Safety Of Endoscopic Sinus Surgery Research Articles

Systematic review and meta-analysis of the curative effects and safety of endoscopic sinus surgery in children with chronic sinusitis with nasal polyps.

BackgroundAt present, the surgical treatment of sinusitis with nasal polyps has made great progress, but its recurrence rate is still high. Therefore, this time, meta-analysis is used to study the therapeutic effect of endoscopic sinus surgery on children with chronic sinusitis with nasal polyps, analyze its effectiveness and safety, and provide theoretical basis for clinical treatment.MethodsBoolean logic searching was adopted to retrieve articles from various databases, including PubMed, Medline, and Chinese National Knowledge Infrastructure (CNKI), published from the establishment of the database to December 30, 2021. The following search terms were used: “endoscopic sinus surgery”, “antrochoanal polyps”, “chronic sinusitis with nasal polyps”, and “nasal polyps”. Comparative studies on traditional surgical treatment and endoscopic sinus surgery were also screened out. Review Manager was utilized for meta-analysis.ResultsA total of 9 references were included in the study, and most of them were low risk bias (medium and high quality). Meta-analysis showed that there was no statistical heterogeneity between the control group and the experimental group (Chi2=0.03, I2=0%, P=0.98). According to the fixed effect model analysis, the number of patients with polyp formation in the experimental group was significantly less than that in the control group (Z=2.65, P=0.008). Compared with the control group, there is no statistical heterogeneity in the postoperative recurrence (Chi2=1.59, I2=0%, P=0.45). According to the analysis of fixed effect model, the postoperative recurrence in the experimental group is significantly less than that in the control group (Z=2.92, OR =2.78, 95% CI: 1.40–5.52, P=0.004). Compared with the control group, the results of postoperative visual analogue scale (VAS) were statistically different (Chi2=12.63, I2=84%, P=0.002). According to the random effect model analysis, the VAS score of the experimental group was significantly lower than that of the control group (Z=18.06, MD =4.51, 95% CI: 3.96–5.05, P<0.00001).DiscussionEndoscopic sinus surgery could reduce the postoperative recurrence and pain of patients, and showed high curative effects and safety in the treatment of children with chronic sinusitis with nasal polyps.

Safety of Endoscopic Sinus Surgery in the Elderly-Are Octogenarian Patients at a Higher Risk?

Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients. To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians. Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018. We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups. Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.

Outcomes of Endoscopic Sinus Surgery in Geriatric Patients: An Institutional Study.

The aim of this study was to investigate the efficacy and safety of Endoscopic Sinus Surgery (ESS) as a treatment modality for chronic rhinosinusitis refractory to maximal medical therapy in the elderly population. ESS has gained importance over the past 2-3 decades. A prospective review of outcome was done in fifty seven patients over age of 60years who underwent ESS. They were evaluated preoperatively and postoperatively at 3, 6, and 12months with a rigid nasal endoscopy scoring system, and the Sino Nasal Outcome Test-20 questionnaire. Data analysis was performed using the Student's t test to compare mean scores. All complications were noted. All of the patients in the study reported postoperative symptomatic improvement. And it was concluded that ESS in the geriatric population is a safe and effective treatment modality for rhinosinusitis which is refractory to medical therapy.

Clinical Effect and Safety of Endoscopic Sinus Surgery in Patients over Seventy

Clinical Effect and Safety of Endoscopic Sinus Surgery in Patients over Seventy

Safety of endoscopic sinus surgery in children with cystic fibrosis

IntroductionData on the safety of endoscopic sinus surgery (ESS) are limited in children with cystic fibrosis (CF). We used a multi-institutional surgical registry to examine ESS outcomes in children with CF. MethodsThe 2014–2015 American College of Surgeons' National Surgical Quality Improvement Program-Pediatric database was queried for patients age <18 years undergoing elective ESS. Prolonged hospital stay (>1 day), 30-day readmission, and 30-day unplanned reoperation were compared according to presence of CF diagnosis. ResultsThe data included 213 children with CF (age 10 ± 5 years, 105/108 male/female) and 821 children without CF (age 10 ± 5 years, 504/317 male/female). CF patients were more likely than non-CF patients to require prolonged hospital stay (30% vs. 9%, p < 0.001), yet had similar rates of readmission (6% vs. 4%; p = 0.189) and reoperation (0 vs. 1%; p = 0.133). All readmissions but one among CF patients were unrelated to ESS. In the non-CF cohort, reasons for ESS-related readmissions included recurrence of sinusitis, postoperative pain, and bleeding. ConclusionsWe demonstrate the safety of ESS in the largest cohort of children with CF reviewed to date. Multi-institutional review of ESS safety may contribute to monitoring expansion of this intervention in children with CF.

