Comparison of Delivery of Topical Medications to the Paranasal Sinuses via “Vertex-to-floor” Position and Atomizer Spray after FESS

INTRODUCTION: Topical nasal medications are frequently employed for persistent sinonasal symptoms after functional endoscopic sinus surgery (FESS) in chronic rhinosinusitis patients. The optimal means for the delivery of these medications is unclear. In this study, the efficacy of the vertex to floor (VF) position compared to atomizer spray was evaluated in post-FESS patients. METHODS: Three trials were performed: two trials in which patients maintained the VF position for 1 and 5 minutes, respectively, after nasal drop administration were compared to a third trial utilizing an atomizer spray in the upright position. Two independent observers rated the distribution of fluorescein-dyed dexamethasone drops at 5 sinonasal sites: maxillary sinus (MS), ethmoid cavity (EC), frontal recess (FR), sphenoid sinus (SS), and olfactory cleft (OC). RESULTS: VF position consistently delivered nasal drops to the MS, EC, SS, and OC. The atomizer distributed drops to the MS, EC, SS, and FR. The greatest difference was noted with the nasal drops in the olfactory cleft in the VF position; statistical significance was achieved with ANOVA testing ( P = 0.012). Student's paired t test comparing trial 1 to 2, 1 to 3, and 2 to 3 demonstrated greater distribution in the OC at 5 minutes compared with 1 minute and spray ( P = 0.042 and 0.003). CONCLUSIONS: The VF position and atomizer spray were both effective in delivery of the dexamethasone drops to the paranasal sinuses. This has significant implications for management of patients suffering from recalcitrant chronic rhinosinusitis and/or sinonasal polyposis through the delivery of topical medications to the paranasal sinuses and olfactory cleft.

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Chronic rhinosinusitis in adult patients with cystic fibrosis: clinical manifestation and therapeutic approaches

Russian Pulmonology ◽

10.18093/0869-0189-2019-29-3-311-320 ◽

2019 ◽

Vol 29 (3) ◽

pp. 311-320

Author(s):

G. L. Shumkova ◽

E. L. Amelina ◽

V. M. Svistushkin ◽

E. V. Sin’kov ◽

S. A. Krasovskiy ◽

...

Keyword(s):

Cystic Fibrosis ◽

Surgical Treatment ◽

Treatment Group ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Nasal Polyps ◽

Adult Patients ◽

Sinus Surgery ◽

Markers Of Inflammation

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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ʺStomatologyʺ in functional endoscopic sinus surgery – 2 case reports

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0012.1450 ◽

2018 ◽

Vol 7 (2) ◽

pp. 43-47

Author(s):

Paulina Kołodziejczyk ◽

Tomasz Gotlib

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Surgery ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Case Reports ◽

Functional Endoscopic Sinus Surgery ◽

The Body ◽

Sinus Surgery ◽

Facial Region ◽

Rare Phenomenon

Functional endoscopic sinus surgery (FESS) is most commonly used in chronic rhinosinusitis treatment. This method is also applicable to other diseases, including the treatment of symptomatic ectopic teeth. Ectopic teeth are a quite rare phenomenon. They may appear within the facial region, as well as in other parts of the body. The article describes two cases of ectopic teeth appearing within the nose area and paranasal sinuses, there endoscopic surgery has been used in the extraction, which resulted in the remission of symptoms.

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Pneumatisation of turbinates and paranasal sinuses in children: case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215112003271 ◽

2013 ◽

Vol 127 (4) ◽

pp. 419-422 ◽

Cited By ~ 1

Author(s):

K Tsioulos ◽

M Martinez Del Pero ◽

C Philpott

Keyword(s):

Case Report ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Image Guidance ◽

Anatomical Variations ◽

Sinus Surgery ◽

Nasal Blockage ◽

History Of ◽

Maximal Medical Therapy ◽

Tomography Scan

AbstractObjective:To describe a rare case of multiple anatomical variations in the sinonasal skeleton of an adolescent with chronic rhinosinusitis, together with its successful surgical management.Case report:A 15-year-old male adolescent was referred with a 3-year history of nasal blockage and hyposmia. His symptoms did not improve on maximal medical therapy. A pre-operative computed tomography scan revealed numerous anatomical variations in his nose and paranasal sinuses. He underwent neuronavigation-assisted endoscopic sinus surgery without complication, and with subsequent resolution of his symptoms at 10 months.Conclusion:Chronic rhinosinusitis in children offers its own set of unique surgical challenges. The effectiveness and safety of sinus surgery in this population can be improved through the knowledge of anatomical variants, and is aided by the use of image guidance systems.

