Predictors of Disease Control After Endoscopic Sinus Surgery Plus Long-Term Local Corticosteroids in CRSwNP

2020 ◽  
Vol 35 (1) ◽  
pp. 77-85
Author(s):  
Eugenio De Corso ◽  
Stefano Settimi ◽  
Laura Tricarico ◽  
Dario Antonio Mele ◽  
Rodolfo Francesco Mastrapasqua ◽  
...  
Keyword(s):  
Disease Control ◽  
Endoscopic Sinus Surgery ◽  
Preoperative Assessment ◽  
Sinus Surgery ◽  
Cumulative Probability ◽  
Clinical Factors ◽  
Poor Control ◽  
Good Disease Control ◽  
Endoscopic Score

Background in the era of new biological agents it is important to identify patients who may benefit from conventional therapies such as endoscopic sinus surgery (ESS) plus long-term local corticosteroids from those with patterns of inflammation that are more difficult to control post-operatively and who may benefit from other therapies. Objective determine if preoperative assessment of type and grade of inflammation and clinical factors can predict disease control with ESS plus long-term local corticosteroids in chronic rhinosinusitis with nasal polyps (CRSwNP). Methods Eighty patients treated with ESS plus mometasone-furoate 200 μg BID for CRSwNP and followed for at least 1 year were enrolled (November 2017–December 2018) in this prospective observational study. Type and grade of inflammation were evaluated preoperatively by nasal cytology. Based on cellular pattern, patients were grouped as neutrophilic (n = 20), eosinophilic (n = 38), or mixed eosinophil-neutrophilic (n = 22). SNOT-22 and Lund-Kennedy Endoscopic Score were evaluated at baseline and at 3, 6, 9, and 12 months after surgery and used to define disease control. Results The cumulative probability of remaining free of significant modification of endoscopic score (Lund-Kennedy Endoscopic Score >2) at 3, 6, 9, and 12 months was 0.84, 0.76, 0.71, and 0.68, respectively. At 12-month postoperative evaluation good disease control was observed in 54 of 80 patients (67.5%). Compared to those with good post-operative disease control, those with poor control had a significantly higher pre-operative mean count of eosinophils and neutrophils (p < 0.05). The preoperative inflammatory pattern was associated with relative risk of poor control: neutrophilia (RR: 3.10; CI:1.24–7.71), eosinophilia (RR:8.42; CI:2.72–15.12), and mixed eosinophilic and neutrophilic (RR:25.11; CI:19.41–30.01). We also confirmed that asthma, allergy, blood eosinophilia, and ASA triad could predict poor control. Conclusions The type and load of inflammation evaluated preoperatively and selected clinical factors can predict poor control of CRSwNP treated with ESS and local corticosteroids.

scholarly journals Endoscopic Sinus Surgery with Antrostomy Has Better Early Endoscopic Recovery in Comparison to the Ostium-Preserving Technique

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Annika Luukkainen ◽  
Jyri Myller ◽  
Tommi Torkkeli ◽  
Markus Rautiainen ◽  
Sanna Toppila-Salmi
Keyword(s):  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Radiologic Findings ◽  
Ostiomeatal Complex ◽  
Middle Meatal Antrostomy ◽  
Computed Tomography Scans ◽  
Endoscopic Score ◽  
Sinus Ostium

Background. Endoscopic sinus surgery (ESS) is considered for chronic rhinosinusitis (CRS) after failure of conservative therapy. Objective. The aim of this study was to evaluate endoscopically ostium patency and mucosal recovery after ESS, with either maxillary sinus ostium-preserving or -enlarging techniques. Materials and Methods. Thirty patients with non-polypous CRS were enrolled. Uncinectomy-only and additional middle meatal antrostomy were randomly and single-blindly performed for each side. Pre- and postoperative endoscopic scores were semi-quantitatively determined according to findings in the ostiomeatal complex area. Adhesions, maxillary sinus mucosal swelling, secretions, and ostium obstruction were also endoscopically evaluated. In addition, symptoms were asked and computed tomography scans were taken preoperatively and 9 months postoperatively. Results. At 16 days postoperatively, a better endoscopic score and a less obstructed ostium were found with antrosomy. At 9 months postoperatively the endoscopic score improved significantly and identically with both procedures, however, obstructed ostia and sinus mucosal swelling/secretions were insignificantly more frequently found on the uncinectomy-only side. Endoscopic and radiologic findings of the maxillary sinus mucosa and ostium correlated significantly 9 months postoperatively. Conclusion. There was a good long-term mucosal recovery with both surgical procedures. In terms of early mucosal recovery and ostium patency, antrostomy might be slighly superior.

