scholarly journals Long term oral azithromycin versus functional endoscopic sinus surgery in patients suffering from chronic rhinosinusitis: a comparative study

2021 ◽  
Vol 7 (6) ◽  
pp. 1015
Author(s):  
Garima Yadav ◽  
Mayank Yadav ◽  
Deeksha Nautiyal ◽  
T. S. Anand
Keyword(s):  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Sinus Surgery ◽  
Symptom Improvement ◽  
Study Population ◽  
Maximal Medical Therapy ◽  
Objective Outcome ◽  
Oral Azithromycin

<p class="abstract"><strong>Background: </strong>Chronic rhinosinusitis (CRS) is defined as inflammation of the nasal cavity and paranasal sinuses. Azithromycin, a macrolide antibiotic, a well-established class of anti-bacterial agents, which also have anti-inflammatory properties. The present study was designed to compare the role of azithromycin with surgical management in patients with chronic-rhinosinusitis.</p><p class="abstract"><strong>Methods: </strong>The study population included 60 adult patients with symptomatic CRS refractory to 3 weeks of medical therapy. The patients were divided in two groups with 30 patients in each group. One group of patients received oral Azithromycin as main treatment for 12 weeks while the other group of patients underwent sinonasal surgery. Symptom scoring and endoscopic scoring were done previous to the treatment and at 1 month and 3-month follow-ups.</p><p class="abstract"><strong>Results:</strong> A good subjective as well as objective outcome in terms of symptom improvement was obtained with in patients with chronic rhinosinusitis with Surgical intervention as compared to those patients who received long term oral Azithromycin.</p><p class="abstract"><strong>Conclusions: </strong>We advocate that patients suffering from chronic sinonasal disease should be initially targeted with maximal medical therapy using an oral macrolide for at least 3 months. After this patient should be assessed and surgery considered in those cases refractory to medical therapy.</p>

scholarly journals Maximal Medical Therapy for Chronic Rhinosinusitis: A Survey of Chinese Otolaryngologists

2019 ◽  
Vol 99 (3) ◽  
pp. 159-164
Author(s):  
Zhenxiao Huang ◽  
Jingying Ma ◽  
Yan Sun ◽  
Bing Zhou
Keyword(s):  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Practice Patterns ◽  
Demographic Data ◽  
Sinus Surgery ◽  
Oral Antibiotics ◽  
Intranasal Corticosteroid ◽  
Saline Irrigation ◽  
Frequency Of Use ◽  
Maximal Medical Therapy

The aim of the present study was to evaluate the clinical practice patterns in maximal medical therapy (MMT) before endoscopic sinus surgery for chronic rhinosinusitis (CRS) by Chinese otolaryngologists. An anonymous web-based survey of MMT was performed. This survey assessed types of therapies, the frequency of use, duration of use, and demographic data of respondents. A total of 134 (26.8%) questionnaires were completed and returned. The majority (62.69%) of respondents would consider surgery less than 3 months after commencing MMT, 33.58% would wait 3 to 6 months. Intranasal corticosteroid sprays, saline irrigation, oral antibiotics, oral mucolytics, and oral Chinese herbals were the most commonly used therapies and listed as “often (>70%)”. Macrolides were most commonly antibiotics prescribed among the clinicians surveyed (51.49%). Intranasal corticosteroid sprays, oral antibiotics, oral mucolytics, nasal saline irrigations, and oral Chinese herbals are most commonly prescribed by the majority of Chinese otolaryngologists as MMT for CRS. Current practice patterns of MMT among Chinese otolaryngologists are not uniformly based on evidence-based guidelines.

Revision Functional Endonasal Sinus Surgery

1992 ◽  
Vol 71 (3) ◽  
pp. 131-133 ◽  
Author(s):  
Rande H. Lazar ◽  
Ramzi T. Younis ◽  
Thomas E. Long ◽  
Charles W. Gross
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
Retrospective Analysis ◽  
Medical Therapy ◽  
Revision Surgery ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Endonasal Sinus Surgery ◽  
Maximal Medical Therapy

Revision functional endonasal sinus surgery (FESS) is recommended for patients whose symptoms of chronic or recurrent sinusitis persist despite primary FESS, long-term maximal medical therapy, and no sign of other abnormalities as demonstrated by computed tomography. After analyzing the charts of 673 patients who underwent primary FESS, we reviewed the 63 cases of revision surgery performed between 1986 and 1989. This retrospective analysis presents the management and outcome of 16 children (<16 years) and 47 adults who had revision FESS. The overall success rate of revision FESS was 78%, with no major complications, reflecting the improved management of sinus disease offered by this procedure.

scholarly journals Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis

2014 ◽  
Vol 125 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Luke Rudmik ◽  
Zachary M. Soler ◽  
Jess C. Mace ◽  
Rodney J. Schlosser ◽  
Timothy L. Smith
Keyword(s):  
Economic Evaluation ◽  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery