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Role of anatomical variations in chronic rhinosinusitis on diagnostic nasal endoscopy and computed tomography scan of paranasal sinuses

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195697 ◽

2019 ◽

Vol 6 (1) ◽

pp. 101

Author(s):

Falguni J. Parmar ◽

Avani D. Patel

Keyword(s):

Computed Tomography ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Care Center ◽

Tertiary Care ◽

Middle Turbinate ◽

Anatomical Variations ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Advantages And Disadvantages

Background: Diagnostic nasal endoscopy (DNE) and computed tomography (CT) of para nasal sinuses play an important role in the diagnosis and treatment of chronic rhinosinusitis (CRS). The aim and objective of the study is to see the anatomical variations of the sinonasal region in CRS on DNE and CT paranasal sinuses (PNS).Methods: A descriptive type retrospective study of 30 patients attending the ENT outpatient department of our tertiary care center clinically diagnosed as CRS with symptoms persisting for 12 weeks or more, along with previously failed medical management, including topical nasal steroids, systemic decongestant and extended courses of antibiotics and who were willing to undergo endoscopic sinus surgery are included. Results: Majority of the patients had septal deviation either an anterior or posterior deviation but majority of the cases are asymptomatic for the deviation. Anatomical variations of uncinate process, middle turbinate, inferior turbinate, frontal recess, agger nasi cells, haller cells were studied as well.Conclusions: Prolonged duration of rhinosinusitis symptoms (more than 8-12 weeks) is the primary reason to evaluate a patient for CRS and making the choice between CT PNS or DNE is patient and disease dependent. Understanding the advantages and disadvantages of each helps us realize that they are of synergistic in nature and not competitive.

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Use of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00097-7 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Mohamed M. ElSheikh

Keyword(s):

Revision Surgery ◽

Statistical Significance ◽

Poor Quality ◽

Post Treatment ◽

Sinus Surgery ◽

Post Intervention ◽

Hypotensive Anesthesia ◽

Clinical Scoring ◽

Grade 3 ◽

Sinonasal Polyposis

Abstract Background Chronic rhinosinusitis with nasal polyps recurs frequently after functional endoscopic sinus surgery (FESS), with resultant poor quality of life with persistence of nasal obstruction, sinus aches, and discharge as well anosmia and dysgysia; revision FESS is usually the treatment of choice referred to relief patients’ suffering, yet it is not always the case, patients preference as well as fitness for general hypotensive anesthesia, patients age, cardiopulmonary status, and concurrent bronchial asthma might render unfit for an elective procedure. The aim of this study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery. Results Thirty patients suffering from recurrent sinonasal polyposis after single or multiple FESS procedures were selected; all patients were subjected to intranasal application of gelfoam soaked with triamcinolone as a conservative medical office procedure using triamcinolone-soaked absorbable gelatin foam (gelfoam) weekly for a period of 8 weeks followed by intranasal steroid nasal spray for maintenance and as anti-recurrence measure. Patients were followed up for 4 months post-intervention; Meltzer Clinical Scoring System was used to analyze the patients’ pre- and post-intervention via office endoscopy (0° 4-mm Hopkins endoscope). All patients tolerated the procedure well. The study group showed no statistical significance pre-intervention which comprised 17 (56.7%) patients with grade 4 sinonasal polyposis extent and 13 (43.3%) patients with grade 3 sinonasal polyposis extent (P=0.795), denoting no difference between patients pending treatment option. Post-treatment, both groups showed a significant reduction in the extent of polyposis (P<0.001) where post-treatment showed 21 (70%) patients with grades 0 no polyps and 9 (30%) patients with grade 1 sinonasal polyposis extent. Conclusion Triamcinolone-soaked gelfoam packing is an effective and safe method for managing recurrent sinonasal polyposis after FESS. Intervention contributed to a successful result, decreased the need for surgery in poor candidates for hypotensive anesthesia, and could be used as a sole treatment of recurrent sinonasal polypsis in elderly patients whose general condition could not tolerate invasive procedures.