Endoscopic sinus surgery for the treatment of chronic rhinosinusitis in patients with postirradiated nasopharyngeal carcinoma

Purpose Our purpose was to evaluate the efficacy and safety of endoscopic sinus surgery (ESS) in patients with nasopharyngeal carcinoma (NPC) after irradiation. Materials and methods A retrospective study of postirradiated NPC patients who received ESS for the treatment of chronic rhinosinusitis in Taichung Veterans General Hospital. Symptoms, endoscopic findings, and computed tomography were used to evaluate the efficacy of ESS in these patients, and the safety was evaluated by intraoperative findings and complications. Results Since 1996, 10 postirradiated NPC patients with chronic rhinosinusitis have been treated by ESS and followed up for at least 2 years. The interval between radiotherapy and ESS was from 4 months to 16 years. After surgery, 7 patients felt improved except for one patient who died of tumor recurrence and computed tomography scores changed from 6.6 to 3.7, although prolonged nasal crusting was observed in most patients by endoscopy. One patient was complicated with cerebrospinal fluid leakage and the dura defect was immediately repaired without any sequelae. Conclusions This study shows that ESS is effective for the treatment of chronic rhinosinusitis in postirradiated NPC patients if they failed medical treatment.

Ultrasonography in a nasal cavity filled with water during endoscopic sinus surgery.

We developed a new ultrasonographic imaging technique to be used in a water-filled nasal cavity during endoscopic sinus surgery, and estimated how well surgically dangerous sites were depicted. Our newly developed balloon can completely fill the choana, preventing water from leaking into the pharynx. The balloon enables endoscopic sinus surgery to be relatively safely performed in "flowing water." Fifteen patients with chronic sinusitis underwent endoscopic sinus surgery under local anesthesia, and a MicroTip Radial probe was inserted into the water-filled nasal cavity. The orbital contents, skull base, and maxillary sinuses were visualized in all cases. Even in cases with a thin lamina papyracea, the boundary of the orbit could be judged from the motion of the orbital contents. Ultrasound information obtained in real time will be useful for improving the safety of endoscopic sinus surgery. Our ultrasonographic imaging technique can provide an early warning to the surgeon and thereby prevent severe complications.

Safety of Endoscopic Sinus Surgery in a Residency Training Program

Over the past decade, endoscopic sinus surgery has become one of the most frequently performed operations in otolaryngology. Nevertheless, concerns have been raised about the safety of this procedure in a residency training program. To address this issue, we carried out a retrospective review to assess the complications of endoscopic sinus surgery performed by otolaryngology residents under close supervision. We reviewed the medical records of 597 patients who had undergone 719 operations performed by residents in the Department of Otolaryngology-Head and Neck Surgery of the University of Southern California-Los Angeles County Medical Center and at the University Hospital between June 1988 and December 1995. Most of these procedures were performed by junior residents under the supervision of either a senior resident or faculty member. We found that the incidence of minor and major complications was 12.2 and 0.4%, respectively. The most common minor complications were vascular. The only major complication was excessive bleeding that required transfusion. There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. We conclude that endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.

The use of intraoperative CT guidance systems for endoscopic sinus surgery

Due to the complexity and vital nature of the anatomy involved, endoscopic sinus surgery is subject to complications. In recent years, computer-based guidance systems have been developed to incorporate preoperative computed tomography during a procedure. A pointer can be placed at a tissue surface under endoscopic visualization. The location of the tip of that pointer is simultaneously displayed on sagittal, axial, and coronal CT images. This localization provides information as to the surrounding anatomy not visible from the direct view of the surface. It is hoped that such a technique could reduce the duration and improve the safety of endoscopic sinus surgery. The number of systems currently under development testify to the interest in the technology, and the literature presents evidence on behalf of the technique's usefulness and potential.

Holmium: Yttrium aluminum garnet laser‐assisted endoscopic sinus surgery: Laboratory experience

Endoscopic sinus surgery has gained wide acceptance since its introduction into the United States. Complex sinus anatomy and troublesome bleeding have been associated with complications, which vary in severity from synechia to blindness and leakage of cerebrospinal fluid. Endoscopic sinus surgery using a holmium: yttrium aluminum garnet pulsed solid-state laser oscillating at 2.1 microns with fiberoptic delivery was performed in the laboratory, and the results were compared with those of conventional endoscopic sinus surgery. Three beagle dogs, six human cadaver heads, and one calf head were used in the in vivo and in vitro studies to evaluate the bone ablation, tissue coagulation, and hemostatic properties of the holmium: yttrium aluminum garnet laser. Modified endoscopic telescopes for sinus surgery, a newly developed handpiece for fiberoptic delivery, and other surgical instruments were used. The results indicate that the holmium: yttrium aluminum garnet laser and new delivery instrumentation provide good hemostasis and controlled soft-tissue ablation and bone removal. The access to all sinuses in the human cadaver model was very good. The canine in vivo study showed delayed but complete healing on the laser-treated side. Clinical evaluation of the holmium: yttrium aluminum garnet laser is warranted to increase the precision and safety of endoscopic sinus surgery.

COMPUTERIZED TOMOGRAPHY MINI-SERIES: AN ALTERNATIVE TO STANDARD PARANASAL SINUS RADIOGRAPHS

Computerized tomography (CT) imaging provides detailed information on the paranasal sinuses that is not available from standard radiographs. The planning and safety of endoscopic sinus surgery is greatly improved by CT imaging. Frequently standard radiographs are ordered because of the reduced cost. The four-slice CT Mini-series outlined in this paper provides high resolution bone and soft tissue imaging of the key surgical areas. The Mini-series comprises three precisely placed coronal slices and one axial slice. An average Mini-series takes 20 min to perform at a cost of $NZ66.00. Standard radiographs take up to 30 min to perform at a cost of $NZ38.00.