Underwent Sinus Surgery Research Articles

Impact of Sinus Surgery on Pseudomonal Airway Colonization, Bronchiolitis Obliterans Syndrome and Survival in Cystic Fibrosis Lung Transplant Recipients

Background: Lung transplantation (LTx) is a therapy for patients with cystic fibrosis (CF) end-stage lung disease. Pseudomonal airway colonization (PAC) is common in CF. Objectives: We investigated the influence of post-transplant sinus surgery and daily nasal douching on PAC after LTx and the influence of PAC on survival and bronchiolitis obliterans syndrome (BOS). Methods: CF patients transplanted at our centre were included (November 1992 to December 2009). Clinical data, including microbiological data before and after LTx were collected. Survival and BOS following LTx were compared for CF recipients with and without PAC by Kaplan-Meier statistics and Cox regression analysis. Results: Ninety-four CF patients were transplanted, of whom 82 (87%) underwent sinus surgery after transplantation, and 65% of 66 patients with pre-transplant PAC had persistent PAC after transplantation. Upper and lower PAC is related. Patients without PAC after transplantation had a significantly better survival rate, and BOS was less frequent with a later onset. PAC was the only significant parameter for the development of BOS stage 2 in the multivariate analysis for cytomegalovirus infection, acute rejection and PAC. Conclusions: Sinus surgery and daily nasal douching reduced PAC in LTx recipients. Absence of post-transplant PAC had a positive impact on post-transplant survival and the development of BOS.

Prevalence of sinonasal outcome test (SNOT‐22) symptoms in patients undergoing surgery for chronic rhinosinusitis in the England and Wales National prospective audit

Review and evaluate the prevalence and severity of individual symptoms in patients with chronic rhinosinusitis (CRS) with or without nasal polyposis. Retrospective analysis of data from the National Comparative Audit of Surgery for Nasal Polyposis and CRS, carried out across 87 hospitals in England and Wales between 2000 and 2001. A total of 2573 patients with CRS (1784 had CRS with nasal polyposis, 789 without nasal polyposis) who had undergone sinus surgery. Severity of clinical symptoms scores was graded on the Sino-Nasal Outcome Test 22 questionnaire. Prevalence of these symptoms and mean symptom scores were calculated for each group of patients at baseline and 3 months after surgery. In both groups, nasal blockage/congestion had the highest mean symptom score, followed by altered smell/taste and then the need to blow nose. These three symptoms were the most prevalent in the group with nasal polyposis. In the group without nasal polyposis, nasal blockage was also the most prevalent individual symptom (93.5%) followed by altered smell/taste (75.7%). The third most prevalent symptom was waking up tired (69.9%). The average test score preoperatively was 41.5 (group with nasal polyposis) and 44.4 (group without nasal polyposis). This decreased to 18.3 and 14.1, respectively, 3 months after surgery (P < 0.001). The leading three symptoms were nasal blockage/congestion, altered taste/smell and the need to blow the nose in terms of severity and prevalence. The total Sino-Nasal Outcome Test 22 and all individual symptom scores improved significantly after surgery.

Evidence‐Based Long‐term Outcomes in ESS

Objective: 1) Analyze appropriateness of endoscopic sinus surgery. 2) Understand the long-term results of endoscopic sinus surgery at an academic institution with an academic and private practice blend of patients using the Sino Nasal Outcome Test (“SNOT 22”) statistically validated tool. Method: Included consecutive patients undergoing sinus surgery at CSMC since January 2009 who were able to complete SNOT-22 prior to surgery. Three hundred fifty patients were included from 17 physicians. Patients mailed the postop form 3, 6, and 12 months following surgery. Patients ranged from 22 years to 67 years split between 220 females and 330 males. Results: The results were quite impressive for patients from immediate to long-term (12 month) postoperative results. The results were statistically significant in demonstrating an improvement of symptoms overall and in all 4 subcategories with a univariate analysis demonstrating P values of &lt;.001. These results were very exciting due to the multi-cultural and varied nature of the patients ranging from tertiary care academic referrals to community otolaryngology patients. Conclusion: It was concluded that endoscopic sinus surgery was effective with results reaching statistical significance in demonstrating an improvement of symptoms overall and in all 4 sub-categories with a univariate analysis demonstrating P values of &lt;.001. Scientific findings demonstrate that patients had major improvement scores 3, 6, and 12 months after surgery.