Biological therapy of chronic rhinosinusitis

2021 ◽  
Vol 70 (2) ◽  
pp. 109-114
Author(s):  
Zuzana Balatková ◽  
Zdeněk Knížek ◽  
Jan Vodička ◽  
Jan Plzák
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Biological Therapy ◽  
Immunoglobulin E ◽  
Sinus Surgery ◽  
Therapeutic Choice ◽  
First Choice ◽  
Intranasal Steroids

The aim of this paper is to present an up-to-date information about therapeutical options in chronic rhinosinusitis with nasal polyps. First choice therapy is a long term regular application of intranasal steroids in combination with salinic solution douches. If this treatment is not eff ective enough, then the pulses of systemic steroids are indicated. If the sufficient control of the disease is not achieved, then surgery is a therapeutic choice; it means functional endoscopic sinus surgery in the extent corresponding to the extension of the sinus disease. However, there remains a certain group of patients in whom the results with this treatment are not optimal. The type 2 immunopathological response affects relevantly the course of the disease. Nowadays, the research is done in this field. Specific agents, which are able to block circulating inflammatory mediators or bind receptors for these mediators are developed and studied. The results of the studies having been completed by now are promising. Keywords: biological therapy – chronic rhinosinusitis – nasal polyps – dupilumab – immunoglobulin E – interleukin

Balloon Sinuplasty Utilization in the Pediatric Population: A National Database Perspective

2019 ◽  
Vol 161 (4) ◽  
pp. 683-687 ◽  
Author(s):  
Gerard Thong ◽  
Natasha D. Dombrowski ◽  
Kosuke Kawai ◽  
Michael J. Cunningham ◽  
Eelam A. Adil
Keyword(s):  
Chronic Rhinosinusitis ◽  
Pediatric Population ◽  
Health Information System ◽  
Sinus Surgery ◽  
National Database ◽  
Inclusion Criteria ◽  
Readmission Rates ◽  
Balloon Sinuplasty ◽  
Before And After

Objective Balloon sinuplasty (BS) is a surgical management option in the treatment of chronic rhinosinusitis. The purpose of this study was to examine BS utilization among children with a national database. Study Design Retrospective review. Setting National pediatric database. Subjects and Methods All cases of children aged ≤18 years who underwent BS or traditional endoscopic sinus surgery (ESS) 5 years before and after the introduction of BS billing codes were studied with the Pediatric Health Information System database. We evaluated overall trends, demographics, performing physicians, readmissions, and cost data. Results A total of 14,079 patients met inclusion criteria: 13,555 underwent traditional ESS and 524 had a BS procedure. There was no significant increase in BS rates between 2011 and 2016. BS was more commonly performed among younger children than ESS (median age [interquartile range], 6 years [4-10] vs 9 years [6-13]; P < .001). There were 23 (4.4%) readmissions within 30 days in the balloon cohort versus 474 (3.5%) in the ESS cohort. The median cost of balloon maxillary antrostomy (US $6560 [$5420-$8250]) was higher than that of traditional maxillary antrostomy (US $5630 [$4130-$7700], P < .001). Physicians who performed BS had a larger volume of ESS procedures when compared with those who did not perform BS. Conclusion Rates of BS performance in the pediatric population have not increased over time. Results showed no difference in readmission rates between BS and ESS. BS was associated with higher costs as compared with ESS. The role of BS in the pediatric chronic rhinosinusitis population remains unclear.

scholarly journals A 10-Year Follow-Up of a Randomized Prospective Study of 2 Treatments for Chronic Rhinosinusitis Without Nasal Polyps and Investigation of the Impact of Gastroeosophageal Reflux Disease in the Resistance to Treatment

2019 ◽  
pp. 014556131989246
Author(s):  
Jerome R. Lechien ◽  
Gersende Debie ◽  
Virginie Mahillon ◽  
Marie-Paule Thill ◽  
Alexandra Rodriguez ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Chronic Rhinosinusitis ◽  
Reflux Disease ◽  
Nasal Polyps ◽  
Sinus Surgery ◽  
Amoxicillin Clavulanate ◽  
The Impact

