scholarly journals High Variability of Postsurgical Anatomy Supports the Need for Individualized Drug-Eluting Implants to Treat Chronic Rhinosinusitis

Life ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 353
Author(s):  
Ziwen Gao ◽  
Farnaz Matin ◽  
Constantin Weber ◽  
Samuel John ◽  
Thomas Lenarz ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Standard Procedure ◽  
Sinus Surgery ◽  
Common Disease ◽  
Therapy Failure ◽  
Medical Treatments ◽  
Anatomical Structures ◽  
Drug Eluting ◽  
Management Techniques

Chronic rhinosinusitis (CRS) is a common disease in the general population that is increasing in incidence and prevalence, severely affecting patients’ quality of life. Medical treatment for CRS includes self-management techniques, topical and oral medical treatments, and functional endoscopic sinus surgery (FESS). FESS is a standard procedure to restore sinus ventilation and drainage by physically enlarging the inflamed sinus passageways. Nasal drug-releasing stents are implanted to keep the surgically expanded aperture to the sinus frontalis open. The outcome of such an intervention is highly variable. We defined the anatomical structures which should be removed, along with ‘no-go areas’ which need to be preserved during FESS. Based on these definitions, we used cone beam computed tomography (CBCT) images to measure the dimensions of the frontal neo-ostium in 22 patients. We demonstrate anatomical variability in the volume and diameter of the frontal sinus recess after surgery. This variability could be the cause of therapy failure of drug-eluting implants after FESS in some patients. Implants individually made to fit a given patient’s postsurgical anatomy may improve the therapeutic outcome.

scholarly journals Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or Olfactory Function in Chronic Rhinosinusitis

2021 ◽  
pp. 194589242098743
Author(s):  
Nyssa F. Farrell ◽  
Jess C. Mace ◽  
David A. Sauer ◽  
Andrew J. Thomas ◽  
Mathew Geltzeiler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyposis ◽  
Cross Sectional Study ◽  
Olfactory Function ◽  
Sinus Surgery ◽  
Small Subset ◽  
Cross Sectional ◽  
Snot 22

Background Chronic rhinosinusitis (CRS) is often differentiated by histopathologic phenotypes (eosinophilic versus neutrophilic), which may impact disease severity measures and outcomes. As such, it has been suggested that counts of cellular elements be included as part of a standard pathological report following endoscopic sinus surgery (ESS). Objectives This cross-sectional study evaluated associations of mucosal eosinophilia and neutrophilia with measures of quality-of-life (QoL) and olfactory function. Methods Patients with medically refractory CRS completed the SNOT-22 survey and Brief Smell Identification Test (BSIT) at enrollment. In addition, baseline Lund-Mackay computed tomography (CT) and Lund-Kennedy endoscopy scores were collected. Ethmoid mucosa was biopsied during ESS and reviewed using microscopy to quantify densest infiltrate of eosinophils or neutrophils per high-powered-field (HPF). Eosinophilic CRS (eCRS) and neutrophilic CRS (nCRS), both with and without nasal polyposis (NP), were compared across SNOT-22 and BSIT scores. Results 77/168 patients demonstrated mucosal eosinophilia (eCRS) while a total of 42/168 patients demonstrated mucosal neutrophilia (nCRS). After adjusting for polyp status, 35/168 had eCRSsNP, 42/168 eCRSwNP, 75/168 non-eCRSsNP, 16/168 non-eCRSwNP. Additionally, 22/161 were noted to have nCRSsNP, 20/161 nCRSwNP, 84/161 non-nCRSwNP, and 35/161 non-nCRSsNP. A small subset of patients demonstrated both eosinophilia and neutrophilia: 14 CRSwNP and 7 CRSsNP. When evaluating average Lund-Mackay Scores (LMS), significant differences existed between non-eCRSsNP and eCRSsNP (p = 0.006). However, after controlling for nasal polyps, eosinophilia did not significantly associate with differences in the Lund-Kennedy Score. Neutrophilia did not significantly associate with any changes in LMS or LKS after controlling for NP. Eosinophilic and neutrophilic histopathologic subtypes did not significantly associate with differences in baseline SNOT-22 or BSIT measures after controlling for NP. Conclusion Neither the presence of mucosal eosinophilia nor mucosal neutrophilia demonstrated significant associations with SNOT-22 quality-of-life or BSIT olfactory function scores when controlling for comorbid nasal polyposis.