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A Cadaveric Model for Balloon-Assisted Endoscopic Paranasal Sinus Dissection without Fluoroscopy

American Journal of Rhinology ◽

10.2500/ajr.2007.21.3081 ◽

2007 ◽

Vol 21 (5) ◽

pp. 579-583 ◽

Cited By ~ 18

Author(s):

Martin J. Citardi ◽

Seth J. Kanowitz

Keyword(s):

Paranasal Sinus ◽

Balloon Catheter ◽

Sinus Surgery ◽

Lacrimal Duct ◽

Frontal Recess ◽

Conventional Instruments ◽

Flexible Wire ◽

Sinus Ostium ◽

Cadaveric Model ◽

Sinonasal Polyposis

Background Recently, balloon catheter (BC) dilatation of paranasal sinus ostia has been introduced. In this procedure, a balloon-tipped catheter is placed across a sinus ostium over a flexible wire under fluoroscopic guidance, and inflation of the balloon enlarges the ostium. Some rhinologists have criticized this procedure for its failure to remove tissue and bone, especially in the setting of sinonasal polyposis. This project seeks to develop strategies for incorporating BC technology into standard functional endoscopic sinus surgery procedures. Methods Endoscopic sinus dissection of three human cadaveric heads was performed with conventional instruments supplemented by lacrimal duct BCs (LacriCATH; Quest Medical, Allen, TX). No fluoroscopy was used. Each dissection was videotaped for later review. Results For frontal recess dissection, these steps were performed under endoscopic visualization: (1) passage of the BC between frontal recess partitions, (2) BC inflation, and (3) removal of fractured frontal recess partitions with conventional instruments. This approach was used successfully in each frontal recess. Under endoscopic visualization, a BC was passed into the sphenoid ostium and inflated; this maneuver successfully dilated each sphenoid ostium. It was not feasible to reliably pass the BC through the natural maxillary ostium. Each BC was inflated to 8 atm for 30 seconds. No evidence of orbital or skull base injury was noted. No fluoroscopy was used. Conclusion BCs may be used as adjunctive instrumentation for endoscopic sinus dissection without fluoroscopy. This strategy warrants additional technical and clinical development.

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Anatomy of Nasal Cavity and Paranasal Sinuses; Surgical Perspective

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2020.00227 ◽

2020 ◽

Vol 63 (5) ◽

pp. 189-198

Author(s):

Seung-Kyu Chung

Keyword(s):

Surgical Treatment ◽

Medical Treatment ◽

Nasal Cavity ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Treatment Method ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery

Endoscopic sinus surgery is a treatment method for chronic rhinosinusitis not controlled with medical treatment. It had started with functional endoscopic sinus surgery and the concept of reboot approach was introduced recently. For safe surgical treatment, understanding the anatomy especially personal variations between well-known structures is important. The practical points of surgical concept during endoscopic sinus surgery was suggested.

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Evaluation of MMP-12 expression in chronic rhinosinusitis with nasal polyposis

Rhinology Journal ◽

10.4193/rhin21.320 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

S. Lygeros ◽

G. Danielides ◽

G.C. Kyriakopoulos ◽

K. Grafanaki ◽

F. Tsapardoni ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Gene Expression Regulation ◽

Statistical Significance ◽

Sinus Surgery ◽

Mrna Levels ◽

Tissue Samples ◽

Potential Implication ◽

Protein Levels ◽

Healthy Mucosa ◽

The Difference

Background: The purpose of this study was to evaluate the expression of MMP-12 in patients with chronic rhinosinusitis with polyps (CRSwNP). Methodology: Tissue samples from 37 patients with CRSwNP undergoing functional endoscopic sinus surgery and healthy mucosa specimens from 12 healthy controls were obtained intraoperatively. The mRNA and protein expression levels of MMP-12 were quantified by real-time polymerase chain reaction and Western blotting, respectively. Results: mRNA levels of MMP-12 were significantly elevated in the CRSwNP tissue samples compared to those in control ones. The protein levels of MMP-12 showed a trend of increasing but with no statistical significance. Conclusions: Elevation of MMP-12 in patients with CRSwNP suggests its potential implication in the pathogenesis of the disease. The difference in the expression profile observed between mRNA and protein levels could be due to post-translational gene expression regulation. Our findings provide evidence that MMP-12 along with other MMPs may serve as a biomarker and therapeutic target in the management of the disease.

