Evidence Supporting Endoscopic Sinus Surgery in the Management of Adult Chronic Rhinosinusitis: A Systematic Review

2005 ◽  
Vol 19 (6) ◽  
pp. 537-543 ◽  
Author(s):  
Timothy L. Smith ◽  
Pete S. Batra ◽  
Allen M. Seiden ◽  
Maureen Hannley
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Critical Evaluation ◽  
Case Series ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Future Research ◽  
Case Control Studies ◽  
Retrospective Case ◽  
Level 2

Background Evidence-based medicine calls for a critical evaluation of the scientific evidence for treatments of disease. This report synthesizes the available evidence on the use of endoscopic sinus surgery (ESS) in the management of adult chronic rhinosinusitis (CRS) examining the clinical question: “In adults with CRS who have failed medical management, does ESS improve symptoms and/or quality of life (QOL)?” Methods The American Rhinologic Society and the American Academy of Otolaryngology–Head and Neck Surgery convened a steering committee composed of the authors. Primary research articles evaluated for this report were identified using appropriate search terms and a Medline search. Two authors independently reviewed each article. Articles were assigned an evidence level based on accepted guidelines (level 1 = randomized trials; level 2 = prospective cohort studies with comparison group; level 3 = case-control studies; level 4 = retrospective case series; level 5 = expert opinion). Results We identified 886 abstracts to review, retrieved 75 articles for full review, and included 45 articles in our report. The vast majority of articles represented level 4 evidence (n = 42) and two articles represented level 5 evidence. One article was identified that qualified for level 2 evidence. All of these articles generally supported the finding that ESS improves symptoms and/or QOL in adult patients with CRS. Conclusion There is substantial level 4 evidence with supporting level 2 evidence that ESS is effective in improving symptoms and/or QOL in adult patients with CRS. Future research efforts should focus on prospective studies that include appropriate comparison groups in their design.

Endoscopic Sinus Surgery Improves Sleep Quality in Chronic Rhinosinusitis: A Systematic Review and Meta-analysis

2017 ◽  
Vol 158 (2) ◽  
pp. 249-256 ◽  
Author(s):  
Daniel C. Sukato ◽  
Jason M. Abramowitz ◽  
Marina Boruk ◽  
Nira A. Goldstein ◽  
Richard M. Rosenfeld
Keyword(s):  
Systematic Review ◽  
Sleep Quality ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Research Direction ◽  
Sinus Surgery ◽  
Future Research ◽  
Apnea Hypopnea Index ◽  
Poor Sleep

Objective Up to 75% of patients with chronic rhinosinusitis (CRS) suffer with poor sleep quality and reduced quality of life. Endoscopic sinus surgery has demonstrated encouraging results in improving sleep function. The aim of this systematic review is to assess the change in sleep quality after surgery for CRS. Data Sources PubMed, Web of Science, EMBASE. Review Methods An electronic search was conducted with the keywords “sinusitis” or “rhinosinusitis” and “sleep.” Studies were included only when adults underwent endoscopic sinus surgery and were evaluated pre- and postoperatively by the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), the Apnea-Hypopnea Index (AHI), the sleep domain of Sino-Nasal Outcome Test–22, or the sleep domain of Rhinosinusitis Disability Index. Results The database search yielded 1939 studies, of which 7 remained after dual-investigator screening. The standardized mean differences (95% CI) for the ESS, PSQI, and AHI were −0.94 (−1.63 to −0.26), −0.80 (−1.46 to −0.14), and −0.20 (−0.32 to −0.07), indicating large, moderate to large, and small improvements, respectively. All analyses displayed high heterogeneity ( I2 = 95%-99%). Conclusion Sleep quality, as measured by the ESS and PSQI surveys, shows substantial improvement after surgery for CRS, with smaller improvement seen for AHI. Generalizability of our results is limited by high heterogeneity among studies and by broad confidence intervals that cannot exclude small to trivial changes. The findings of this meta-analysis provide insight into the effect of CRS-related endoscopic sinus surgery on sleep quality, which should guide future research direction and counseling of patients in the clinical setting.

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

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. 

