Patient perspectives on endoscopic sinus surgery for chronic rhinosinusitis

Abstract Background Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients’ perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success. Methods Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings. Results Exploration of themes on patients’ perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients’ QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success. Conclusions Patients’ level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient’s principal complaints within the context of a personalized approach and to refer back to patients’ preoperative goals in their assessment of operative success. Graphical abstract

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The Effects of Endoscopic Sinus Surgery on Voice Characteristics in Chronic Rhinosinusitis Patients

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419861124 ◽

2019 ◽

Vol 128 (12) ◽

pp. 1129-1133

Author(s):

Danny B. Jandali ◽

Ashwin Ganti ◽

Inna A. Husain ◽

Pete S. Batra ◽

Bobby A. Tajudeen

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Tertiary Care ◽

Voice Quality ◽

Upper Airway ◽

Sinus Surgery ◽

Perceptual Evaluation ◽

Snot 22

Objectives: Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed. Methods: Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms. Results: 18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p = .005) and VHI (10-4.7, p < .001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p < .001). Conclusions: Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality.

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Office-Based Sinus Surgery for Cystic Fibrosis Chronic Rhinosinusitis

ORL ◽

10.1159/000512495 ◽

2020 ◽

pp. 1-4

Author(s):

Daniel B. Spielman ◽

David A. Gudis

Keyword(s):

Cystic Fibrosis ◽

Mechanical Ventilation ◽

Chronic Rhinosinusitis ◽

Local Anesthesia ◽

Endoscopic Sinus Surgery ◽

Care Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Sinus Surgery ◽

Office Setting

Objective: Chronic rhinosinusitis (CRS) is nearly ubiquitous in the cystic fibrosis (CF) population, and many patients require multiple endoscopic sinus surgeries throughout their lifetime. Recent studies have demonstrated the profound pulmonary and systemic health benefits of comprehensive CRS treatment. Both endotracheal intubation with mechanical ventilation and inpatient hospital care represent significant risks for CF patients. The goal of this study is to evaluate the safety and feasibility of performing revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia to decrease the need for mechanical ventilation and inpatient hospitalization. Methods: This is a prospective cohort study conducted at a tertiary care academic medical center with a CF Foundation-accredited care center. Patients with CF and refractory CRS despite prior surgery and medical therapy were eligible for inclusion. Comprehensive revision ESS was performed in the office using only local anesthesia. Results: Five patients were enrolled and underwent revision endoscopic sinus surgery without complication. The average preoperative Sinonasal-Outcome Test-22 score was 52.0 ± 12.1 and the average preoperative Lund-Mackay score was 15.2 ± 3.8. No patients requested aborting the procedure early due to pain, discomfort, or any other reason. No subjects required prolonged observation or postoperative hospital admission. Conclusion: This prospective pilot study is the first to demonstrate the safety and feasibility of performing comprehensive revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia.

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The Prevalence and Effect of Asthma on Adults with Chronic Rhinosinusitis

Ear Nose & Throat Journal ◽

10.1177/014556130708600719 ◽

2007 ◽

Vol 86 (7) ◽

pp. 409-411 ◽

Cited By ~ 37

Author(s):