Three‐Dimensional Imaging for Sinus Surgery Informed Consent

Objective: 1) Compare the efficacy of using standard 2-dimensional computed tomography (CT) and magnetic resonance imaging (MRI) against 3-dimensional reconstruction during the informed consent process of sinus surgery. 2) Determine whether 3D visualization technology affects patient anxiety prior to sinus surgery. Method: A randomized, controlled prospective study of patients undergoing sinus surgery was conducted at a tertiary academic center from 2011-2012. Patients were assigned to receive preoperative informed consent with the assistance of 2-dimensional CT/MRI or 3D reconstruction. Questionnaires were administered and compared to assess understanding, satisfaction, and anxiety during the process. Results: Thirty-four patients were enrolled in this study. There was no significant variation of age, gender, or education level between the groups. The 3D reconstruction group demonstrated significant improvement in the perceived understanding of their condition, the operation, and the potential complications from the procedure as compared to the 2-dimensional CT/MRI group ( P &lt; .05). Patients in the 3D reconstruction group were also more satisfied with the informed consent process as a whole. Preoperative anxiety did not vary significantly between the groups. Conclusion: Three-dimensional reconstruction technology is an effective tool to improve patient understanding and satisfaction during the informed consent process prior to sinus surgery.

Paranasal sinus exostoses: An unusual complication of topical drug delivery using cold nasal irrigations

The use of topical drug delivery through nasal irrigations can minimize systemic side effects and deliver higher concentrations of drugs directly to diseased sinus mucosa. Complications related to this popular method of treatment are not well described. We present our experience with paranasal sinus exostosis (PSE), a new diagnostic entity that appears to be a complication of cold nasal irrigations. Retrospective chart review. Retrospective chart reviews were performed on patients within the Cleveland Clinic Foundation from 2005 to 2011. Six patients were identified with sinus exostoses. A literature review for "sinonasal exostoses" and "paranasal sinus exostoses" was performed using PubMed. Six patients with PSE were identified at the Cleveland Clinic Foundation between 2005 and 2011. All patients had undergone sinus surgery, and none had documented evidence of PSE prior to surgery. There was no evidence of worsening PSE once the cold irrigations were stopped. No patients showed any resolution of PSE over time. None of our patients has progressed to have disease burden significant enough to require intervention. PSE is a rare condition that mirrors a well-described otologic process; exostoses of the external auditory canal. PSE appears to be a complication of cold nasal irrigations. It does not resolve with the halting of cold irrigations, but does not appear to progress further after intervention. PSE only affects postoperative patients. With the evolving trend to treat postoperative sinus disease topically, the clinician should be aware of the dangers of cold irrigations, and patients should be counseled accordingly.

Long-term low-dose antibiotics in recalcitrant chronic rhinosinusitis: a retrospective analysis

In recalcitrant Chronic RhinoSinusitis (CRS) treatment with intranasal corticosteroids, short-term antibiotics and even sinus surgery is frequently insufficient. Long-term low-dose administration of antibiotics has been suggested as a treatment option in these patients. We analysed the outpatient clinic population treated with different long-term low-dose antibiotics at the AMC Amsterdam. Eligible patients, who were treated with trimethoprim-sulfamethoxazole or macrolides, were retrospectively identified from our outpatient clinic in 2009. The two main outcome measures were sinonasal complaints and nasal endoscopic findings. A 5-point grading scale was used to score the results compared with the pre-treatment situation. This was measured at several time-points during, and after the antibiotic course, and at the end of the follow-up term. Seventy-six patients were included, 53 per cent had asthma and all of them had undergone sinus surgery. Seventy-eight per cent showed improvement of the symptoms, and 84 per cent demonstrated improvement of the sinonasal mucosa at the end of the course. No significant difference was found between the trimethoprim-sulfamethoxazole and macrolide group. Long-term low-dose treatment with antibiotics seems to improve CRS symptoms and the appearance of the sinonasal mucosa on nasal endoscopy. However, at this stage, strong conclusions are immature because no placebo-group has been included. Despite increasing use of long-term low-dose treatment of recalcitrant CRS in referral centres, hard clinical evidence is lacking. More research is urgently required.

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.

Effectiveness of FESS in Smell Improvement of Sinusitis Patients.