Bony nasolacrimal duct dehiscence in functional endoscopic sinus surgery: radiological study and discussion of surgical implications

2015 ◽  
Vol 129 (S3) ◽  
pp. S35-S40 ◽  
Author(s):  
M J Ali ◽  
J Murphy ◽  
P J Wormald ◽  
A J Psaltis
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Case Series ◽  
Nasolacrimal Duct ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Retrospective Case ◽  
Computed Tomography Images ◽  
Before And After ◽  
Surgically Induced

AbstractObjectives:To analyse the radiological features of the bony nasolacrimal duct before and after functional endoscopic sinus surgery, and document the incidence of surgically induced dehiscence.Methods:A retrospective case series analysis was conducted of 63 consecutive patients who underwent uncinectomy as a part of 118 functional endoscopic sinus surgical procedures. All patients underwent pre- and post-operative computed tomography scans. Axial computed tomography images at the level of maxillary sinus were evaluated for the presence of bony nasolacrimal duct dehiscence, osteitis and completeness of uncinectomy.Results:The rate of nasolacrimal duct dehiscence prior to surgery was 6.8 per cent (8 out of 118 cases). Nasolacrimal duct dehiscence as a consequence of surgery was observed in 3.3 per cent of cases (4 out of 118), with a further 4.2 per cent (5 out of 118) showing post-operative reactive bony change of the nasolacrimal duct in the absence of dehiscence.Conclusion:The incidence of nasolacrimal duct injury observed was much lower than that previously reported in the literature.

Correlation between Preoperative Clinical Diagnosis and Histopathological Findings in Patients with Rhinosinusitis

2005 ◽  
Vol 19 (2) ◽  
pp. 153-157 ◽  
Author(s):  
Nicolas Y. Busaba ◽  
Luciano Vilela de Oliveira ◽  
David L. Kieff
Keyword(s):  
Chronic Rhinosinusitis ◽  
Clinical Diagnosis ◽  
Endoscopic Sinus Surgery ◽  
Preoperative Diagnosis ◽  
Case Series ◽  
Sinus Surgery ◽  
Histopathological Diagnosis ◽  
Fungal Sinusitis ◽  
Chronic Invasive ◽  
Type Of Surgery

Background The diagnosis of chronic rhinosinusitis (CRS) or chronic rhinosinusitis with polyposis (CRSP) is typically clinical and based on the combination of medical history, physical examination, and imaging. The recommendation to perform surgery and the type of surgery is tailored to the diagnosis. The objective of this study is to determine the accuracy of preoperative clinical CRS or CRSP diagnosis in patients who underwent endoscopic sinus surgery. Methods This is a retrospective review of a case series of 380 consecutive patients who underwent endoscopic sinus surgery for the preoperative clinical diagnosis of CRS or bilateral CRSP. Data regarding symptoms, nasal endoscopy, computed tomography findings, preoperative diagnosis, and postoperative histopathology results were collected. Results The preoperative diagnoses were CRS (n = 180) and CRSP (n = 200). Two of the 180 patients (1.1%) with the preoperative diagnosis of CRS had a different postoperative histopathological diagnosis. The histopathology in both patients showed noncaseating granulomata, leading to a diagnosis of sarcoidosis. Nine of the 200 patients (4.5%) with the preoperative diagnosis of CRSP had a different postoperative histopathological diagnosis. Of these nine patients, five had inverted papilloma (bilaterally in one instance); one had adenocarcinoma; one had squamous-cell carcinoma; one had chronic invasive granulomatous fungal sinusitis; and one had sinonasal sarcoidosis. Conclusion The preoperative clinical diagnosis can be inaccurate in patients with CRS and bilateral CRSP. The misdiagnosis is more common in CRSP, including patients with recurrent polyposis.

Identification and Treatment of Nontuberculous Mycobacterium Sinusitis

2011 ◽  
Vol 25 (6) ◽  
pp. 421-424 ◽  
Author(s):  
Jeffrey D. Suh ◽  
Vijay R. Ramakrishnan ◽  
Bobby Tajudeen ◽  
Christine Reger ◽  
David W. Kennedy ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Case Series ◽  
Sinus Surgery ◽  
Nontuberculous Mycobacterium ◽  
Mycobacterium Fortuitum ◽  
Retrospective Case ◽  
Mycobacterium Chelonae ◽  
Atypical Mycobacterium ◽  
Retrospective Case Series ◽  
Positive Culture Result

