Therapeutic indications for sinonasal topical steroid treatment and its effects on eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

2021 ◽  
pp. 1-6
Author(s):  
T Saito ◽  
K Okazaki ◽  
Y Hamada ◽  
K Hashimoto ◽  
K Tsuzuki
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Topical Steroid ◽  
Steroid Treatment ◽  
Sinus Surgery ◽  
Olfactory Loss ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Group A ◽  
Operative Indications ◽  
Group B

Abstract Objective This study evaluated the post-operative indications for sinonasal topical steroid treatment using a corticosteroid (steroid)-eluting, sinus-bioabsorbable device and its effects in patients with eosinophilic chronic rhinosinusitis. Method Post-operative courses were investigated in two groups: group A with patients who underwent sinonasal topical steroid treatment, and group B with control patients who did not. Results Group A was significantly younger than group B (p < 0.01), and the pre-operative computed tomography score was significantly higher in group A than in group B (p < 0.05). In the post-operative stage, the nasal symptoms questionnaire component of olfactory loss and the post-operative endoscopic appearance score were significantly worse in group A than in group B (p < 0.01). Conclusion These data suggest that younger age, more severe rhinosinusitis and post-operative olfactory loss led to the need for sinonasal topical steroid treatment to prevent relapsing inflammation after functional endoscopic sinus surgery in patients with eosinophilic chronic rhinosinusitis.

scholarly journals Impact of septoplasty alone or with endoscopic sinus surgery for treatment of chronic rhinosinusitis with deviated septum

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Soad Yehia Mostafa ◽  
Fatma Mohamed Abd-Elgaber ◽  
Bothina Ahmed Mohamed ◽  
Al-Shimaa Said Hammad
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Septal Deviation ◽  
Sinus Surgery ◽  
Osteomeatal Complex ◽  
Group A ◽  
Group B ◽  
Mucosal Thickening

Abstract Background Chronic rhinosinusitis represents an important health care problem in the world. Deviated nasal septum leads to increased chance of impaired mucociliary clearance, osteomeatal complex obstruction, and development of rhinosinusitis. Studies have revealed the role of septoplasty in curing chronic rhinosinusitis in patients with significant septal deviation. The purpose of this study is to reveal the role of septoplasty alone or combined with functional endoscopic sinus surgery in improving the outcome of chronic rhinosinusitis in patients with significant septal deviation. Results Postoperative computed tomography findings in group A (underwent septoplasty only) were mild opacity of ethmoid (25%), sinus mucosal thickening (15%), and occluded osteomeatal complex with discharge (25%). Postoperative computed tomography findings in group B mild opacity of ethmoid (30%), sinus mucosal thickening (20%), and occluded osteomeatal complex with discharge (30%). The Sino-Nasal Outcome Test score in group A decreased significantly from 85.75 to 28.85 (P < 0.05). In group B (underwent combination of septoplasty and functional endoscopic sinus surgery), the Sino-Nasal Outcome Test score also decreased significantly from 87.75 to 32.55 (P < 0.05). The improvement was 85% in group A and 80% in group B. Conclusion The post-operative improvement has no significant difference between the two groups. Hence, we suggest that septoplasty alone can be adequate for the treatment of chronic rhinosinusitis with septal deviation.

scholarly journals Comparison of Endoscopic Sinus Surgery and Continued Medical Treatment Therapy for Refractory Chronic Rhinosinusitis

2021 ◽  
Vol 15 (9) ◽  
pp. 2285-2288
Author(s):  
Sadaf Raffat ◽  
Mustafa . ◽  
Nighat Arif ◽  
Usman Aslam ◽  
M Mubarik Ali ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medical Treatment ◽  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Group A ◽  
Group B ◽  
Disease Specific