The aim of this research was to verify the effect of functional endoscopic sinus surgery (FESS) on olfactory dysfunction in patients who suffer from chronic rhinosinusitis. We enrolled prospective consecutive patients at a tertiary institution who were undergoing FESS; for these patients prolonged medical therapy for chronic rhinosinusitis had failed. Patients were asked to grade their olfactory dysfunction from 1 to 5 with 1 representing lack of any smell function and 5 representing a completely normal sense of smell. Moreover, the pre- and postoperative smell identification test of the University of Pennsylvania was performed for all participating patients. In addition, data including computed tomography scores, nasal endoscopy, and the presence or absence of asthma as well as smoking habits were recorded and analyzed. Patients were followed at least 1year after surgery. Data were collected on 89 patients who had undergone sinus surgery. Postoperative olfactory function was 77% improved for all subjects as a group. Higher involvement of sinus in computed tomography correlated with poorer results in olfactory UPSIT40 score. Patients' olfaction was significantly related to polyp pathology, duration of disease, age, smoking habits and history of asthma. A variety of patients' characteristics have impact on olfactory outcome of sinusitis patients after FESS.

Sinus Surgery in Children: Trends in Kosovo over a Nine Year Period

Aim: The paranasal sinuses are a common site of infection in children and adolescents and are associated with frequent morbidity. Rarely, life-threatening complications occur. The aim of this study was to investigate cases of sinus complications in children treated over the last nine years at the University Clinical Center, ENT Clinic, in Pristina, Kosovo. Methods: The total number of sinus complication was 56. Based on Chandler’s classification, the most frequent was group I, with palpebral inflammatory edema (27 cases), while the most infrequent was group V, with only one case of septic thrombosis of the cavernous sinus. Children with sinusitis with complications had markedly higher CRP levels (median: 10.05 mg/dL) and ESRs (median: 67 mm/h) than those with uncomplicated sinusitis (median CRP: 0.8 mg/dL; median ESR: 7 mm/h). Results: Six children underwent sinus surgery and 50 were treated with medications (p 0.05). Three of the children had more than one sinus infection (p>0.05). Of the 56 cases with sinus complications, 9.3% had nasal polyposis. Conclusions: Sinus complication surgery in children is decreasing in Kosovo not only because of treatment with aggressive antibiotic therapy, but also because of primary surgical interventions such as septoplasty, adenoidectomy and nasal polypectomy.

Cyclooxygenase 2 and Lipoxin A4 in Nasal Polyps in Cystic Fibrosis

The etiology of nasal polyps (NPs) and sinusitis in cystic fibrosis (CF) patients is still unknown. This study investigates the presence of cyclooxygenase 2 (COX-2) and lipoxin A(4) (LXA(4)) in epithelial cultures derived from NPs and turbinates in patients with CF and without CF. NPs and turbinates were evaluated from eight CF patients with obstructing NPs undergoing sinus surgery. NPs and tissue from the hypertrophic inferior turbinate from 14 patients without history of CF undergoing sinus surgery served as control specimens. After tissue culturing, the presence of COX-2 protein and LXA(4) (ELISA) was detected in CF polyps and turbinates and compared with that of the control group. COX-2 and LXA(4) were detectable in tissue specimens of all CF patients and control patients. COX-2 was highest in CF polyps, but the difference was not significant compared with CF turbinates or polyps and turbinates of patients not suffering from CF. LXA(4), however, was significantly higher in CF NPs compared with CF turbinate tissue. Compared with NPs of patients not having CF disease, CF polyps showed markedly higher concentrations of LXA(4). LXA(4) is significantly elevated in CF NPs, whereas COX-2 is only slightly increased. The present data support the concept that LXA(4) plays an important role in CF nasal polyposis. Chronic infection in nasal polyposis and, because of inflammation, induced COX-2 in CF NPs may be related to increased LXA(4). The suspected interaction of COX-2 and LXA(4) needs further investigation.

A Case of Bilateral Silent Sinus Syndrome Presenting With Chronic Ocular Surface Disease

The silent sinus syndrome is characterized by atelectasis of the maxillary sinus in the setting of subclinical maxillary sinusitis and obstruction of the osteomeatal unit. The resultant expansion of orbital volume causes enophthalmos and hypoglobus. A review of the literature reveals only unilateral cases. The authors present a case of bilateral silent sinus syndrome presenting with chronic ocular surface disease. A 56-year-old man was referred for tarsorrhaphy to treat a chronic recurrent corneal ulcer. Exam revealed an area of corneal thinning in the left eye. The patient appeared cachectic and there was enophthalmos, hypoglobus, and lagophthalmos on both sides, left worse than right. Due to the patient's appearance and a history of sinonasal malignancy, recurrent malignancy was suspected. A systemic workup was unrevealing, and radiographic studies showed the features of silent sinus syndrome bilaterally. The patient underwent sinus surgery and placement of a left orbital floor implant.

