Sinus Surgery For Nasal Polyposis Research Articles

The subjective and objective outcomes of endoscopic sinus surgery for nasal polyposis using microdebrider versus conventional instruments: a randomized controlled trial

BackgroundSince the evolution of the microdebrider technology and its modulations to be suitable for rhinology, many attempts were carried out to replace the conventional instruments with microdebrider especially in cases of nasal polyposis. Also, many studies were conducted to compare the efficacy of both tools in functional endoscopic sinus surgery. Those studies focused on objective outcomes as the duration of surgery and the amount of blood loss.Aim of the studyComparing the efficacy of microdebrider in cases of resistant chronic rhinosinusitis with nasal polyposis to conventional instruments. Analysis of subjective outcomes is mainly the quality of life of our patients, and not neglecting the objective outcomes but analyzing them thoroughly.MethodThis is a randomized controlled clinical trial, conducted on 100 patients which were diagnosed to have resistant chronic rhinosinusitis with polyposis. We used the microdebrider in functional endoscopic sinus surgery for 50 patients and conventional instruments for the other 50 cases. We compared the operative time, amount of blood loss, and postoperative improvement of quality of life, the presence of adhesions, crustations, and complications, or recurrence of nasal polyposis in both groups.ResultsWe found significant differences in favor of microdebrider mainly in the duration of surgery and the amount of blood loss. Patient satisfaction was better in the microdebrider group, especially in the short-term follow-up, while the postoperative clinical scores were better in the long run.ConclusionUsing the microdebrider in dealing with nasal polyposis is much preferable to conventional instruments. For patients, they feel much better in a shorter duration postoperatively. For surgeons, the manipulations are easier, and the operative field is bloodless and clear.

Endotyping of nasal polyps in a multiracial Asian population

Background: Chronic rhinosinusitis is a heterogenous disease with variation in the endotypes of nasal polyps, with type 2 inflammation being more prevalent in Caucasian populations whereas Chinese populations are more heterogenous. We aim to describe the variation in endotypes for patients with chronic rhinosinusitis with nasal polyposis in our unique multiracial population. Methodology: Demographic, clinical and structured histopathological data of 66 patients who underwent sinus surgery for nasal polyposis were evaluated retrospectively. Results: 54.6% had eosinophilic disease, and 45.4% had non-eosinophilic disease with no significant demographic differences between the 2 populations. There were significantly higher peripheral eosinophil levels in patients with eosinophil-predominant inflammation on tissue histology (mean absolute eosinophil count 0.59 ± 0.18 x 109) compared with non-eosinophilic disease (mean absolute eosinophil count 0.24 ± 0.11 x 109). Structured histopathological reporting revealed that patients with eosinophilic disease had higher degree of inflammation and eosinophil aggregates. Conclusions: Our population is shown to have a slight preponderance toward eosinophilic disease, however the Chinese majority tended to have non-eosinophilic disease. Serum eosinophilia and the presence of asthma seems to correlate well with tissue eosinophilia, which can potentially be utilised as markers of type 2 inflammatory disease.

A comparative study of microdebrider assisted versus conventional endoscopic sinus surgery for nasal polyposis

<p class="abstract"><strong>Background:</strong> Nasal polyps are benign, chronic, inflammatory lesions arising from the mucosa of the nasal sinuses or from the mucosa of the nasal cavity. They are a challenge to treat due to their uncertain etiology and tendency to recur. Therapy involves both medical and surgical treatment. Surgical management includes Endoscopic sinus surgery using conventional instruments or by microdebrider.</p><p class="abstract"><strong>Methods:</strong> We conducted a study on 80 patients with nasal polyposis in whom conservative management failed. They were equally randomised into powered and conventional instruments Endoscopic Sinus Surgery (ESS) groups. The groups were compared for surgical outcomes, intra and postoperative complications and recurrence rates. </p><p class="abstract"><strong>Results:</strong> Age of patients suffering from bilateral nasal polyposis ranged from 18 to 55 years with maximum number of patients in the group 31 to 40 years. Nasal polyps were more commonly seen in men (53.75%) than women (46.25%). Most common symptom experienced was nasal obstruction (100%), followed by olfactory disturbance in 88.7% and nasal discharge in 76.25%. There was statistically significant difference in operative time, blood loss and postoperative synechiae, with the microdebrider group showing better outcomes. There was no statistically significant difference in the postoperative VAS (visual analogue score) and recurrence rates between the two groups.</p><p class="abstract"><strong>Conclusions:</strong> Powered endoscopic sinus surgery offers a better therapeutic approach for patients with nasal polyposis than with conventional instruments. It provides bloodless operative field with better visualisation for a more precise, less traumatic procedure with shorter operative time.</p>

Evaluation of residual symptoms: A method to assess surgical outcomes for nasal polyposis.