Aim: To compare endoscopic sinus surgery and continued medical treatment in refractory refractory chronic rhinosinusitis (CRS) patients regarding diseases specific quality of life measurement Study design: RCT (Randomized controlled trial) Place and duration of study: Study was conducted at ENT (Ear, nose and throat) department, Railway Hospital Rawalpindi. Study duration was one year (January 2018-Deecember 2018) Methods: A sample size of 22 patients was calculated using WHO calculator. Non probability consecutive sampling was used. A prior ethical approval and consent form was taken. Patients were randomly divided into two groups; Group A was given medical therapy while Group B comprised contain patients in whom medical therapy failed and had undergone endoscopic sinus surgery. Patients were followed for disease specific quality of life scores. Data was analyzed using SPSS version22. Chi-square and t test was applied. P value ≤ 0.05 was considered significant. Results: Total of 22 refractory CRS patients were included in study. There were 10(45.5%) males and 12(54.5%) females. Mean age of refractory CRS patients was 33.4 years±6.2SD. Group A (continued medical therapy) N=11, had significantly high SNOTT -22 scores 60.6±7.1SD as compared to endoscopic sinus surgery 21±3.9SD (p=0.000). Group B (endoscopic sinus surgery) had significantly low endoscopic scores 2.7±0.3SD as compared to group A (continued medical therapy) 7.14±0.53SD (p=0.000). Endoscopic sinus surgery group showed significant reduction in work days lost 17.4±4.9SD as compared to continued medical therapy (Group A) 30.1±2.5SD (p=0.000). Conclusion: Endoscopic sinus surgery is an effective treatment option as compared to continued medical therapy with improved quality of life in refractory CRS patients (with reduced baseline disease specific quality of life). Keywords: Refractory chronic rhinosinusitis, endoscopic sinus surgery, quality of life

Efficacy of Endoscopic Posterior Nasal Neurectomy in Treating Eosinophilic Chronic Rhinosinusitis

ORL ◽  
2021 ◽  
pp. 1-5
Author(s):  
Manman Chen ◽  
Ming Xu ◽  
Xuefeng Lei ◽  
Bin Zhang
Keyword(s):  
Chronic Rhinosinusitis ◽  
Surgical Recurrence ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Group A ◽  
Sinonasal Outcome Test ◽  
Random Number Table ◽  
Group B

<b><i>Objectives:</i></b> Recent guidelines have revealed that eosinophilic chronic rhinosinusitis (ECRS) exhibits a strong tendency for recurrence after surgery and impairs quality of life. Neuropeptides play an important neuroimmunological role. The aim of this study was to determine the efficacy of posterior nasal neurectomy (PNN) for the treatment of ECRS by inhibiting type 2 cytokine expression. <b><i>Methods:</i></b> Forty-six patients were divided into group A and group B according to a random number table. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN, and group B underwent conventional FESS alone. The subjective and objective symptoms included a 10-cm visual analog scale (VAS), 22-item SinoNasal Outcome Test (SNOT-22) score, nasal speculum Lund-Kennedy score, and paranasal sinus computed tomography (CT) Lund-Mackay score at the 1-year postoperative follow-up. <b><i>Results:</i></b> Postoperative VAS (10.33 ± 2.18 vs. 8.38 ± 2.11, <i>p</i> &#x3c; 0.01) and Lund-Kennedy score (1.95 ± 1.32 vs. 3.14 ± 1.35, <i>p</i> &#x3c; 0.01) were significantly improved. The rhinorrhea score (1.76 ± 0.83 vs. 2.90 ± 1.14, <i>p</i> &#x3c; 0.001) in the VAS and the discharge (0.43 ± 0.51, vs. 0.95 ± 0.67, <i>p</i> &#x3c; 0.01) and edema (0.57 ± 0.60 vs. 0.95 ± 0.59, <i>p</i> &#x3c; 0.05) scores in the Lund-Kennedy score were observed to have improved significantly in group A compared with those in group B. <b><i>Conclusions:</i></b> FESS combined with PNN suppresses edema symptoms, which might significantly decrease the surgical recurrence rate of ECRS in the long term.

scholarly journals Role of Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery in Private Practice