Biofilm Presence vs Postoperative Outcomes in Chronic Rhinosinusitis with Polyps

Objective: Evaluate the role of biofilms on sinus surgery outcomes of patients with chronic rhinosinusitis with nasal polyps (CRSwP). Method: Prospective study conducted in a tertiary care center among 2008-10. Patients underwent sinus surgery for CRSwNP, and mucosal samples were harvested for scanning electron microscopic. Preoperative and postoperative (followed up to 12 months) data were recorded. Data were considered nonparametric. Mann-Whitney test and Spearman rank correlation were used. Results: This was the first report to analyze the effect of biofilms only in patients with CRSwNP. Biofilms were present in 67.9 % (19/28) of the CRSwNP patients. Both groups had similar age median (Interquartile-Range = 45.0[15.0] vs 46.5[27.0]). Patients with biofilms had better Lund-Kennedy outcome (-3[5] vs -1[2], U = 46.0, P = .036). These patients had worst outcomes in SNOT-20 (-0.75[1.15] vs -1.30[1.32], U = 69.0, P = .21) and similar outcomes in NOSE (-55.0[50.0] vs -60.0[50.0], U = 81.0, P = .67) and Lund-Mackay (-4[5] vs -4[4], U = 75.5, P = .49). There was a correlation among QoL outcome scores in both groups, and between NOSE and Lund-Mackay outcomes scores in the biofilms group. (Spearman’s rank). Conclusion: This study showed that biofilms were present in most patients with CRSwNP, and these patients have less improvement of QoL. Moreover, the best endoscopic improvement may reflect a worse clinical preoperative status. Although CRSwNP is not caused by biofilms, it could act as an aggravating factor to the clinical picture of these patients.

Assessment of Predictive Factors for Biofilms Presence in Chronic Rhinosinusitis with Polyps

Objective: Evaluate predictive factors for the presence of biofilms during sinus surgery for chronic sinusitis with nasal polyps (CRSwP). Method: Prospective study conducted in a tertiary care center in 2008 to 2009. Patients underwent sinus surgery for CRSwP, and mucosal samples were harvested for scanning electron microscopic. Preoperative data were recorded. Data were considered nonparametric. Mann-Whitney test and Spearman rank correlation were used. Results: Biofilms were present in 66.6 % (22/33) of the CRSwNP patients. Both groups had similar age median [Interquartile Range] = 45.0 [15.0] (38-56) vs 46.5 [27.0] (22-78) and the same sex distribution (male:female ratio = 1.75). Patients with biofilms had worst Lund-Kennedy score (6.0[3.0] (3-10) vs 8.0[3.0] (3-11), U = 69.5, P = .44). Although patients with biofilms had worst NOSE and Lund-Mackay scores and best SNOT-20 and SNOT-20(5+) scores, those were not statistically different between groups. There was a strong correlation between preoperative NOSE and SNOT-20 scores in both groups. Conclusion: This study showed that biofilms were present in most patients with CRSwNP. Despite the fact that NOSE and Lund-Mackay scores were worse in patients with biofilms, only Lund-Kennedy scores shown a significant predictive value to find biofilms intraoperatively.

Syk-kinase inhibition prevents mast cell activation in nasal polyps

Mast cells are crucial effector cells in the allergic cascade. The cross-linking of the high affinity IgE receptor (FcεRI) activates mast cells and basophils. Spleen tyrosine kinase (Syk) is positioned upstream of the IgE receptor signal transducing pathway and may represent an important target for the treatment of nasal inflammatory diseases. We measured effects of a specific Syk inhibitor in the release of mast cell mediators in human cord blood-derived mast cells (CBDMCs) (in-vitro) and in human nasal tissue (ex-vivo). Surgical samples were collected from patients with nasal polyposis who underwent sinus surgery. Tissue cubes of +- 0.9 mm3 were primed with myeloma IgE (1 microg/ml), preincubated with Syk inhibitor NVP-QAB205 in different concentrations and then stimulated with tissue culture medium, anti-IgE 10 microg/ml and anti-IgE 30 microg/ml. Supernatants were analysed for concentrations of histamine, LTC4/LTD4/LTE4 and PGD2. CBDMCs were likewise pre-incubated with compound, prior to stimulation with anti-IgE at 10 microg/ml. In CBDMCs, the Syk inhibitor prevented degranulation assessed by measurement of histamine release and the production of LTC4/LTD4/LTE4 and PGD2. Furthermore, the Syk inhibitor was similarly able to significantly inhibit the release of these granules and newly synthesized mediators by nasal polyp mast cells in a dose dependent manner. Although the critical role of Syk in the IgE receptor signal transduction pathway has been well documented in vitro, this study supports the importance of Syk in IgE receptor-mediated degranulation of mast cells ex-vivo within nasal tissue. Thus, inhibition of Syk may represent an important therapeutic strategy for the treatment of upper airway disease with mast cell involvement, such as allergic rhinitis.