Melanie W. Seybt ◽

Kevin C. McMains ◽

Stilianos E. Kountakis

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Congestion ◽

Adult Population ◽

Tertiary Care ◽

Sinus Surgery ◽

Postnasal Drip ◽

Asthma Patients ◽

General Adult Population ◽

Tertiary Care Institution ◽

The Difference

We conducted a retrospective review of 145 consecutively presenting adults treated for chronic rhinosinusitis (CRS) in a tertiary care institution. Our goals were to determine (1) the prevalence of asthma in these patients, (2) the prevalence of specific CRS symptoms in both asthmatic and nonasthmatic patients, and (3) the frequency of surgical treatment for CRS in patients with and without asthma. We found that asthma was present in 23.4% of CRS patients, a much higher rate than the 5% prevalence of asthma in the general adult population. Patients with asthma had a significantly higher prevalence of nasal polyps (47 vs. 22%; p = 0.004), olfactory dysfunction (26 vs. 6%; p = 0.001), and nasal congestion (85 vs. 60%; p = 0.027) than did those without asthma. Patients without asthma had a significantly higher prevalence of headache (72 vs. 53%; p = 0.037) and rhinorrhea (58 vs. 38%; p = 0.047). The prevalence of postnasal drip and environmental allergies in the two groups was similar. Although the difference between the proportions of patients with and without asthma who required primary sinus surgery was not statistically significant (76 vs. 64%; p = 0.175), patients with asthma did require significantly more revision sinus procedures overall (mean: 2.9 vs. 1.5; p = 0.003).

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Biofilm bakteri pada penderita rinosinusitis kronis: laporan seri kasus berbasis bukti

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v47i2.227 ◽

2018 ◽

Vol 47 (2) ◽

pp. 179

Author(s):

S Silvia ◽

Delfitri Munir ◽

Andrina Yunita Murni Rambe ◽

Amran Simanjuntak ◽

Jessy Chrestella ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Nasal Congestion ◽

Clinical Manifestations ◽

Functional Endoscopic Sinus Surgery ◽

Bacterial Biofilm ◽

Sinus Surgery ◽

Literature Study ◽

Duration Of Symptoms ◽

Hematoxylin Eosin

Latar belakang: Rinosinusitis kronis merupakan penyakit yang sering dijumpai pada bagian telinga hidung tenggorok kepala dan leher. Melalui berbagai macam teknik pencitraan, biofilm dijumpai pada mukosa sinonasal dari pasien rinosinusitis kronis. Beberapa peneliti mengemukakan bahwa biofilm adalah penyebab yang umum dari infeksi persisten kronis. Peranan biofilm pada penderita rinosinusitis kronis dapat membantu menjelaskan manifestasi klinis pada penyakit tersebut. Ketersediaan pewarnaan hematoksilin-eosin yang luas dalam laboratorium patologi klinik membuatnya menjadi metode yang sangat praktis untuk mendeteksi biofilm dalam praktik klinis. Tujuan: Mempresentasikan ekspresi biofilm bakteri pada penderita rinosinusitis kronis yang menjalani tindakan bedah sinus endoskopi fungsional. Kasus: Sebanyak 33 pasien rinosinusitis kronis menjalani tindakan bedah sinus endoskopi fungsional di beberapa rumah sakit di Sumatera Utara selama bulan Januari-Desember 2016. Prevalensi biofilm didapati pada 22 pasien (66,7%) penderita rinosinusitis kronis. Pada penderita rinosinusitis kronis dengan biofilm positif dijumpai jenis kelamin pria lebih banyak, umur lebih tua, lama gejala lebih singkat, keberadaan polip lebih sering, dan keluhan hidung tersumbat lebih sering. Metode: Pencarian literatur melalui Pubmed dengan kata kunci: chronic rhinosinusitis and biofilm. Setelah melalui proses skrining didapati 2 literatur yang dianalisis. Hasil: Penatalaksanaan rinosinusitis kronis dengan medikamentosa, meliputi pemberian antibiotik, dekongestan, kortikosteroid dan mukolitik disertai terapi tambahan irigasi hidung, serta pembedahan. Bila dijumpai biofilm, maka regimen pemberian antibiotik memakai protocol Marshall. Kesimpulan: Prevalensi biofilm pada penderita rinosinusitis kronis cukup tinggi, pemeriksaan biofilm dapat dipertimbangkan pada pasien rinosinusitis kronis yang menjalani tindakan bedah sinus endoskopi fungsional. Kata kunci: Biofilm, rinosinusitis kronis, hematoksilin-eosin, bedah sinus endoskopi fungsional ABSTRACT Background: Chronic rhinosinusitis is a disease that often found in otorhinolaryngology. Its pathogenesis is not fully understood. Using variety techniques, biofilms have been found in the mucosa of chronic rhinosinusitis patients. Some researchers have suggested that biofilm is a common cause of chronic persistent infection. The role of biofilms in patients with chronic rhinosinusitis can help explain the clinical manifestations of the disease. The extensive availability of hematoxylin-eosin staining in clinical pathology laboratories makes it a very practical method for detecting biofilms in clinical practice. Purpose: To present bacterial biofilm expression in chronic rhinosinusitis patients who had underwent functional endoscopic sinus surgery. Cases:About 33 chronic rhinosinusitis patients who had underwent functional endoscopic sinus surgery in several hospitals in North Sumatera during January-December 2016.Biofilms were found in 22 (66.7%) patients with chronic rhinosinusitis. Chronic rhinosinusitis patients with positive biofilms found mostly male, older in age, shorter duration of symptoms, more frequent polyps, and more frequent nasal congestion complaints. Method: Literature study was conducted through Pubmed with keywords chronic rhinosinusitis and biofilm. After screening process, we obtained two articles that were analyzed based on the critical appraisal. Result: Management of chronic rhinosinusitiswas medical treatment with antibiotic, decongestant, corticosteroid and mucolytic, accompanied by additional nasal irrigation therapy, and surgery. If biofilm was found, antibiotic regimen given using Marshal protocol. Conclusion: The prevalence of biofilms in patients with chronic rhinosinusitis was quite high. Biofilm examination should be considered in patients with chronic rhinosinusitis who undergo functional endoscopic sinus surgery. Keywords: Biofilm, chronic rhinosinusitis, hematoxylin-eosin, fungsional endoscopic sinus surgery