Background The purpose of this study was to identify the incidence of atypical Mycobacterium identified by routine sinus cultures and review the recent literature on management. Methods A retrospective case series was performed in a tertiary academic hospital. A retrospective case series of all patients treated with atypical Mycobacterium rhinosinusitis from 2005 to 2010 was performed. Cases were identified from a prospective database of 676 endoscopically guided sinus cultures. Results Eight patients with atypical Mycobacterium sinusitis were identified. There were five women and three men. Median age was 63 years (range, 55–71 years). All patients had prior endoscopic sinus surgery a median of 14 months (range, 0.8–162 months) before a positive culture result. Species identified included Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium abscessus, and Mycobacterium avium complex. Chief presenting symptoms were postnasal discharge (88%), followed by decreased smell and taste (63%), and facial pain/pressure (38%). Patients were treated based on sensitivity results with long-term oral antibiotics for at least 2 months based on improvements on endoscopy. Median follow-up for patients in this study after treatment was 1.3 years (range, 0.6–4.6 years). Conclusion In this study, atypical mycobacteria were identified in < 1% of sinus cultures. Prolonged, culture-directed antibiotic therapy remains the mainstay of treatment when there is clinical evidence of infection. Previous endoscopic sinus surgery may represent a risk factor for colonization and subsequent infection. Further research is necessary to determine the optimal treatment duration and management to prevent disease relapse

Combined approach for paediatric recurrent antrochoanal polyp: a single-centre case series of 27 children

2019 ◽  
Vol 133 (7) ◽  
pp. 627-631 ◽  
Author(s):  
E Mantilla ◽  
P Villamor ◽  
C De La Torre ◽  
H Álvarez-Neri
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Case Series ◽  
Complete Removal ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Correct Identification ◽  
Antrochoanal Polyp ◽  
Combined Approach ◽  
Retrospective Case ◽  
Polyp Recurrence

AbstractObjectiveTo compare functional endoscopic sinus surgery with a combined approach (functional endoscopic sinus surgery plus Caldwell–Luc procedure) for the treatment of paediatric antrochoanal polyp, in terms of antrochoanal polyp recurrence and safety.MethodThis retrospective case series comprises 27 paediatric patients with recurrent antrochoanal polyp, treated from January 2010 to January 2018.ResultsThe average age of the patients at the time of diagnosis was 10.4 ± 2.49 years. The recurrence rate after functional endoscopic sinus surgery alone was 72.9 per cent, compared with 12.5 per cent after functional endoscopic sinus surgery plus the Caldwell–Luc procedure (p < 0.00001). No complications were reported during surgery or follow up.ConclusionThe correct identification of the origin of the antrochoanal polyp and an adequate returning of maxillary ventilation by widening the ostium can prevent recurrences. Although functional endoscopic sinus surgery continues to be the ‘gold standard’ for antrochoanal polyp treatment, in cases of revision surgery, a combined approach could ensure the complete removal of the polyp through the two openings.

The Role of Endoscopic Sinus Surgery in Children Undergoing External Drainage of Non-Medial Subperiosteal Orbital Abscess

2020 ◽  
pp. 194589242095379
Author(s):  
Stephen R. Chorney ◽  
Adva Buzi ◽  
Mark D. Rizzi
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Case Series ◽  
Primary Objective ◽  
Acute Sinusitis ◽  
Sinus Surgery ◽  
Symptom Duration ◽  
Retrospective Case ◽  
Orbital Abscess ◽  
Significant Difference ◽  
Subperiosteal Orbital Abscess

