Effect of functional endoscopic sinus surgery in patients of chronic sinusitis with bronchial asthma

The advent of functional endoscopic sinus surgery (FESS) has revolutionized the treatment of chronic sinusitis over the last decade. Although it has been well-established that FESS is more efficacious than conventional surgery, the lack of a quantifiable means of assessing results remains one of the major shortcomings of the technique, and hence a source of criticism. Since the pathophysiology of chronic sinusitis is intimately related to the mucociliary mechanism of the nose and sinuses, it seems logical to use this parameter as a yardstick of success. We undertook a prospective, controlled study of 40 patients and measured their “saccharin times” before and after surgery. The results show a marked reduction in clearance times postoperatively, corresponding well with improvement in symptom profile. We therefore propose this technique as a simple, safe and reliable method of assessing the results of surgery. Furthermore, the method could act as a preoperative indicator of ciliary motility disorders, as the prognosis in these patients is distinctly poor.

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Functional Endoscopic Sinus Surgery in Patients with Chronic Sinusitis and Asthma

Otolaryngology ◽

10.1177/019459989411000604 ◽

1994 ◽

Vol 110 (6) ◽

pp. 494-500 ◽

Cited By ~ 38

Author(s):

Gary J. Nishoka ◽

Paul R. Cook ◽

William E. Davis ◽

Joel P. McKinsey

Keyword(s):

Endoscopic Sinus Surgery ◽

Hospital Admissions ◽

Chronic Sinusitis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Office Visits ◽

Sinus Disease ◽

Physician Office ◽

Steroid Dependent ◽

The Impact

Twenty asthma patients who underwent functional endoscopic sinus surgery for chronic sinusitis were studied. Medical records and questionnaire data for these 20 patients were studied regarding the Impact of sinus disease and functional endoscopic sinus surgery on their asthma. We found that 95% reported that their asthma was worsened by their sinus disease (95% confidence interval, 0.74 to 0.99+), and 85% reported that functional endoscopic sinus surgery improved their asthma (0.60 to 0.97). Of the 13 patients who used both inhalers and systemic medication, 53.8% were able to eliminate some of their medication (0.21 to 0.79). Furthermore, 61.5% of these patients had a concomitant reduction in their inhaler use (0.28 to 0.85). All patients (six) who used only inhalers experienced a reduction in their inhaler use (0.54 to 1.00), and two patients were able to eliminate their inhalers completely. One of two patients who were steroid dependent was able to discontinue steroids after surgery. Of patients who used steroids intermittently (13), 53.8% were able to eliminate the use of steroids after surgery (0.21 to 0.79). Patients who required preoperative hospital admissions (4) and emergency room or urgent physician office visits (18) had a 75.0% and 81.3% ( p < 0.001) reduction in visits, respectively, after surgery. Because 43% of the cost of asthma is the result of hospitalizations and emergency department/urgent physician office visits, a significant Impact on health care costs can be realized with functional endoscopic sinus surgery in this patient population.

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Immunotherapy in Patients Undergoing Functional Endoscopic Sinus Surgery

Otolaryngology ◽

10.1177/019459989411000410 ◽

1994 ◽

Vol 110 (4) ◽

pp. 406-412 ◽

Cited By ~ 71

Author(s):

Gary J. Nishioka ◽

Paul R. Cook ◽

William E. Davis ◽

Joel P. McKinsey

Keyword(s):

Endoscopic Sinus Surgery ◽

Chronic Sinusitis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Outcome Parameters ◽

Allergic Symptoms ◽

Polyp Recurrence ◽

Better Than

A total of 283 consecutive patients with chronic sinusitis underwent functional endoscopic sinus surgery. There were 72 allergic patients and 211 nonallergic patients. Data were collected on the effect of immunotherapy on middle meatotomy patency, synechiae formation, and recurrent polyps in allergic patients. Data supported the following conclusions: (1) Immunotherapy given either before or after surgery does not statistically influence middle meatotomy patency, synechiae formation, or recurrence of polyps after functional endoscopic sinus surgery. However, the data do suggest, for all three outcome parameters, that allergic patients who undergo immunotherapy do better than those who do not undergo immunotherapy and, with the exception of recurrent polyps, do as well as nonallergic patients. (2) The prevalence of preoperative polyps is the same for allergic and nonallergic patients in this study, but polyp recurrence is higher in allergic patients. (3) Approximately 40% of allergic patients who began preoperative immunotherapy stopped immunotherapy after surgery because their allergic symptoms resolved or were minimal. A comment regarding this observation is provided.

