scholarly journals The Effect of Triamcinolone-Soaked Gelfoam in Patients with Polypoid Mucosal Change after Endoscopic Sinus Surgery

2020 ◽  
Vol 27 (1) ◽  
pp. 16-20
Author(s):  
Gwanghui Ryu ◽  
Young Sang Cho ◽  
Sang Duk Hong ◽  
Hyo Yeol Kim ◽  
Seung-Kyu Chung ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Eosinophil Cationic Protein ◽  
Sinus Surgery ◽  
Cationic Protein ◽  
Failure Group ◽  
Success Group ◽  
Endoscopic Guidance ◽  
Poor Outcomes ◽  
Tissue Eosinophil

Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) recurs frequently after endoscopic sinus surgery (ESS). The aim of study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurred polypoid changes after ESS.Subjects and Method: A total of 35 patients and 57 nasal cavities was retrospectively reviewed. All patients underwent triamcinolone- infused gelfoam packing for 1 week under nasal endoscopic guidance. Endoscopic scores were evaluated at 1 week, 1 month, and 3 months. We analyzed clinical characteristics between success and failure groups.Results: Endoscopic scores were significantly improved after triamcinolone-soaked gelfoam packing, and the effects were maintained at 3-month follow-up (1.85±0.61 vs. 0.82±0.77, p＜0.001). Duration between surgery and gelfoam packing was shorter in the success group compared to the failure group (8.2±6.9 vs. 13.7±8.4 weeks, p=0.033). Serum eosinophil cationic protein and tissue eosinophil counts were significantly higher in the failure group (p=0.025 and p=0.010, respectively).Conclusion: Triamcinolone-soaked gelfoam packing is an effective and safe method for managing recurrent polypoid change in patients with CRSwNP after ESS. Early intervention contributed to a successful result, and eosinophilic inflammation was associated with poor outcomes.

Revision Functional Endoscopic Sinus Surgery: Objective and Subjective Surgical Outcomes

2005 ◽  
Vol 19 (4) ◽  
pp. 344-347 ◽  
Author(s):  
K. Christopher McMains ◽  
Stilianos E. Kountakis
Keyword(s):  
Medical Therapy ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Patient Symptom ◽  
Before And After ◽  
Revision Sinus Surgery ◽  
Preoperative Ct ◽  
The Mean

Background The aim of this study was to report objective and subjective outcomes after revision sinus surgery (RESS) for chronic rhinosinusitis (CRS). Methods We performed a retrospective analysis of prospectively collected data in 125 patients requiring revision functional endoscopic sinus surgery after failing both maximum medical therapy and prior sinus surgery for CRS. Patients were seen and treated over a 3-year period (1999–2001) in a tertiary rhinology setting. Computed tomography (CT) scans were graded as per Lund-MacKay and patient symptom scores were recorded using the Sinonasal Outcome Test 20 (SNOT-20) instrument. Individual rhinosinusitis symptoms were evaluated on a visual analog scale (0–10) before and after surgery. All patients had a minimum 2-year follow-up. Results The mean number of prior sinus procedures was 1.9 ± 0.1 (range, 1–7) and the mean preoperative CT grade was 13.4 ± 0.7. Patients with asthma and polyposis had higher CT scores than those without these processes. Preoperative mean SNOT-20 and endoscopy scores were 30.7 ± 1.3 and 7.3 ± 0.4, respectively. At the 2-year follow-up, mean SNOT-20 and endoscopy scores improved to 7.7 ± 0.6 and 2.1 ± 0.4, respectively (p < 2.8 X 10-10). At 12-month follow-up, each individual symptom score decreased significantly. Overall, 10 patients failed RESS and required additional surgical intervention for an overall failure rate of 8.0%. All patients who failed RESS had nasal polyposis. Conclusion Revision functional endoscopic sinus surgery benefits patients that fail maximum medical therapy and prior sinus surgery for CRS by objective and subjective measures.

scholarly journals A 16-Year Study on Incidence and Progression of Diseased Sphenoethmoidal (Onodi) Cell

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ethan I. Huang ◽  
Chia-Ling Kuo ◽  
Li-Wen Lee
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Optic Nerve ◽  
Endoscopic Sinus Surgery ◽  
Visual Loss ◽  
Sinus Surgery ◽  
Acute Visual Loss ◽  
Computed Tomography Images ◽  
Onodi Cell

Traumatic operative injury of the optic nerve in an endoscopic sinus surgery may cause immediate or delayed blindness. It should be cautioned when operating in a sphenoethmoidal cell, or known as Onodi cell, with contact or bulge of the optic canal. It remains unclear how frequent progression to visual loss occurs and how long it progresses to visual loss because of a diseased sphenoethmoidal cell. Research to discuss these questions is expected to help decision making to treat diseased sphenoethmoidal cells. From July 2001 to June 2017, 216 patients received conservative endoscopic sinus surgery without opening a diseased sphenoethmoidal cell. We used their computed tomography images of paranasal sinuses to identify diseased sphenoethmoidal cells that could be associated with progression to visual loss. Among the 216 patients, 52.3% had at least one sphenoethmoidal cell, and 14.8% developed at least one diseased sphenoethmoidal cell. One patient developed acute visual loss 4412 days after the first computed tomography. Our results show that over half of the patients have a sphenoethmoidal cell but suggest a rare incidence of a diseased sphenoethmoidal cell progressing to visual loss during the follow-up period.