2020 ◽  
Vol 24 (1) ◽  
pp. 8-13
Author(s):  
Md Nurullah ◽  
Md Arif Hossain Bhuyan ◽  
Syed Ariful Islam ◽  
Md Shah Alam
Keyword(s):  
Heart Rate ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Hypotension ◽  
Operative Field ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Functional endoscopic sinus surgery (FESS), effective control of bleeding is essential to maintain a clear operative field and to minimize complications. Intraoperative bleeding is one of the major problems in endoscopic surgery of sinuses. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery. Objective: The objective of study was role of Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery and designed to compare intraoperative hemorrhage and the visibility of the operative field during normotension and hypotension anesthesia. Methods: Prospective randomized study includes a total of 60 ASA I-II patients who underwent elective FESS surgery. Patients randomly assigned in two groups the hypotension group (Group A) and the normotension group (Group B). Intraoperative mean arterial pressure (MAP), heart rate (HR) were recorded. Results : This study shows the mean ages of the patients of group A group B were 33.36±7.61 and 32.46±7.73 years respectively. No statistically significant difference was observed among groups at 0.05 level in term of age. The mean heart rate pre-anaesthesia and preoperative among the patients of different groups in different follows up period. Significance differences were observed among groups in term of heart rate at 5 minute, 15 minute, 30 minute, 45 minute and 60 minute. The mean arterial mean blood pressure before pre-anaesthesia and preoperative estimation among the patients of different groups in different follows up period. Significance differences were observed among groups at 5 minute, 15 minute, 30 minute, 45 minute and 60 minute. Conclusion: This study demonstrated that Controlled hypotension can be achieved equally and effectively by nitroglycerin and labetalol reduced significantly intraoperative hemorrhage and produce hypotensive anesthesia. Both are equally effective in providing ideal surgical field during functional endoscopic sinus surgery (FESS). Bangladesh J Otorhinolaryngol; April 2018; 24(1): 8-13

scholarly journals Efficacy of endoscopic sinus surgery for eosinophilic chronic rhinosinusitis with asthma

2020 ◽  
Vol 69 (1) ◽  
pp. 144-145 ◽  
Author(s):  
Nobuo Ohta ◽  
Yusuke Suzuki ◽  
Hiroki Ikeda ◽  
Naoya Noguchi ◽  
Risako Kakuta ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Eosinophilic Chronic Rhinosinusitis

Predictors of disease progression after endoscopic sinus surgery in patients with chronic rhinosinusitis

2019 ◽  
Vol 133 (8) ◽  
pp. 678-684 ◽  
Author(s):  
K Tsuzuki ◽  
K Hashimoto ◽  
K Okazaki ◽  
H Nishikawa ◽  
M Sakagami
Keyword(s):  
Disease Progression ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Early Period ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Operative Findings

AbstractObjectiveThis study aimed to determine the predictors of disease progression after functional endoscopic sinus surgery in patients with chronic rhinosinusitis.MethodA total of 281 adult chronic rhinosinusitis patients who underwent primary bilateral functional endoscopic sinus surgery between 2007 and 2017 and had at least 12 months of follow-up endoscopic evaluation were examined. Patients were divided into eosinophilic (n= 205) and non-eosinophilic chronic rhinosinusitis groups (n= 76). In order to determine adverse factors, post-operative endoscopic appearance scores were analysed in relation to the pre- and intra-operative findings using multiple regression analyses.ResultsThe post-operative course of eosinophilic cases deteriorated over time, like the early period for non-eosinophilic cases. Frontal sinus polyps recurred early in eosinophilic chronic rhinosinusitis. Multivariate analyses indicated young adulthood, asthma, high computed tomography score and frontal sinus polyps as significant adverse predictors.ConclusionEarly, appropriate estimation of sinonasal conditions appears to be crucial for successful surgical management of chronic rhinosinusitis.

scholarly journals To Compare the Results of Endoscopic Sinus Surgery with and without Microdebrider in Patients of Nasal Polyposis

2014 ◽  
Vol 7 (2) ◽  
pp. 61-63
Author(s):  
Poonam Singla ◽  
Ankit Gulati ◽  
Surender Singh ◽  
Priya Malik
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Middle Turbinate ◽  
Sinus Surgery ◽  
Nasal Discharge ◽  
Nasal Blockage ◽  
Diagnostic Endoscopy ◽  
Group A ◽  
Group B ◽  
Olfactory Disturbance

ABSTRACT Objective To compare the results in patients of nasal polyposis undergoing endoscopic sinus surgery with or without the use of microdebrider. Materials and methods The study was conducted on 40 patients of either sex in age group 15 to 60 years with nasal polyposis. They were divided into two groups (20 each), in group A microdebrider was used and in group B it was not used. Symptom scoring of each patient was done on the basis of nasal blockage, headache, olfactory disturbance, nasal discharge and trigeminal pressure pain. Similar scoring was followed for diagnostic endoscopy in which the scoring was done on the basis of extent of polyps, edema of middle turbinate and secretions in middle meatus. Both the left and right sides were examined and scored separately. Results The symptom and endoscopy scores were significantly higher (p < 0.02 and < 0.0001 respectively) in group B post-operatively on 14th day and after 3 months as compared to group A. Conclusion Microdebrider assisted endoscopic sinus surgery gives better results. How to cite this article Kakkar V, Sharma C, Singla P, Gulati A, Singh S, Malik P. To Compare the Results of Endoscopic Sinus Surgery with and without Microdebrider in Patients of Nasal Polyposis. Clin Rhinol An Int J 2014;7(2):61-63.