Prevalence and histopathology of chronic polypoid sinusitis in pediatric patients with cystic fibrosis

Background Chronic sinusitis is almost invariably a feature of cystic fibrosis. However, data on the endoscopically confirmed prevalence of chronic polypoid sinusitis (CPS) and its histological features are limited. Methods Single centre prospective observational study. Unselected pediatric CF patients (n = 81; ≤ 18 years) were endoscopically assessed for the prevalence of CPS. Sixteen of these underwent sinus surgery. The surgically obtained sinus specimens were compared to sinus specimen of non-CF-patients undergoing sinus surgery (n = 61), using conventional histology and immunohistochemistry. Results The prevalence of endoscopically confirmed CPS increased with age from 19% in infants younger than six years reaching 45% in adolescents. In CF patients, histology typically showed dilated glandular ducts and a predominance of mucous glands. The number of plasma cells and mast cells but not of eosinophils was significantly elevated compared to non-CF patients. Conclusion Prevalence of CPS in pediatric CF patients increases with age. Our findings indicate that chronic bacterial infection rather than allergic mechanisms may forward this pathology.

Complete Unilateral Maxillary Sinus Opacity in Computed Tomography

Unilateral maxillary sinus opacity can be caused by many diseases, but an exact diagnosis is difficult to make. The aim of this study was to describe the pathological conditions and clinical features of patients with unilateral maxillary sinus opacity. From 2004 to 2008, 830 consecutive patients underwent sinus surgery or endonasal endoscopic biopsy at an academic tertiary care center. The preoperative computed tomography (CT) images for these patients were reviewed, and 11 6 patients were identified with complete unilateral maxillary sinus opacification. We then analyzed presenting symptoms, physical examinations, specific CT findings, and pathology. The most frequent diagnoses were as follows: chronic rhinosinusitis (52.6%), fungus ball (29.3%), antrochoanal polyp (2.6%), benign tumor (10.4%), and malignancy (5.1%). Fungus ball was the most common diagnosis (10/18, 55.6%) in the subgroup of patients with isolated maxillary sinus opacity without disease in the other sinuses. Nasal discharge and foul-smelling breath were more common in inflammatory disease than in neoplastic disease. Neoplastic disease was more likely to present as epistaxis; a polyp or mass revealed by nasal endoscopy; mass effect in the cheek, palate, or gingiva; and bony erosion on CT. Erosion of the maxillary posterolateral wall and extra-sinus extension suggested malignancy. Although unilateral maxillary sinus opacity is usually inflammatory in origin, fungal sinusitis and neoplastic disorder are also likely. A careful history-taking, a thorough head and neck examination including nasal endoscopy, and CT evaluation are all imperative for reaching a correct diagnosis.

Sinus aspirates in chronic rhinosinusitis: fungal colonization of paranasal sinuses, evaluation of ICAM-1 and IL-8 and studying of immunological effect of long-term macrolide therapy

In patients with chronic fungal sinusitis, concentrations of interleukin-8 (IL-8), immunoglobulin E (IgE), and soluble intercellular adhesion molecule-1 (sICAM-1) were compared in paranasal sinus aspirates and serum. Furthermore, immunological effects of macrolide treatment of our patients with chronic fungal rhinosinusitis were also studied. In our cohort study, 108 patients with chronic rhinosinusitis undergoing sinus surgery were selected. Sinus aspirates were collected, and used for immunological assasy and cultured for fungal study. All patients were examined for the presence of characteristic allergic mucin of chronic allergic fungal rhinosinusitis and this was confirmed later by measurement of total serum IgE. Our cases were classified into 3 groups: chronic rhinosinusitis with positive fungal culture and negative allergic mucin, chronic rhinosinusitis with positive fungal culture and positive allergic mucin and chronic rhinosinusitis without fungal growth. A control group was included. We found 57.4% of the patient cultures positive for fungus and 36.4% of the control subjects. Aspergillus ssp. were the most prevalent followed by Bipolaris ssp., and Curvularia. IgE levels were increased in group II compared to group I, III and IV. ICAM-1 and IL-8 levels were increased in groups I, II and III compared to the control group. Erythromycin given in group II decreased the levels of IL-8 and ICAM-1. Aspergillus species were the most common. These results confirm the role of ICAM-1 and IL-8 in all types of rhinosinusitis. Erythromycin modulated the immune status of the patients.

