Usefulness of endonasal mucoplasty in the surgical treatment of chronic rhinosinusitis with nasal polyps. Prospective study

The aim of this study was to evaluate prevalence of chronic rhinosinusitis (CRS) and nasal polyps in adult patients with cystic fibrosis (CF) in Russian Federation. Additionally, we investigated the clinical course of CRS and developed the optimal therapeutic strategy.Methods. Three hundred and forty eight CF patients were involved in the study. Physical examination, computed tomography (CT) of paranasal sinuses and audiometry, if needed, were used. CRS and bilateral nasal polyps were diagnosed in 28 patients. Nasal endoscopy, SNOT-20 questionnaire, rhinomanometry, micro - biological examination of sputum and mucus from paranasal sinuses (obtained during puncture or surgery), spirometry, and measurement of serum markers of inflammation were used. Endoscopic sinus surgery was used in 14 patients (the group 1) and others were treated non-surgically (the group 2). Both group were treated during 6 months using intranasal mometasone, mucolytics and antibiotics via PARI SINUSTM nebulizer.Results. An improvement in symptoms, CT signs, rhinomanometry parameters and endoscopic signs was seen in both groups after treatment and was more prominent in the surgical treatment group compared to the non-surgical treatment group. Bacterial load reduction in nasal sinuses, decrease in the rate of pulmonary disease exacerbations, and an improvement in oxygen blood saturation were found in the surgical treatment group only. Treatment of CRS did not affect lung function, sputum microbiology and serum inflammatory markers.Conclusion. Endoscopic sinus surgery followed by intranasal mucolytics and antibacterials is an effective and well-tolerated treatment in adult CF patients with CRS.

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The nose and sinuses

Oxford Handbook of ENT and Head and Neck Surgery ◽

10.1093/med/9780199550791.003.09 ◽

2009 ◽

pp. 159-184

Author(s):

Rogan Corbridge ◽

Nicholas Steventon

Keyword(s):

Surgical Treatment ◽

Medical Treatment ◽

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Chronic Sinusitis ◽

Structure And Function ◽

Acute Sinusitis ◽

And Function ◽

Nose And Sinuses

Structure and function of the nose 160 Rhinitis 164 Types of rhinitis 165 Medical treatment of rhinitis 166 Surgical treatment of rhinitis 168 Sinusitis 169 Acute sinusitis 170 Recurrent acute sinusitis 171 Chronic sinusitis 172 Surgery for chronic rhinosinusitis 174 Complications of sinusitis 176 Nasal polyps ...

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Periostin as a promising biological marker of early recurrence of polyposis rhinosinusitis after surgical treatment

Medical Council ◽

10.21518/2079-701x-2021-6-113-119 ◽

2021 ◽

pp. 113-119

Author(s):

V. M. Svistushkin ◽

N. V. Chichkova ◽

D. M. Pshonkina

Keyword(s):

Surgical Treatment ◽

Chronic Rhinosinusitis ◽

Bronchial Asthma ◽

Nasal Polyps ◽

Biological Marker ◽

Early Recurrence ◽

Global Strategy ◽

Nasal Secretion ◽

High Concentration ◽

Serum Periostin

Introduction. In spite of the numerous studies devoted to the issues of chronic rhinosinusitis with nasal polyps, the urgency of this problem remains due to the high incidence of the disease. The relapsing course of chronic rhinosinusitis with nasal polyps determines the uncontrolled course of bronchial asthma by patients with combined pathology. The main goal of case management of patients with chronic rhinosinusitis with nasal polyps is to achieve control over the polyposis process. It has been shown, that a promising direction is the study of biological markers. Goal. Study of the concentration of serum periostin in combination with serum eosinophilia and the number of eosinophils of the nasal secretion to predict early recurrence of chronic rhinosinusitis with nasal polyps after surgical treatment.Materials and methods. The study included 47 patients with a diagnosis of chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis with nasal polyps in combination with bronchial asthma. All patients underwent bilateral endoscopic polysinusotomy followed by case follow-up for a year. The diagnosis of bronchial asthma was made based on the diagnostic criteria defined in the Global Strategy for the Treatment and Prevention of Bronchial Asthma and in the Federal Clinical Guidelines for the Diagnosis and Treatment of Bronchial Asthma. All patients were consulted by a pulmonologist. Control examinations of patients were carried out every 3 months. All patients underwent a study of the concentration of periostin in the blood serum. Blood probe samples were taken before the start of treatment and after 12 months.Results and discussion. In the course of the study, was proved the relationship between a high concentration of serum periostin in combination with increased eosinophils of blood and nasal secretion with an early relapse of polyposis rhinosinusitis.Conclusions. An increased concentration of serum periostin before surgical treatment is a prognostically unfavorable factor for early recurrence of chronic rhinosinusitis with nasal polyps.