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Computed tomographic and endoscopic analysis of supraorbital ethmoid cells

Otolaryngology ◽

10.1016/j.otohns.2007.06.737 ◽

2007 ◽

Vol 137 (4) ◽

pp. 562-568 ◽

Cited By ~ 23

Author(s):

Luo Zhang ◽

Demin Han ◽

Wentong Ge ◽

Jianhua Tao ◽

Xianzhong Wang ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Ct Scanning ◽

Spiral Ct ◽

Sinus Surgery ◽

Spiral Computed ◽

Computed Tomographic ◽

Endoscopic Anatomy ◽

Frontal Recess ◽

Frontal Sinuses ◽

Chinese Subjects

Objectives The aim of this study is to look at the incidence of supraorbital ethmoid cells (SOEC) in normal Chinese subjects by using spiral computed tomography (CT) scanning. In addition, subjects with chronic rhinosinusitis with SOEC were reviewed for endoscopic analysis. Methods A total of 202 normal Chinese subjects underwent spiral CT. Meanwhile, a retrospective review of patients who had undergone endoscopic sinus surgery over a 1-year period was conducted. Results SOEC showed an incidence of 5.4% (22 sides), and all of them arose from the anterior ethmoid cells. On coronal CT, an SOEC might give the appearance of multiple frontal sinuses, type III frontal cells, suprabullar cells, frontal bullar cells, inter-frontal septal cells, or that there was a septation present within the frontal sinus. Meanwhile, 11 chronic rhinosinusitis patients with 12 SOEC were identified. Conclusion A thorough knowledge of endoscopic anatomy and CT of the frontal recess and various fronto-ethmoid cells were required for safe dissection of the SOEC and frontal ostium.

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Analysis of the Suprabullar and Retrobullar Recesses for Endoscopic Sinus Surgery

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894011100s501 ◽

2001 ◽

Vol 110 (5_suppl) ◽

pp. 3-14 ◽

Cited By ~ 17

Author(s):

William E. Bolger ◽

Christopher B. Mawn

Keyword(s):

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Human Cadaver ◽

Posterior Aspect ◽

Endoscopic Techniques ◽

Frontal Recess ◽

Secondary Purpose ◽

Large Cleft ◽

Subtle Feature

Presently, the basic structures and spaces of the paranasal sinuses are more clearly understood by otolaryngologists than ever before. Yet, the more subtle and complex ethmoid features, especially of the ethmoidal pre-recesses and recesses, still elude many otolaryngologists. One of the most nebulous, elusive, and difficult-to-understand recesses is the sinus lateralis, or as it is more correctly called, the retrobullar and suprabullar recesses. The primary purpose of this investigation was to ascertain the prevalence of the sinus lateralis in humans. The secondary purpose was to better characterize this subtle feature of ethmoid anatomy. Human cadaver sinonasal complexes were meticulously dissected by both gross and endoscopic techniques. The hiatus semilunaris superior and sinus lateralis were present in all specimens. A separate and discrete retrobullar recess was present in 93.8%. Typically, a crestlike projection from the basal lamella to the lamina papyracea was noted within the posterior aspect of the retrobullar recess. A single, discrete, well-developed suprabullar recess was present in 70.9%, and a rudimentary suprabullar recess was present in 22.9%. In 7.2%, a single large cleft collectively excavated the retrobullar and suprabullar recess areas; separate retrobullar and suprabullar tracts were not present in this subgroup. Typically, the suprabullar recess was separate from and did not communicate with the frontal recess. The data from this investigation indicate that the separate terms retrobullar recess and suprabullar recess more accurately designate the anatomy and are recommended over the term sinus lateralis.

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