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Does pterygopalatine canal injection with local anaesthetic and adrenaline decrease bleeding during functional endoscopic sinus surgery?

The Journal of Laryngology & Otology ◽

10.1017/s0022215114001790 ◽

2014 ◽

Vol 128 (9) ◽

pp. 814-817 ◽

Cited By ~ 10

Author(s):

C J Valdes ◽

Y Al Badaai ◽

M Bogado ◽

M Samaha

Keyword(s):

Blood Loss ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Tertiary Care ◽

Functional Endoscopic Sinus Surgery ◽

Pterygopalatine Fossa ◽

Sinus Surgery ◽

Significant Difference ◽

Duration Of Surgery ◽

Surgical Field

AbstractObjective:To determine the effect of pterygopalatine fossa injection with xylocaine and adrenaline on: surgical field bleeding and blood loss during functional endoscopic sinus surgery for chronic rhinosinusitis, and the duration of the procedure.Methods:A prospective, single-blinded, controlled trial was performed in a tertiary care academic centre. A total of 45 patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis, whose disease was symmetrical based on computed tomography grading, were included. A unilateral pterygopalatine fossa injection with 1 per cent xylocaine and 1:100 000 adrenaline was performed after the induction of anaesthesia. The contralateral side served as the control. The operating surgeon, who was blinded to the injected side, assessed the surgical field using a validated six-item grading system. Blood loss, blood pressure, heart rate and end-tidal carbon dioxide were recorded every 15 minutes for each side separately, and duration of surgery was noted.Results:There was no statistically significant difference in the surgical field grade between the injected and non-injected sides (p = 0.161). There were no differences in blood loss or duration of surgery.Conclusion:Pterygopalatine fossa injection prior to functional endoscopic sinus surgery did not decrease intra-operative surgical field bleeding, blood loss or duration of surgery.

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What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00519-9 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Nadim Saydy ◽

Sami P. Moubayed ◽

Marie Bussières ◽

Arif Janjua ◽

Shaun Kilty ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Patient Reported Outcome ◽

Sinus Surgery ◽

Structured Interviews ◽

Subjective Data ◽

Operative Outcomes ◽

Patient Reported ◽

Definition Of Success ◽

Reported Data

Abstract Objectives Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. Methods A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. Results According to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. Conclusions According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2). Graphical abstract

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