Objectives: To compare the 2 long-term medical strategies in chronic rhinosinusitis without nasal polyps (CRSnNP) and to identify the role of gastroesophageal reflux disease (GERD) and Helicobacter pylori as factors of treatment failure. Material and Methods: Fifty-seven patients with CRSnNP were randomized into 2 therapeutic groups. The first group was treated with 4 weeks of amoxicillin/clavulanate and a short course of oral steroids. The second group received 8 weeks of clarithromycin. Sinonasal Outcome Test-20 (SNOT-20) and Lund and Mackay scores were assessed at baseline and after treatment, and GERD Health-Related Quality of Life (GERD-HRQL) questionnaire was evaluated in all patients. Patients with a GERD-HRQL score >8 received esogastroscopy and H pylori detection. Patients were followed during a 10-year period for clinical course and GERD evolution. The 10-year evolution of patients was described in terms of recurrence, medical, and surgical treatments. Results: Thirty-seven patients completed the study; SNOT-20 and Lund and Mackay scores similarly improved in both groups. Amoxicillin/clavulanate group had significantly more adverse reactions than the clarithromycin group (P = .03). After the therapeutic course, 35% (amoxicillin/clavulanate) and 41% (clarithromycin) of patients needed functional endoscopic sinus surgery (FESS). During the long-term follow-up, 54% (amoxicillin/clavulanate) and 40% (clarithromycin) of patients had late CRSnNP recurrence; FESS was performed in less than 15% of cases of recurrence. Gastroesophageal reflux disease complaint’s severity was associated with late recurrence of CRSnNP. Conclusion: Amoxicillin/clavulanate and clarithromycin would be competitive treatments for CRSnNP. Gastroesophageal reflux disease seems to be a negative factor for treatment response and recurrence.

Osteomeatal Complex Obstruction is not Associated with Adjacent Sinus Disease in Chronic Rhinosinusitis with Polyps

2011 ◽  
Vol 25 (6) ◽  
pp. 401-403 ◽  
Author(s):  
Randy M. Leung ◽  
Robert C. Kern ◽  
David B. Conley ◽  
Bruce K. Tan ◽  
Rakesh K. Chandra
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Disease Process ◽  
Subsequent Development ◽  
Ct Scans ◽  
Osteomeatal Complex ◽  
Maximal Medical Therapy ◽  
Previous Pilot Study

Background It is universally accepted that osteomeatal complex (OMC) disease is linked to the subsequent development of chronic rhinosinusitis without nasal polyps (CRSsNPs) via postobstructive mechanisms. The role of OMC obstruction in the pathogenesis of CRSwNPs is less clear. This study was designed to identify if there is an association between OMC obstruction and inflammation of the adjacent sinuses, when patients are stratified by polyp status. This is a follow-up and expanded series of a previous pilot study from our group. Method CT scans of 144 patients with CRSsNPs and 123 patients with CRS with nasal polyps (CRSwNPs) were evaluated for each sinus and OMC. Patients had no previous surgeries for NPs. CT scans were obtained after a trial of maximal medical therapy. Results Increasing OMC involvement was associated with increasing Lund-Mackay score for both CRSsNPs and CRSwNPs. In CRSsNP patients, OMC status significantly correlated with adjacent sinus status (p < 0.0001). Meanwhile in CRSwNPs, OMC status does not correlate with adjacent sinus status (p = 0.328). Conclusion OMC obstruction in the setting of CRSwNP may be a barometer of the overall disease process, but in this scenario, paranasal sinus inflammation can not be classified as a postobstructive phenomenon. These findings question the role of minimally invasive procedures in the management of CRSwNPs.

American Rhinologic Society Member Survey on “Maximal Medical Therapy” for Chronic Rhinosinusitis

2007 ◽  
Vol 21 (4) ◽  
pp. 483-488 ◽  
Author(s):  
Marc G. Dubin ◽  
Cindy Liu ◽  
Sandra Y. Lin ◽  
Brent A. Senior
Keyword(s):  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Demographic Data ◽  
Standard Of Care ◽  
Oral Antibiotics ◽  
Saline Irrigation ◽  
Frequency Of Use ◽  
Nasal Steroids ◽  
Oral Steroids ◽  
Maximal Medical Therapy

Background “Maximal medical therapy” is the standard of care for chronic rhinosinusitis (CRS) treatment before the recommendation for surgery. However, this therapy is not consistent. Therefore, as a first step in determining the role of the disparate “maximal medical” treatments for CRS, American Rhinologic Society (ARS) members were surveyed. Methods A survey was mailed to all nonresident members of the ARS (n = 723). Focusing on the time period before surgical intervention is first considered for CRS patients, the survey assessed types of therapies, frequency of use, details on antibiotic and steroid usage, use of computed tomography (CT), and demographic data of respondents. All responses were anonymous. Results Three hundred eight surveys were returned (43%). A majority of respondents used oral antibiotics and nasal steroids “almost always (>90%).” Oral antibiotics, oral steroids, nasal steroids, saline irrigation, and allergy testing were most commonly used at least “usually (50–90%).” The median antibiotic length was 3.1–4 weeks. The mean peak prednisone dose was 51.7 mg when oral steroids were used. Therapies that were rarely or never used by the majority included oral antifungals, antifungal spray, antibiotic spray, antibiotic nebulizer, steroid nebulizer, and i.v. antibiotics. Conclusion Oral antibiotics (median, 3.1–4 weeks) and nasal steroids are used >90% of the time by a majority of ARS members for maximal medical treatment of CRS.

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