incidence of polyp recurrence and the need for revision within 2 years after the operation. Results: The presented study recorded lower postoperative values of postoperative SNOT-22 questionnaire in patients with D3 frontal sinotomy, but the difference was not statistically significant compared to the group of patients after traditional FES. A significantly lower need for revision surgery was proved in patients with more radical surgery. Conclusion: These data suggest that more radical surgical procedure in a subgroup of patients with severe recurrent polyps may be beneficial for these patients.

Role of navigation system in functional endoscopic sinus surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Functional endoscopic sinus surgery (FESS) is a challenging procedure for otorhinolaryngologists. Navigation can reassure the surgeon’s judgement and enhance surgical performance and prevent complication. The study done with aim of comparison between FESS with navigation and conventional FESS and explore other indication of navigation in endoscopic sinus surgery in difficult clinical scenario.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a cross-sectional study on patients with sino-nasal disease. 100 patients in whom the ability to identify surgical site is assumed to be compromised by various conditions like previous surgery, massive/ recurrent polyposis, front oethmoidal mucocele, frontal, sphenoid sinus disease were included in the study. Patients were randomly allocated into two groups, group A (50 patients) FESS with navigation and group B (50 patients) conventional FESS. Pre-operative preparation time, intraoperative time, blood loss (Fromme–Boezzaart scoring), surgeon satisfaction, patient satisfaction (SNOT-20), complications were documented on a preformed, pretested proforma. Equipments used were –StealthStation S7 system, CD for recording intraoperative findings. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Preoperative preparation time duration was applicable for group A only. Intraoperative time was slightly and insignificantly higher in group A. Blood loss according to Fromme-Boezzaart scoring had lesser scoring values in group A and difference among gradings was statistically insignificant. Surgeons satisfaction and confidence was statistically significant higher in group A. The SNOT-20 score values were lower and insignificant in group A.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; FESS with navigation is more convenient to surgeon, appears to be safer tool.&lt;/p&gt;

Efficacy of steroid-eluting stents in management of chronic rhinosinusitis after endoscopic sinus surgery: updated meta-analysis.

Recently, there has been mounting evidence suggesting the efficacy of steroid-eluting stents (SES) for management of chronic rhinosinusitis after endoscopic sinus surgery (ESS). This meta-analysis serves to evaluate the efficacy of SES in improving postoperative outcomes after ESS. A systematic literature search was performed of PubMed for articles published between 1985 and 2018. The outcome variables were reported at, on average, 30 days postintervention. Seven of the 76 published studies, all of which were industry-sponsored, were included for a collective cohort of 444 SES and 444 control sinuses. In patients who received SES vs controls, collective odds ratios (ORs) for postoperative need for intervention, surgery, and oral steroid were 0.45 (95% confidence interval [CI], 0.33-0.62; p < 0.001), 0.30 (95% CI, 0.18-0.52; p < 0.001), and 0.58 (95% CI, 0.40-0.84; p = 0.004), respectively. In addition, collective ORs for frontal sinus ostia (FSO) patency, moderate-to-severe adhesion/scarring, and increase in polyp score were 2.53 (95% CI, 1.61-3.97; p < 0.001), 0.28 (95% CI, 0.13-0.59; p < 0.001), and 0.42 (95% CI, 0.25-0.74; p = 0.002), respectively. Collective mean differences for FSO/ethmoid inflammation and FSO diameter were -10.86 mm (p < 0.001) and +1.34 mm (p < 0.001), respectively. Aggregate evidence suggests that SES can improve ESS outcomes by reducing rates of postoperative intervention and recurrent polyposis and inflammation, while promoting FSO patency. All included and analyzed studies were industry-sponsored and ruling-out publication bias was not possible. Future independent and nonsponsored studies to further evaluate SES's long-term efficacy are warranted.

Role of Omega-3 Polyunsaturated Fatty Acids in Treatment of Nasal Polyposis.