The assessment of residual symptoms after endoscopic sinus surgery for nasal polyposis (NP) could be an accurate way to evaluate surgical outcomes. To assess the residual symptoms and their severity at 6 weeks and 7 months after radical ethmoidectomy for NP. Sixty-five patients who had surgery for NP were included in this prospective study. Six residual symptoms (nasal obstruction, anterior rhinorrhea, postnasal discharge, olfactory disturbances, facial pain, and cough) were assessed by using the validated Dysfonctionnement Nasal Chronique (French) or Chronic Nasal Dysfunction (English) questionnaire at 6 weeks and 7 months after surgery. Olfactory measurements were performed with the Sniffin' Stick test. A self-rating score of ≥1 was considered as "having a complaint." Radical ethmoidectomy for NP improved not only the number of symptoms but also the intensity of symptoms. Before surgery, 64 of 65 patients (98.46%) reported at least three of the six symptoms, whereas 26 patients (40%) reported six symptoms, 16 (24.62%) reported five symptoms, and 14 (21.54%) reported four symptoms. At 6 weeks and at 7 months after surgery, one-third of the patients had fewer than three symptoms. Olfactory disturbance remained the most mentioned postoperative disabling problem. Posterior discharge tended to become more pronounced at 7 months than at 6 weeks after surgery but remained considerably improved compared with the preoperative state. This information is useful to warn patients about the difficulty of getting rid of all symptoms and that there is a chance that some symptoms remain or even reappear after NP surgery.

Quality of life outcomes after functional endoscopic sinus surgery for nasal polyposis

PurposeThe objective of this study is to determine the results of functional endoscopic sinus surgeries (FESS) for chronic rhinosinusitis with polyps and assess the association between surgery and specific quality of life outcomes. Materials and methodsA prospective study was performed in a tertiary referral center. Fifty-eight patients affected by chronic rhinosinusitis with nasal polyposis underwent endoscopic sinus surgery from January 2011 to April 2013 and followed for 1year. The rhinosinustis disability index (RSDI), a validated disease-specific instrument, was used to quantify the patient's symptoms before and 12months after surgery. ResultsA strongly statistically significant reduction was seen between the mean scores on RSDI before and after FESS [86.43 (IQR=16.10) versus 51.16 (IQR=18.95), Wilcoxon signed-rank test, p<0.0001]. In multiple regression model, only four preoperative characteristics predicted the outcomes. The high mucosal eosinophilia density was the most important preoperative predictor. ConclusionsThere is evidence which supports the efficacy of FESS to improve long-term QOL outcomes in patients with CRS. The mucosal eosinophilia density and prior sinus surgery appeared to be the most predictive factors of surgical outcomes.

Non-steroidal anti-inflammatory drug-activated gene-1 expression levels in nasal polyposis

This study aims to investigate the possible role of non-steroidal anti-inflammatory drug-activated gene-1 (NAG-1) in nasal polyp development. Twenty-one patients (15 males, 6 females; mean age 44.3 years; range 16 to 65 years) who underwent endoscopic sinus surgery for nasal polyposis (NP) were included in the study. Inferior turbinate mucosa samples were taken in addition to the polyp tissue which was already removed during routine procedure. The NAG-1 gene messenger ribonucleic acid (mRNA) expression levels of the polyp tissue and healthy turbinate mucosa were examined by real-time polymerase chain reaction (PCR). Patients were divided into two groups based on the presence or absence of comorbid asthma. The NAG-1 gene expression of the polyp tissue was 1,089 fold higher, compared to the healthy nasal mucosa (p=0.757). The NAG-1 mRNA levels were 2.13 times decreased in the patients with comorbid asthma (p=0.275). There was no statistically significant difference between the groups. With the findings of this study NAG-1 gene may play a role in nasal polyp development in the presence of comorbid asthma.

Effect of polyvinyl acetal sponge nasal packing on post-operative care of nasal polyposis patients: a randomised, controlled, partly blinded study

To compare the effects of routine nasal packing with polyvinyl acetal sponge (Merocel) versus no packing, after endoscopic sinus surgery for nasal polyposis. This clinical, randomised, controlled trial was performed in an academic tertiary referral centre between 2008 and 2011. Sixty patients with resistant nasal polyposis underwent endoscopic sinus surgery, and were then randomly divided into two groups: packed and non-packed. The amount of bleeding and pain in each group during pack removal was documented. There was no significant difference between the two groups in the outcome of surgery and complications. One patient in each group needed extra packing. In the packed group, the mean ± standard deviation pain score on pack removal was 61 ± 3 (using a visual analogue scale in which 0 = no pain and 100 = worst pain imaginable). This study found no significant difference between polyvinyl acetal packed and non-packed groups, following endoscopic sinus surgery for nasal polyposis. This confirms the findings of similar studies, and supports the reconsideration of routine post-operative packing in selected cases.

Evaluation of Peripheral Eosinophil Counts Pre and Post-Functional Endoscopic Sinus Surgery for Nasal Polyposis in Patients with Concomitant Asthma and Allergic Rhinitis

The etiology of elevated peripheral eosinophil counts is extensive, but common causes include asthma and allergic rhinitis. Individuals with extensive chronic rhino-sinusitis with nasal polyposis can also have eosinophilia. In patients with all three, it is hard to determine which disease is the primary cause. We describe two patients with asthma, allergic rhinitis, and chronic rhino-sinusitis/nasal polyposis with persistent eosinophilia that underwent functional endoscopic sinus surgery (FESS) and post-operative blood counts showed a significant decline in the absolute eosinophil counts.