scholarly journals Comparison by Objective Parameters in Patients with Chronic Rhinosinusitis Managed Medically and Surgically (with and without Powered Instruments)

2016 ◽  
Vol 7 (3) ◽  
pp. ar.2016.7.0169
Author(s):  
Samarendra Behera ◽  
Satyawati Mohindra ◽  
Sourabha K. Patro ◽  
Ashok K. Gupta
Keyword(s):  
Chronic Rhinosinusitis ◽  
Test Scores ◽  
Mucociliary Clearance ◽  
Sinus Surgery ◽  
Clearance Time ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Treatment Surgery

Objective To compare mucociliary clearance time and quality of life in patients who underwent sinus surgery using conventional and powered instruments, and in patients who were treated nonsurgically. Methods A total of 151 patients with chronic rhinosinusitis were included. Fifty-four patients were treated conservatively, 48 patients were managed surgically by using conventional instruments and 49 patients were managed by using a microdebrider. Kupferberg nasal endoscopy grades, 20-item Sino-Nasal Outcome Test scores, Lund-Mackay scores, and mucociliary clearance time were analyzed. Results On comparison among the groups, it was found that there was a significant difference between group A (nonsurgically treated) compared with group B (surgery by conventional means) or group C (surgery with microdebrider) in nasal endoscopic grades, Lund-Mackay scores, 20-item Sino-Nasal Outcome Test scores, and mucociliary clearance time. However, in comparison between groups B and C, there was no statistically significant difference. Conclusion Mucociliary clearance time tended to recover after starting treatment for chronic rhinosinusitis both after conservative treatment and after surgical treatment. Surgery provided better improvement in different objective scores in chronic rhinosinusitis. There exists no statistical difference in parameters independent of the instrument used for surgery.

scholarly journals Effects of Endoscopic Sinus Surgery for Eosinophilic Chronic Rhinosinusitis on Respiratory Functions and FeNO Production in the Lower Respiratory Tract

2021 ◽  
pp. 014556132110320
Author(s):  
Tetsuya Terada ◽  
Takaki Inui ◽  
Kou Moriyama ◽  
Keiki Noro ◽  
Yusuke Kikuoka ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Lower Airway ◽  
Act Scores ◽  
Asthma Control Test ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Before And After ◽  
The Mean ◽  
Asthma Group

Objective: To confirm the relevance of upper and lower airway inflammation in eosinophilic chronic rhinosinusitis (ECRS), the effects of endoscopic sinus surgery (ESS) on lower airway functions and inflammation need to be examined in ECRS patients. Methods: Chronic rhinosinusitis patients with nasal polyps (25 non-ECRS, 28 ECRS) were enrolled. The 12 patients in the ECRS group had comorbid asthma, in contrast to none in the non-ECRS group. We divided ECRS patients into 2 groups of ECRS with and without asthma. Clinical markers, including fraction of exhaled nitric oxide (FeNO), respiratory functions, and the Asthma Control Test (ACT) questionnaire, were investigated before and after ESS. Results: The FeNO levels in the ECRS with asthma group decreased after ESS. The mean FeNO levels in this group were 56.3 ppb before ESS and 24.9, 25.1, 25.0, and 15.5 ppb 1, 2, 3, and 4 months, respectively, after ESS. The mean forced expiratory rates in 1 second before and after ESS were 67.6% and 73.0%, respectively. The mean maximal expiratory flow rates at 50% of the vital capacity before and after ESS were 45.8% and 58.0%, respectively. Significant differences were observed in respiratory functions before and after ESS. The mean ACT scores in the ECRS with asthma group before and after ESS were 17.5 and 23.5, respectively. The ACT scores were significantly higher after than before ESS. Conclusions: The present results indicate that ECRS and bronchial asthma are common eosinophilic airway inflammatory diseases, and ESS for eosinophilic sinusitis may improve lower airway function.

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