Background Nasal polyposis is a common disease with steroids either systemic or topical being the key element in its medical treatment. With known side effects of systemic steroids, other anti-inflammatory agents should be evaluated, preferably the natural ones. Objective To evaluate the role of omega-3 polyunsaturated fatty acids in the treatment of nasal polyposis. Methods This is a single-blinded randomized-controlled trial including 164 patients with grade II nasal polyposis receiving a short course of systemic steroids until subsidence of polyposis. Patients were distributed equally after into 2 groups according to maintenance therapy with group I receiving omega-3 fatty acids in a dose of 3 g per day with local budesonide nasal spray and group II receiving only local budesonide nasal spray. Both groups were compared regarding incidence and grade of recurrence of polyposis and duration from onset of maintenance therapy to onset of recurrence. Results A nonsignificant effect for omega-3 was found on the incidence of recurrence of nasal polyposis ( P = .1) and the grade of recurrent polyposis ( P = .66). However, omega-3 intake had a highly significant effect on delaying the incidence of recurrence of polyposis ( P &lt; .0001). Conclusion Omega-3 fatty acid has a beneficial effect on delaying the incidence of recurrence of nasal polyposis through its proven anti-inflammatory mechanism of action. This minimizes the need for systemic steroid administration with its known side effects. Omega-3 fatty acids supplementation should be considered while tailoring the maintenance regimen for medical treatment of chronic rhinosinusitis with nasal polyposis.

Mometasone furoate sinus implant – a new targeted approach to treating recurrent nasal polyp disease

ABSTRACTIntroduction: Chronic rhinosinusitis (CRS) is a broad heterogeneous inflammatory disorder of the nose and paranasal sinuses, resulting from the dysfunctional interplay between host immunity, defective epithelial barrier, and environmental factors. CRS with nasal polyps (CRSwNP) is considered a more severe clinical phenotype with greater burden of symptoms and higher relapse rate, especially with comorbid asthma or aspirin sensitivity. Available treatment options after endoscopic sinus surgery (ESS) – systemic corticosteroids or revision surgery – have significant risks and limitations.Areas covered: Bioabsorbable, steroid-eluting implants have been studied extensively for the ability to dilate and re-establish sinus patency by the localized, controlled delivery of topical corticosteroids to diseased sinonasal lining and nasal polyps. This review provides a comprehensive, up to date analysis of the literature regarding a novel, office-based, mometasone furoate (MF) sinus implant that may treat patients with recurrent CRSwNP after ESS.Expert commentary: Clinical evidence has demonstrated the safety and efficacy of steroid-eluting implant in the reduction of polyp size, symptom burden, and the need for revision sinus surgery. MF sinus implants may play an important role in the management of patients with recurrent polyposis after sinus surgery.

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique.

Transanal minimally invasive surgery (TAMIS) has emerged as a relatively new technique in treating early cancer and benign lesion of the rectum. The technique is likely to be widely adopted, surpassing other comparable techniques owing to its simple setup and cost-effectiveness. We assessed the outcomes of TAMIS at our centre. We retrospectively reviewed prospectively collected data on 50 patients who underwent TAMIS for benign, malignant T1 or T2 cancers that were unfit for radical surgery over a 4-year period. Outcomes, including 30-day complications and recurrence, as well as our ability to implement and integrate this technique at our centre were assessed. All 50 TAMIS procedures were successful. The average lesion was 7 cm from the anal verge, the average tumour size was 2.5 cm, the average duration of surgery was 73 minutes, the average length of stay was 1.1 days, and the margin negativity was 84%. Major indications in our series included 25 lesions that were too large for endoscopic resection, 14 early cancers or high-grade dysplasia, 10 margin checks postpolypectomy, 6 cases of recurrent polyposis, and 4 medically unfit patients. There were no deaths. The rate of short-term complications, including rectal bleeding, reoperation and urinary retention, was 16%. The rate of long-term complications, including anal incontinence and stenosis, was 4%. Benign and malignant recurrence rates were 2% and 6%, respectively. Overall long-term requirement for invasive procedures, low anterior resection or abdominoperineal resection, was 12%. To our knowledge, this is the first Canadian study showing TAMIS to be an efficient and safe procedure for the treatment of well-selected patients with rectal lesions. Outcomes from our centre are comparable with those found in the literature.