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Basic principles for the treatment of chronic rhinosinusitis with nasal polyps

Medical Council ◽

10.21518/2079-701x-2020-16-73-78 ◽

2020 ◽

pp. 73-78

Author(s):

E. L. Savlevich ◽

V. A. Cherenkova ◽

A. Yu. Molodnitskaia

Keyword(s):

Surgical Treatment ◽

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Mometasone Furoate ◽

Dynamic Monitoring ◽

Basic Therapy ◽

Intranasal Corticosteroids ◽

European Forum ◽

Group 2

Introduction. Chronic rhinosinusitis with nasal polyps (CRSwNP) is based on a chronic inflammatory hyperplastic process in the mucosa membrane of the nasal cavity and paranasal sinuses (SNPs). According to the consensus on the biological treatment of CRSwNP with or without asthma, which is one of the latest consensus documents of the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), which was published in December 2019, the need for surgical treatment or systemic administration of corticosteroids due to the active nasal polyps growth are conditional signs for the decompensation of clinical control. Currently, the basic treatment for patients with CRSwNP is the long-term use of intranasal corticosteroids (INCS), which leads to an improvement in the quality of life, while minimizing the risk of exacerbations and complications.Research purpose. To evaluate the effectiveness of the basic therapy of intranasal glucocorticosteroid mometasone furoate for different phenotypes of CRSwNP.Methods. All patients with recurrent CRSwNP were divided into 3 equal phenotypic groups of 40 people each: group 1 – CRSwNP without asthma and respiratory allergies, group 2 – CRSwNP + atopy, group 3 – CRSwNP + non-allergic asthma. The observation period was 3 years.Results. Using the algorithm of stepwise therapy of CRSwNP, dynamic monitoring of these patients by an ENT and an allergistimmunologist, basic therapy with corticosteroids with constant treatment correction once every 3 months, it was possible to stabilize the inflammatory process throughout the respiratory tract and reduce the need for surgical treatment.Conclusion. With CRSwNP, long-term use of Mometasone furoate INCS is the main drug of basic therapy to minimize the recurrence of nasal polyp growth and is accompanied by clinical efficacy and the absence of adverse side effects.

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SURGICAL TREATMENT OF PATIENTS WITH CHRONIC RHINOSINUSITIS AND NASAL POLYPS UNDER ELECTIVE DENTAL IMPLANTAT PLACEMENT WITH SINUS LIFTING SURGERY

Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії ◽

10.31718/2077-1096.21.3.123 ◽

2021 ◽

Vol 21 (3) ◽

pp. 123-128

Author(s):

Ya.V. Shkorbotun

Keyword(s):