scholarly journals Efficacy and Safety of Long-Term Low-Dose Clarithromycin in Patients With Refractory Chronic Sinusitis After Endoscopic Sinus Surgery: A Prospective Clinical Trial

2021 ◽  
pp. 014556132110320
Author(s):  
Han Chen ◽  
Bing Zhou ◽  
Qian Huang ◽  
Cheng Li ◽  
Yubin Wu ◽  
...  
Keyword(s):  
Oral Administration ◽  
Nasal Cavity ◽  
Endoscopic Sinus Surgery ◽  
Low Dose ◽  
Continuous Treatment ◽  
Sinus Surgery ◽  
Efficacy And Safety ◽  
Endoscopic Findings ◽  
Before And After

Objective: To observe the efficacy and safety of postoperative long-term low-dose oral administration of clarithromycin in patients with refractory chronic rhinosinusitis (RCRS), to explore the characteristics of postoperative microbiota in the nasal cavity in patients with RCRS, and to compare the differences and changes in microbiota in the nasal cavity before and after medication. Methods: This was a prospective, self-controlled study. Eighteen patients with RCRS who had persistent symptoms after endoscopic sinus surgery and standard therapy with normal immunoglobulin E and eosinophil level were included. Low dose (250 mg, once daily) clarithromycin was orally administrated for 12 weeks. Symptom severity and endoscopic findings were evaluated before, after 4 weeks, and 12 weeks of treatment, and nasal cavity microbiota was analyzed simultaneously. Results: A total of 18 patients with RCRS were enrolled and 17 patients completed the study. Four weeks after oral administration of clarithromycin, significant improvement was observed in subjective symptoms including nasal congestion, rhinorrhea, postnasal drip, and general discomfort, as well as endoscopic findings including general surgical cavity condition, rhinedema, and rhinorrhea ( P < .05). After continuous treatment to the 12th week, symptoms showed significant improvement compared with baseline, and endoscopic score showed significant improvement compared with both baseline and 4 weeks after treatment. Analysis of middle nasal meatus flora revealed a significant decrease of Streptococcus pneumoniae after 12 weeks of clarithromycin treatment ( P < .05), while the richness, composition, and diversity were similar before and after treatment. Patients enrolled experienced no adverse drug reaction or allergic reaction, nor clinical significant liver function impairment observed. Conclusion: Postoperative low-dose long-term oral administration of clarithromycin in patients with RCRS can improve the clinical symptoms and facilitate the mucosal epithelialization, with good tolerance and safety. The efficacy of clarithromycin in patients with RCRS may be related to its regulatory effect on nasal cavity microbiota.

Anatomical Variations in Osteomeatal Complex among Patients undergoing Functional Endoscopic Sinus Surgery

2016 ◽  
Vol 9 (1) ◽  
pp. 28-32 ◽  
Author(s):  
V Narendrakumar ◽  
V Subramanian
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Middle Turbinate ◽  
Preoperative Assessment ◽  
Ct Scanning ◽  
Anatomical Variations ◽  
Uncinate Process ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Frequency Of Occurrence ◽  
Osteomeatal Complex

ABSTRACT Aims To study the anatomical variations of osteomeatal complex and the importance of preoperative computed tomography (CT) in patients with chronic sinusitis undergoing functional endoscopic sinus surgery. We studied the different variations and their frequency of occurrence. Materials and methods A total of 100 patients undergoing endoscopic sinus surgery were studied by nasal endoscopy, CT scanning, and at the time of definitive surgery, variations were recorded. Results The frequency of occurrence of sinonasal anatomical variations was septal deviation in 76%, agger nasi cells in 71%, concha bullosa in 61%, medialized uncinate process in 48%, prominent bulla ethmoidalis in 41%, paradoxical middle turbinate in 33%, accessory maxillary ostium in 28%, frontal cell in 22%, intumescentia septi nasi anterior in 21%, lateralized uncinate in 15%, pneumatized uncinate process in 4%, Haller cells in 12%, and Onodi cells in 8%. Conclusion The high incidence of variations emphasizes the need for proper preoperative assessment for safe and effective endoscopic sinus surgery. How to cite this article Narendrakumar V, Subramanian V. Anatomical Variations in Osteomeatal Complex among Patients undergoing Functional Endoscopic Sinus Surgery. Clin Rhinol An Int J 2016;9(1):28-32.