Is topical high-volume budesonide sinus irrigation safe?

Is topical high-volume budesonide sinus irrigation safe?

Functional endoscopic sinus surgery improves the quality of life in children suffering from chronic rhinosinusitis with nasal polyps

ObjectiveTo evaluate the impact of FESS in children with chronic rhinosinusitis with nasal polyps, regarding their overall postoperative quality-of-life (QoL) and constituent QoL domains. Potential differences between cystic fibrosis (CF) sufferers and non-sufferers, or cases with recurrent sinonasal polyposis versus single-operations were also explored. Methods39 children were studied. The mean patient age was 10.9 years; four children suffered from cystic fibrosis. The children (or parents) completed the Glasgow Benefit Inventory for Children (GCBI) at least six months after their operation. The Mann-Whitney test compared the GCBI scores between non- and CF sufferers, as well as children with and without recurrent polyposis. ResultsThe median overall QoL score was 98. There were no statistically significant differences between CF sufferers and non-sufferers regarding their overall QoL, or the respective individual QoL domains, apart from their physical postoperative activity (p = 0.04). Twelve children demonstrated recurrent polyposis (30.7%); among them three were cystic fibrosis sufferers. No statistically significant differences were identified in the overall QoL score, or individual GCBI subscale scores between children with recurrent polyposis versus single-operations. Children with recurrent polyposis but not CF performed better regarding their overall QoL (p = 0.021) and medical status (p = 0.015), compared to their CF counterparts. ConclusionFESS performed for chronic rhinosinusitis with nasal polyps in children is associated with improved postoperative QoL, irrespective of the presence of CF (although the latter needs to be confirmed in larger patient cohorts). The absence of appreciable differences in the overall QoL, or its constituent domains, between single and re-operated children, indicate that the positive effect of FESS outweighed the burden of re-operation. Appropriate preoperative informed consent in cases of recurrent sinonasal polyposis necessitates acknowledging worse respective outcomes in CF sufferers.

The effect of topical vancomycin on the recurrent postoperative sinonasal polyposis: a triple-blinded randomized controlled trial

ObjectiveTo assess the effect of topical vancomycin on the prevention of recurrent sinonasal polyposis after functional endoscopic sinus surgical procedure.Design, setting, and participantsA triple-blind, randomized clinical trial of patients aged 18–70 years with sinonasal polyposis whose nasal swab results were positive for Staphylococcus aureus and were candidates for functional endoscopic sinus surgical procedure at Besat Hospital, Hamadan University of Medical Sciences, from September 2014 to September 2015.InterventionsPatients were randomly assigned to receive a solution of normal saline including 1 g/l vancomycin or a solution of normal saline alone (placebo). Patients were asked to irrigate their nose with 20ml of the prepared solution three times a day for 8 weeks.Main outcomes and measureThe recurrent polyposis and reinfection with S. aureus at 2, 4, and 6 months after sinus surgery.ResultsOf 118 patients identified, 35 patients whose nasal swab results were positive for S. aureus remained for analysis, and of those, 18 patients were allocated to the placebo group and 17 to the vancomycin group. There was no statistically significant but clinically important difference in the severity of recurrent postoperative polyposis between the two groups. The recurrence rate of postoperative sinonasal polyposis was clinically different between the two groups, although the difference was not statistically significant. The proportion of reinfection with S. aureus in the second month after surgery was 11/18 (61.1%) in the control group versus 3/17 (17.6%) in the vancomycin group (P=0.015). No significant drug adverse effect was reported by the patients.Conclusion and relevanceThis trial indicated that topical vancomycin is a safe drug with no important adverse effects that may reduce the recurrent postoperative polyposis. However, more evidence based on large clinical trials is required to justify the efficacy of topical vancomycin for preventing postoperative polyposis.