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Clinical Evaluation of Maxillary Diffuse Polypoid Sinusitis after Functional Endoscopic Sinus Surgery

American Journal of Rhinology ◽

10.2500/105065894781882666 ◽

1994 ◽

Vol 8 (1) ◽

pp. 7-12 ◽

Cited By ~ 7

Author(s):

Chia-Ming Liu ◽

Te-Huei Yeh ◽

Mow-Ming Hsu

Keyword(s):

Clinical Evaluation ◽

Endoscopic Sinus Surgery ◽

Chronic Sinusitis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Maxillary Sinuses

Functional endoscopic sinus surgery (FESS) for chronic sinusitis has become popular as a substitution for radical operations. We selected 24 patients with diffuse polypoid rhinosinopathy who had been admitted for FESS and followed up for at least 6 months. The recovery of 39 maxillary sinuses was inspected with endoscopy through the enlarged middle meatal antrostomies. We found that of 8 sinuses recovered, 19 still had diffuse polypoid change, and another 12 had focal polypoid sinuses. We conclude that for diffuse polypoid rhinosinopathy, management of maxillary polypoid mucosa is complicated, and recovery of polypoid mucosa is dependent not only on the patency of the sinus ostia, but also on other factors such as alterations of mucosal, glandular, and epithelial changes by chronic stimuli.

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Evaluation of the benefits of functional endoscopic sinus surgery on bronchial asthma in patients with concomitant nasal polyposis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190780 ◽

2019 ◽

Vol 5 (2) ◽

pp. 465

Author(s):

Vijay Gupta ◽

Arindam Gupta

Keyword(s):

Bronchial Asthma ◽

Endoscopic Sinus Surgery ◽

Nasal Polyposis ◽

Upper Airway ◽

Positive Influence ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Asthmatic Patients ◽

Post Surgery ◽

Act Score

Background: It is important to understand the relationship between diseases of the upper and lower respiratory tracts because of the prevalence of nasal polyp and asthma, their impact on patients’ lives, the resultant burden on the health care system, and the potential benefits of functional endoscopic sinus surgery. Objective of the study was to evaluate the benefits of functional endoscopic sinus surgery (FESS) on bronchial asthma in patients with concomitant nasal polyposis.Methods: A total of 30 patients having nasal polyposis with asthma were taken up in the study. Patients were evaluated in reference to radiographic study of nose and PNS, pulmonary function by spirometry and asthma symptoms by ACT score. FESS was performed in all patients. Post-surgery spirometry and ACT score was done at 3 and 6 months. Results: Maximum patients belonged to the age group of 35-49 years. When compared pre and post-operative ACT score, we observed a mean of 15.7 (pre-operative), 13.6 (at 3 months) and 19.8 (at 6 months). FEV1% score was 74.6 pre-operatively, which was 90.2% at 3 months and 95.5% at 6 months of follow up.Conclusions: FESS has a positive influence in the lower airways function of asthmatic patients. Recorded improvement of the subjective and objective parameters measured, should not only be attributed to alleviation of upper airway symptoms and to concomitant improvement of a patient's quality of life, but also to the positive influence of FESS on the intrinsic mechanisms.

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The role of functional endoscopic sinus surgery (FESS) in patients with asthma with chronic sinusitis

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-008-0037-6 ◽

2008 ◽

Vol 60 (2) ◽

pp. 152-155 ◽

Cited By ~ 11

Author(s):

S. P. Gulati ◽

Dhruva Chaudhry ◽

Vijay Kalra ◽

Raman Wadhera ◽

Ajay Garg

Keyword(s):

Endoscopic Sinus Surgery ◽

Chronic Sinusitis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery

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Nebulized Antibiotics for the Treatment of Acute Exacerbations of Chronic Rhinosinusitis

Ear Nose & Throat Journal ◽

10.1177/014556130208100913 ◽

2002 ◽

Vol 81 (9) ◽

pp. 648-652 ◽

Cited By ~ 55

Author(s):

Philip A. Scheinberg ◽

Alan Otsuji

Keyword(s):

Endoscopic Sinus Surgery ◽

Chronic Sinusitis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Response To Treatment ◽

Oral Antibiotics ◽

Aerosol Delivery ◽

Treatment Side Effects ◽

Acute Exacerbations ◽

Symptom Scores

We studied the effectiveness of aerosol delivery of antibiotics to the sinuses via a nebulizer in 41 patients who had chronic, recurrent sinusitis that had persisted despite endoscopic sinus surgery and that had not responded to multiple courses of oral antibiotics. We compared pre- and post-treatment symptom scores in five categories: nasal obstruction, facial pain, pressure, mucopurulent rhinorrhea, and malaise. Following 3 to 6 weeks of treatment, 34 patients (82.9%) experienced either an excellent or good response to treatment. Side effects were infrequent, mild, and transient. We conclude that nebulized antibiotics should be considered for all patients with chronic sinusitis who have undergone functional endoscopic sinus surgery and who have failed to respond to oral antibiotics or who do not tolerate them.

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