Outcome of computer-assisted surgery in patients with chronic rhinosinusitis

To compare the complication rates and outcome of computer-assisted versus non-computer-assisted functional endoscopic sinus surgery. We reviewed retrospectively the medical records of 276 patients who had undergone sinus surgery for chronic rhinosinusitis with (n = 108) or without (n = 168) computer assistance, from 1996 to 2004, to determine the incidence of complications and need for revision surgery. The incidence of complications was 6.5 per cent in the computer-assisted group and 6.0 per cent in the non-computer-assisted group (p = 1.00). In the computer-assisted group, 9.2 per cent needed revision surgery, compared with 10.7 per cent in the non-assisted group (p = 0.84). Although our study found no significant difference in complications or revision rates, computer-assisted surgery serves as an important orientation aid during functional endoscopic sinus surgery.

Digital volume tomography (DVT) measurements of the olfactory cleft and olfactory fossa

Conclusion: Preoperative imaging is important, because of the small size of the cribriform plate, different anatomical variants of the olfactory fossa in varied patients and unequal width of the cribriform plate in the anterior and posterior third. Objective: Digital volume tomography (DVT) is a rather new imaging technique for the diagnosis of diseases of paranasal sinuses. This technology is dedicated to the evaluation of the distinctive structures of the anterior skull base due to the high resolution of the DVT. Based on the Keros classification this anatomic area was analyzed radiologically and also in relation to the uncinate process. Methods: The investigation was performed on 111 patients. The Accu-I-tomo F17 was used. Patients with total nasal polyposis and patients who had undergone sinus surgery were excluded from the study. Results: Keros type I was found in 11.25% of the patients, type II in 68.05% and type III in 20.7%. Significant asymmetry of the olfactory fossa was identified in nine patients (8.1%). The width of the olfactory cleft varied from 0 to 3.25 mm. No relation between Keros type and a particular onset of the uncinate process to orbit, skull base or middle turbinate could be detected.

A prospective, randomised, placebo-controlled trial of postoperative oral steroid in allergic fungal sinusitis

The aim of this study is to determine the effectiveness of postoperative oral steroid in controlling disease in patients with allergic fungal sinusitis (AFS). The study design includes prospective, randomised, double blind,placebo-controlled trial using oral prednisolone.Twenty-four patients diagnosed with AFS underwent sinus surgery (endoscopic sinus surgery with or without open surgery) to completely excise disease. Patients were randomised to receive either oral steroid (n = 12) or placebo(n = 12) soon after surgery. All patients were also administered itraconazole and steroid nasal spray in the postoperative period. Subjective evaluation of symptom relief and objective evaluation by rigid nasal endoscopy at 6 and 12 weeks following surgery was performed. After12 weeks, the code was broken and the two groups of patients were identified to note their response to treatment.At 6 weeks, complete relief of preoperative symptoms was obtained in eight patients who had received oral steroid and none who had received placebo (p = 0.001). Partial relief of preoperative symptoms was obtained in four who had received oral steroid and eight who had received placebo.Nasal endoscopy revealed that 8 of 12 patients who had received oral steroid and 1 patient who had received placebo were disease free (p = 0.009). At 12 weeks, complete symptom relief was obtained by all patients who received oral steroid but only one who received placebo(p = 0.0001). Nasal endoscopy at 12 weeks revealed that all 12 patients who had received oral steroid and only 1 patient (the same patient) who had received placebo were disease free (p = 0.0001). In conclusion, postoperative oral steroid in a tapering dose produces significant subjective and objective improvement of patients with AFS. It is also effective in preventing early recurrence. Inclusion of post operative oral steroid therapy for at least 12 weeks is recommended in all patients who undergo excisive surgery for AFS.