Relationship between Olfactory Acuity and Peak Expiratory Flow during Postoperative Follow-up in Chronic Rhinosinusitis Associated with Asthma

2010 ◽  
Vol 119 (11) ◽  
pp. 749-754 ◽  
Author(s):  
Katsuhisa Ikeda ◽  
Hidenori Yokoi ◽  
Takeshi Kusunoki ◽  
Tatuya Saitoh ◽  
Toru Yao ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Peak Expiratory Flow ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Olfactory Acuity ◽  
Smell Test ◽  
Initial Symptoms ◽  
Lower Airways ◽  
Expiratory Flow

Objectives The link between nasal and bronchial disease has been studied extensively for chronic rhinosinusitis and asthma. The concept of “united airway allergy” has become widely accepted in the past decade. We evaluated the relationship between the upper and lower airways during follow-up after endoscopic sinus surgery by monitoring sinonasal and pulmonary functions. Methods Thirty-nine subjects with chronic rhinosinusitis associated with bronchial asthma were entered in this study. A self smell test using stick-type odorant materials was carried out daily to evaluate postoperative recurrence of sinonasal disease. Each patient was assessed for peak expiratory flow (PEF) 3 times daily. Results The average (±SD) scores of initial symptoms were 8.3 ± 2.2, which was significantly decreased to 1.5 ± 1.4 by 3 months after operation. During postoperative follow-up, 25 of 39 patients showed no decrease in PEF, whereas the other 14 patients had at least 1 episode of a significant decline in PEF. In the postoperative course, with respect to the self smell test, 24 patients showed no aggravation of smell, but 15 patients had episode(s) of decreased olfaction. Twelve patients demonstrated worsening on the smell test concomitant with a decreased PEF. A discrepancy between olfactory acuity and pulmonary function was recognized in 5 patients. There were 22 patients with a good prognosis of parameters of both the upper and lower airways. Conclusions Daily monitoring of both upper and lower respiratory tract functions clearly revealed dual relationships, indicating that worsening of sinusitis accompanies asthma exacerbation. Appropriate measures of the upper and lower airways following endoscopic sinus surgery can be used to predict patient outcome.

Balloon catheter sinusotomy: One-year follow-up—Outcomes and role in functional endoscopic sinus surgery

2008 ◽  
Vol 139 (3_suppl_1) ◽  
pp. S27-S37 ◽  
Author(s):  
Frederick A. Kuhn ◽  
Christopher A. Church ◽  
Andrew N. Goldberg ◽  
Howard L. Levine ◽  
Michael J. Sillers ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Balloon Catheter ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
One Year

Endoscopic Surgery for Frontal and Ethmoid Sinus Mucoceles

1994 ◽  
Vol 8 (3) ◽  
pp. 107-112 ◽  
Author(s):  
Thomas L. Kennedy
Keyword(s):  
Endoscopic Surgery ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Ethmoid Sinus ◽  
Endoscopic Approach ◽  
Sinus Surgery ◽  
Difficult Cases

Seven patients with frontal and ethmoid mucoceles treated by endoscopic sinus surgery were reviewed. Five cases were successfully managed, with two requiring a trephine procedure in combination with the intranasal endoscopic approach. Follow-up ranged from 3 to 33 months with a mean of 17.8 months. The use of endoscopic instruments through a trephine incision is recommended in difficult cases to assure patency of the frontal sinus recess. When a large frontal sinus mucocele extends into the anterior ethmoid, the endoscopic approach becomes ideal. Sinus mucoceles can be handled safely and successfully by endoscopic surgery and may eliminate the need for more traditional external procedures.