Background The extent of surgery required in the management of pediatric non-medial subperiosteal orbital abscess (SPOA) due to medically refractory complicated acute sinusitis is unknown. Objectives The primary objective is to compare operative outcomes of children treated with combined endoscopic sinus surgery (ESS) and external orbital drainage (EOD) versus those treated with EOD alone. Methods Retrospective case series from a tertiary children’s hospital analyzing outcomes in children requiring surgical management for acute sinusitis complicated by non-medial SPOA between November 2007 and September 2019. Results Sixteen children with a mean age of 9.4 years (95% CI: 7.3–11.4) met inclusion. Eleven (68.8%) underwent combined EOD and ESS, while five (31.2%) underwent EOD alone. Groups were similar in age, symptom duration, white blood cell count, C-reactive protein level, intraocular pressure, Lund-Mackay score, and abscess volume. There was no significant difference in median length of stay between patients treated with a combined approach versus those treated by EOD alone. Cultures identified non-beta-hemolytic Streptococcus species in 56.3% of patients, with Streptococcus intermedius representing the most common organism in 37.5%. In one case, ESS identified a pathogen not acquired via concomitant EOD, which did influence management. No child required a subsequent surgical procedure and there were no operative complications. Conclusions The addition of ESS in the management of pediatric non-medial SPOA was not associated with a statistically different duration of hospitalization. Cultures from concomitant ESS rarely aided in diagnosis or antibiotic therapy. Further study should delineate the indications for ESS in these cases.

Odontogenic chronic rhinosinusitis patients undergoing tooth extraction: oral surgeon and otolaryngologist viewpoints and appropriate management

2020 ◽  
Vol 134 (3) ◽  
pp. 241-246
Author(s):  
K Tsuzuki ◽  
K Kuroda ◽  
K Hashimoto ◽  
K Okazaki ◽  
K Noguchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Tooth Extraction ◽  
Functional Endoscopic Sinus Surgery ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Oroantral Fistula ◽  
Improvement Ratio

AbstractObjectiveThis study aimed to propose appropriate management for odontogenic chronic rhinosinusitis.MethodThirty-one adult patients with odontogenic chronic rhinosinusitis undergoing maxillary extraction were retrospectively analysed. Patients with (n = 21) and without (n = 10) oroantral fistula on computed tomography were classified. Functional endoscopic sinus surgery was performed when sinusitis did not improve after extraction. The critical indicators for surgical requirement in the management of odontogenic chronic rhinosinusitis were analysed.ResultsSinusitis significantly improved after extraction in both groups. Patients without oroantral fistula had significantly more severe remnant sinusitis than those with oroantral fistula after extraction on computed tomography (p = 0.0037). The requirement for functional endoscopic sinus surgery was statistically significant for patients without orofacial fistula over those with orofacial fistula (p < 0.0001). The surgical improvement ratio was 93 per cent.ConclusionThe absence of oroantral fistula and severe sinusitis can be critical indicators for the requirement of functional endoscopic sinus surgery after extraction in the management of odontogenic chronic rhinosinusitis.

scholarly journals Extraocular muscle injury during endoscopic sinus surgery: a series of 10 cases at a single center

2014 ◽  
Vol 52 (3) ◽  
pp. 238-245
Author(s):  
J.H. Sohn ◽  
S.D. Hong ◽  
J.H. Kim ◽  
H.-J. Dhong ◽  
S.-K. Chung ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Extraocular Muscle ◽  
Muscle Injury ◽  
Case Series ◽  
Rectus Muscle ◽  
Strabismus Surgery ◽  
Sinus Surgery ◽  
Medial Rectus ◽  
Inferior Rectus ◽  
Retrospective Case

Background: Extraocular muscle (EOM) injury is a rare but serious complication of endoscopic sinus surgery (ESS). The aim of this study is to describe the clinical characteristics and course of EOM injury occurring during ESS. Design: Retrospective case series. Methods: Medical records and CT images of patients who suffered from EOM injury after ESS between 2006 and 2012 were retrospectively reviewed. Patient demographics, endoscopic anatomy, type of surgery (primary or revision), predisposing risk factors, site and extent of injury on CT imaging, and associated complications were evaluated. In addition, data regarding ophthalmologic management and clinical outcomes were collected. Results: Ten patients with EOM injuries after ESS were included in this study. One patient was undergoing revision ESS. All patients sustained medial rectus muscle injury and one patient suffered concurrent ipsilateral inferior rectus muscle injury. A microdebrider was used in nine cases. Right-sided injury (90% of patients) was more prevalent than left-sided injury, and 70% of injured medial rectus muscles were completely transected. After subsequent strabismus surgery, 8/9 patients regained binocular single vision in primary gaze despite residual diplopia in some gaze positions. Conclusion: Although proper ophthalmologic surgery after EOM injury may improve deviation in the primary gaze position, none of the patients regained normal EOM movement. Therefore, prevention of this complication through adequate surgical technique and precautions is important.

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