Long-term Results of Functional Endoscopic Sinus Surgery

1998 ◽  
Vol 108 (2) ◽  
pp. 151-157 ◽  
Author(s):  
Brent A. Senior ◽  
David W. Kennedy ◽  
Jirayu Tanabodee ◽  
Hans Kroger ◽  
Mohammed Hassab ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Long Term Results

Long-term evaluation after endoscopic sinus surgery for chronic pediatric sinusitis with polyps

2012 ◽  
Vol 39 (6) ◽  
pp. 583-587 ◽  
Author(s):  
Toshiharu Tsukidate ◽  
Shinichi Haruna ◽  
Satoshi Fukami ◽  
Itsuo Nakajima ◽  
Wataru Konno ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Term Evaluation ◽  
Pediatric Sinusitis

Long-Term Effects of FloSeal™ Packing After Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (3) ◽  
pp. 240-243 ◽  
Author(s):  
Rakesh K. Chandra ◽  
David B. Conley ◽  
G. Kenneth Haines ◽  
Robert C. Kern
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Scar Tissue ◽  
Sinus Surgery ◽  
Tissue Formation ◽  
Long Term Effects ◽  
Study Evaluation ◽  
Long Term Follow Up ◽  
The Mean

Background A previous study by our group showed increased adhesions and granulation tissue in ethmoid cavities packed with FloSeal (FS) compared with those packed with thrombin-soaked gelatin foam after endoscopic sinus surgery (ESS). That study included 20 patients whose cavities were graded 6–8 weeks postoperatively. The goal of this study was to report long-term follow-up on this cohort. Methods At least 1 year follow-up was available in 18/20 patients. The number of office procedures required to lyse adhesions during the follow-up period was tabulated also. Pathology was available from one patient who underwent lysis of adhesions on an FS side. The histopathological findings are presented. Results The mean follow-up period was 21.4 (±2.3) months, and none of the 18 patients required revision ESS during this interval. The overall incidence of adhesions (p = 0.013) and the number requiring lysis of adhesions (p = 0.046) were both greater in the FS group. During the interval between previous study evaluation (6–8 weeks postop) and last follow-up, five FS sides required a total of seven procedures to lyse adhesions. Silent adhesions were observed in an additional five FS sides. Although asymptomatic adhesions were observed in two thrombin-soaked gelatin sides at last examination, none underwent lysis. Biopsy of an adhesion from a patient packed with FS 25 months earlier revealed incorporated foreign material. Conclusion FS appears to be associated with scar tissue formation and may be incorporated into recovering mucosa. Use of FS may increase the degree of postoperative care required after ESS.

Long-term impact of functional endoscopic sinus surgery on asthma

1999 ◽  
Vol 121 (1) ◽  
pp. 66-68 ◽  
Author(s):  
Brent A. Senior ◽  
David W. Kennedy ◽  
Jirayu Tanabodee ◽  
Hans Kroger ◽  
Mohammed Hassab ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Long Term Impact

Safe application of mitomycin C within the nasal cavity

2011 ◽  
Vol 125 (3) ◽  
pp. 309-310 ◽  
Author(s):  
T Gutierrez ◽  
C Hopkins
Keyword(s):  
Case Report ◽  
Mitomycin C ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Frontal Sinusitis ◽  
Endonasal Surgery ◽  
Simple Manner ◽  
Novel Technique ◽  
Adjacent Mucosa

AbstractObjective:To describe a novel technique of delivering mitomycin C safely via endoscopic sinus surgery.Case report:Mitomycin C was applied in the median frontal drainage pathway of a 44-year-old woman suffering from recalcitrant chronic frontal sinusitis. The mitomycin C was soaked onto a neurosurgical patty, which was delivered through a nasopharyngeal tube trimmed to ensure delivery directly to the desired area, thus sparing adjacent mucosa.Conclusions:Mitomycin C has been suggested to have a useful role in reducing post-operative scarring after endonasal surgery. The long term safety of topical mitomycin C is not yet known, and inadvertent topical application to adjacent mucosa should be avoided. The described technique achieves this in a simple manner, and can be easily applied to other locations.

Sign in / Sign up

Export Citation Format

Share Document