Initial Report on Postoperative Healing after Endoscopic Sinus Surgery With the Microdebrider

1998 ◽  
Vol 118 (6) ◽  
pp. 800-803 ◽  
Author(s):  
JOSEPH M. BERNSTEIN ◽  
RICHARD A. LEBOWITZ ◽  
JOSEPH B. JACOBS
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Chronic Sinusitis ◽  
Middle Turbinate ◽  
Mucosal Healing ◽  
Sinus Surgery ◽  
Crust Formation ◽  
Initial Report ◽  
Low Incidence ◽  
Head Neck

Synechiae formation is a frequent occurrence after endoscopic sinus surgery and may cause symptomatic sinus outflow tract obstruction. Various means are used to reduce the incidence of synechiae formation. These include meticulous operative technique, partial middle turbinate resection, middle meatus spacers or stents, and postoperative debridement. The microdebrider is a powered rotary shaving device that precisely resects tissue, minimizing inadvertent mucosal trauma and stripping. We present 40 cases of endoscopic sinus surgery performed with the microdebrider. Patients had at least a 5-month follow-up and demonstrated rapid mucosal healing, minimal crust formation, and a low incidence of synechiae formation. These initial data suggest that the microdebrider may be advantageous in surgery for chronic sinusitis. (Otolaryngol Head Neck Surg 1998;118:800–3.

scholarly journals Lung function decline in asthma patients with elevated bronchial CD8, CD4 and CD3 cells

2016 ◽  
Vol 48 (2) ◽  
pp. 393-402 ◽  
Author(s):  
Irene den Otter ◽  
Luuk N.A. Willems ◽  
Annemarie van Schadewijk ◽  
Simone van Wijngaarden ◽  
Kirsten Janssen ◽  
...  
Keyword(s):  
Lung Function ◽  
Granzyme B ◽  
Eosinophil Cationic Protein ◽  
Risk Groups ◽  
Forced Expiratory Volume ◽  
Lung Function Decline ◽  
Cationic Protein ◽  
Asthmatic Patients ◽  
Asthma Patients

Which inflammatory markers in the bronchial mucosa of asthma patients are associated with decline of lung function during 14 years of prospective follow-up?To address this question, 19 mild-to-moderate, atopic asthmatic patients underwent spirometry and bronchoscopy at baseline and after 14 years of follow-up (t=14). Baseline bronchial biopsies were analysed for reticular layer thickness, eosinophil cationic protein (EG2), mast cell tryptase (AA1), CD3, CD4 and CD8. Follow-up biopsies were stained for EG2, AA1, neutrophil elastase, CD3, CD4, CD8, CD20, granzyme B, CD68, DC-SIGN, Ki67 and mucins.Decline in forced expiratory volume in 1 s (FEV1) % predicted was highest in patients with high CD8 (p=0.01, both pre- and post-bronchodilator) or high CD4 counts at baseline (p=0.04 pre-bronchodilator, p=0.03 post-bronchodilator). Patients with high CD8, CD3 or granzyme B counts at t=14 also exhibited faster decline in FEV1 (p=0.00 CD8 pre-bronchodilator, p=0.04 CD8 post-bronchodilator, p=0.01 granzyme B pre-bronchodilator, and p<0.01 CD3 pre-bronchodilator).Long-term lung function decline in asthma is associated with elevation of bronchial CD8 and CD4 at baseline, and CD8, CD3 and granzyme B at follow-up. This suggests that high-risk groups can be identified on the basis of inflammatory phenotypes.

scholarly journals Effects of steroid-impregnated middle meatal packing on the postoperative outcome after endoscopic sinus surgery

2021 ◽  
Vol 11 (42) ◽  
pp. 68-73
Author(s):  
Husam Talib Dakhil ◽  
Muhanned Moussa Alwan ◽  
Nassr Abdulsalam Mohammed
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Postoperative Outcome ◽  
Study Groups ◽  
Sinus Surgery ◽  
P Value ◽  
Prospective Clinical Study ◽  
Nasal Discharge ◽  
Operative Outcome ◽  
Medical City

Abstract OBJECTIVE. To evaluate the effects of steroid-impregnated middle meatal packing on post-operative outcome after endoscopic sinus surgery. MATERIAL AND METHODS. We performed a prospective clinical study on 26 randomly selected patients, older than 12 years, with chronic rhinosinusitis, who failed medical management and who were operated on by endoscopic sinus surgery at Al-Imamain Al-Kadhimyain Teaching Medical City over a period of 12 months. Patients were divided into two groups: the 1st with middle meatal packing soaked with steroids (triamcinolone) and the 2nd group with middle meatal packing alone, without steroid. The two study groups were followed-up postoperatively for adhesions, crustations and nasal discharge over a period of three months. RESULTS. The study showed a significant reduction in early nasal crustations (p-value=0.048) and nasal discharge (p-value=0.033) after endoscopic sinus surgery in patients who received triamcinolone-impregnated middle meatal packing. Synechia formation was significantly lower in the steroid-impregnated group one month after surgery (p-value=0.021), but no difference at one week (p-value=0.089). At the three-month follow-up, comparing the two groups, the following variables were not statistically significant: crusts (p-value=0.22), nasal discharge (p-value=0.26), synechia (p-value=0.074). CONCLUSION. There are significant reductions in the incidence of early crustations, synechia, nasal discharge in patients who received triamcinolone middle meatal packing following endoscopic sinus surgery.

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.

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