The role of intranasal prelacrimal recess approach in complete removal of anterior maxillary sinus lesions

Abstract The aim of the study was to assess the role of the intranasal prelacrimal recess approach (PLRA) in complete removal of anterior maxillary lesions. This was a prospective study in which 20 patients were recruited between July 2013 and September 2014 from the Otorhinolaryngology outpatient clinic, Cairo University. Patients with anterior maxillary sinus (MS) lesions underwent endoscopic sinus surgery and had their lesions removed through the maxillary ostium. The PLRA was then performed to assess the presence of any anterior maxillary remnants, which were then removed. The intranasal pathologies included sinonasal polyposis (four patients), recurrent sinonasal polyposis (four patients), antrochoanal polyps (four patients), allergic fungal sinusitis (five patients), inverted papilloma (one patient), lymphoma (one patient), and cancer maxilla (one patient). After the PLRA 45% of the patients showed remnants. These included antrochoanal polyp (two patients), recurrent sinonasal polyposis (one patient), allergic fungal sinusitis (three patients), inverted papilloma (one patient), lymphoma (one patient), and cancer maxilla (one patient). Our preliminary study demonstrated that without the PLRA 45% of the cases will have remnants missed in hidden areas of the MS. The PLRA is a minimally invasive technique to deal with anterior MS lesions.

A prospective investigation of predictive parameters for post-surgical recurrences in sinonasal polyposis.

Even after appropriate surgical therapy, a significant number of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) experience recurrences. The end-point of this prospective study was to apply univariate and multivariate statistical models to identify clinical, pathological, and laboratory variables that could predict CRSwNP recurrence after endoscopic sinus surgery. The study enrolled 143 patients between 2010 and 2013, who were all treated by the same surgeon for CRSwNP. Twenty-one patients developed recurrent polyposis. The recurrence rate was significantly higher for the eosinophilic than for the non-eosinophilic type (p = 0.020). Among the patients who developed a recurrence, the disease-free interval was significantly shorter for those with eosinophilic-type polyposis (p = 0.003). Univariate statistical analysis disclosed significant associations between CRSwNP recurrence and age (p = 0.035), allergy (p = 0.014), and eosinophilic granulomatosis with polyangiitis (p = 0.01). The multivariate model showed that only histological evidence of the eosinophilic type of CRSwNP retained an independent prognostic significance in relation to recurrent polyposis (p = 0.033). Judging from our results, it is reasonable to consider both stricter follow-up protocols and postoperative adjuvant medical treatments for patients with a histological diagnosis of eosinophilic-type CRSwNP.

Surgical management of rhinosinusitis in endoscopic-endonasal skull-base surgery.

Endoscopic-endonasal skull base surgery (ESBS) provides an important approach to select pathologies. There remains a paucity of data, however, regarding morbidity in patients undergoing ESBS with comorbid acute rhinosinusitis (ARS), a fungal ball (FB), or chronic rhinosinusitis (CRS). A retrospective database review between January 2008 and January 2013 identified 35 patients with concurrent skull-base pathology and refractory ARS, FB, CRS, and CRS with nasal polyposis (CRSP) who underwent endoscopic sinus surgery (ESS) and ESBS. Two of 35 (5.7%) had an FB, 3 of 35 (8.6%) had ARS, 19 of 35 (54.2%) had CRSP, and 11 of 35 (31.4%) had CRS. Five of 35 (14.3%) were staged procedures whereas 30 of 35 (85.7%) underwent concurrent ESS and ESBS. Four patients (80%) who were staged carried diagnoses of an FB and ARS. Two patients in the concurrent group required revision ESS for recurrent polyposis. There were no cases of intraorbital or intracranial infectious complications. Management of the paranasal sinuses is paramount to maintain healthy sinonasal function in patients undergoing ESBS. In our experience, most cases of CRS and CRSP can be surgically managed at the time of ESBS without increased risk of intracranial infection. Patients with ARS at the time of surgery or an FB should be staged to avoid postoperative ESBS morbidity.