Surgical Treatment ◽

Chronic Rhinosinusitis ◽

Dental Implant ◽

Nasal Polyps ◽

Sinus Surgery ◽

Endoscopic Polypectomy ◽

Bone Augmentation ◽

Implant Placement ◽

Increased Risk ◽

Sinus Lifting

Dental implant placement is widely used method of dentition restoration, and if necessary, is performed with subantral augmentation of bone tissue and can be associated with an increased risk of complications in cases of mucosa alterations. To the disease and patency of the ostiomeatal complex and to minimize the possible risks is the key task when preparing patients with chronic rhinosinusitis and nasal polyps for sinus lifting. The aim of the study is to investigate the effect of shaver polipectomy method in chronic rhinosinusitis and nasal polyps on the outcomes of sinus lifting and the frequency rate of complications. Materials and methods. The study was based on data obtained from 72 patients having chronic rhinosinusitis and nasal polyps, who underwent endoscopic functional sinus surgery according to the principles of sparing effect on the periosteum in the alveolar bay (periosteum-preserving technology). The patients were divided into two groups: I group included 35 patients subjected to shaver polypectomy; II group consisted of 37 individuals operated on by standard conventional method. Results. The average total Lund-Mackay (LM) score before endoscopic rhinosurgery in I group was 14.57±0.52 scores, and 13.32±0.6 scores in the II group. It went down to 4.26±0.38 in I group and to 4.61±0.39 in II group (p <0.05) 3 months after the intervention. In the 6th month of post-surgical follow up there was a significant increase in the total LM score in the patients of II group up to 6.84±0.6 that indicates a more stable result after shaver-assisted sinusotomy. The incidence of sinus lifting complications after endoscopic polypectomy was 24.32±7.05% of cases in the patients of I group compared to the individuals of II group having 2 37.14±8.17% of complicated cases (p <0.05). Sinus lifting and dental implant placement were found out to be effective in all patients of I group and in 94.29±3.92% of patients in the II group. Conclusions. Endoscopic intervention stuck to principles of preserving periosteum and providing appropriate therapeutic support to patients with chronic rhinosinusitis under control allows oral surgeons to perform safe dental implant placement with subantral bone augmentation. Applying shaver-assisted periosteum-preserving technique for surgical treatment of patients with chronic rhinosinusitis and nasal polyps provides a longer clinical effect and reduces the incidence of postoperative complications of subantral bone augmentation by 12.82%.

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Endoscopic polypectomy performed in clinic for chronic rhinosinusitis with nasal polyps: study protocol for the EPIC multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-042413 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042413

Author(s):

Shaun Kilty ◽

Kednapa Thavorn ◽

Arif Janjua ◽

John Lee ◽

Kristian MacDonald ◽

...

Keyword(s):

Surgical Treatment ◽

Randomised Controlled Trial ◽

Research Ethics ◽

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Controlled Trial ◽

Sinus Surgery ◽

Endoscopic Polypectomy ◽

Research Ethics Board ◽

Randomised Controlled

IntroductionChronic rhinosinusitis (CRS) is common, with a Canadian prevalence of 5%, and associated with significant morbidity. Understandably, CRS impairs workplace productivity but that productivity substantially increases following surgical treatment. CRS with nasal polyps (CRSwNP), the most common type of CRS, is usually treated with a combination of medications and endoscopic sinus surgery (ESS). Historically, surgical treatment has only been performed in the operating room at a cost of about $C3500. However, recent studies have shown that a de-escalated procedure, endoscopic polypectomy performed in clinic (EPIC), can provide an improvement in patient symptoms to levels equal to those for ESS. Moreover, EPIC has additional proposed advantages including shorter recovery time, significantly lower cost to the healthcare system and shorter wait time for the patient. There is currently insufficient evidence to draw conclusions about the superiority of polypectomy or ESS for the management of CRSwNP.Methods and analysisWe designed a multicentre, open-label, randomised controlled trial to evaluate whether EPIC was non-inferior to the current clinical standard, ESS for the treatment of CRSwNP. The primary outcome is the Sinonasal Outcome Test-22 score measured at baseline and at 3 months after surgery. Other outcomes include peak nasal inspiratory flow, quality of life measured by the EuroQoL 5 Dimensions 5 Levels questionnaire and work impairment using the Work Productivity and Activity Impairment Questionnaire.We aim to recruit 140 patients from sites across Canada. Participants will be randomly assigned to EPIC or ESS and followed up for 3 months in clinic after the procedure. Additionally, participants will enter a 5-year long-term follow-up period.Ethics and disseminationThis study was approved by the Ottawa Health Sciences Network Research Ethics Board for all sites in Ontario, Canada (study number CTO0801). Sites located outside of Ontario obtained approval from their local/institutional research ethics board.Trial registration numberNCT02975310.

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