scholarly journals Machine-Learning Points at Endoscopic, Quality of Life, and Olfactory Parameters as Outcome Criteria for Endoscopic Paranasal Sinus Surgery in Chronic Rhinosinusitis

2021 ◽  
Vol 10 (18) ◽  
pp. 4245
Author(s):  
Jörn Lötsch ◽  
Constantin A. Hintschich ◽  
Petros Petridis ◽  
Jürgen Pade ◽  
Thomas Hummel
Keyword(s):  
Quality Of Life ◽  
Machine Learning ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinus ◽  
Endoscopic Sinus Surgery ◽  
Relevant Information ◽  
Olfactory Function ◽  
Sinus Surgery ◽  
Paranasal Sinus Surgery

Chronic rhinosinusitis (CRS) is often treated by functional endoscopic paranasal sinus surgery, which improves endoscopic parameters and quality of life, while olfactory function was suggested as a further criterion of treatment success. In a prospective cohort study, 37 parameters from four categories were recorded from 60 men and 98 women before and four months after endoscopic sinus surgery, including endoscopic measures of nasal anatomy/pathology, assessments of olfactory function, quality of life, and socio-demographic or concomitant conditions. Parameters containing relevant information about changes associated with surgery were examined using unsupervised and supervised methods, including machine-learning techniques for feature selection. The analyzed cohort included 52 men and 38 women. Changes in the endoscopic Lildholdt score allowed separation of baseline from postoperative data with a cross-validated accuracy of 85%. Further relevant information included primary nasal symptoms from SNOT-20 assessments, and self-assessments of olfactory function. Overall improvement in these relevant parameters was observed in 95% of patients. A ranked list of criteria was developed as a proposal to assess the outcome of functional endoscopic sinus surgery in CRS patients with nasal polyposis. Three different facets were captured, including the Lildholdt score as an endoscopic measure and, in addition, disease-specific quality of life and subjectively perceived olfactory function.

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

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.

scholarly journals Outcome of functional endoscopic surgery for chronic rhinosinusitus

2017 ◽  
Vol 5 (1) ◽  
pp. 20-21
Author(s):  
Rabin Chandra Acharya ◽  
B. Pradhan ◽  
N.M. Thapa
Keyword(s):  
Chronic Rhinosinusitis ◽  
Early Postoperative Period ◽  
Functional Endoscopic Sinus Surgery ◽  
University Teaching ◽  
Sinus Surgery ◽  
Radiological Criteria ◽  
Prospective Comparative Study ◽  
Sinonasal Outcome Test ◽  
Psychosocial Domain

Objective: To measure the outcome of Functional Endoscopic Sinus Surgery (FESS) for Chronic Rhinosinusitis in early postoperative period.Materials and Methods: This is a prospective comparative study conducted in Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from November 2009 to March, 2011. Thirty cases of Chronic Rhinosinusitis diagnosed by clinical and radiological criteria were included in this study. Modified sinonasal outcome test was used to record the pre and postoperative scores and compared by using paired t- test.Results: All the cases showed significant improvement in postoperative scores in both physical and psychosocial domains of modified sinonasal outcome test. Two symptoms, concentration and misery of psychosocial domain didn’t improve significantly.Conclusion: This study attempts to measure the outcome of FESS in patients with CRS. Nepali version of SNOT-10 has been used in the Nepalese population. Significant improvement in quality of life score has been observed in early postoperative period.

Concha Bullosa Affects Baseline and Postoperative Quality-of-Life Measures in Surgically Managed Chronic Rhinosinusitis

2019 ◽  
Vol 34 (2) ◽  
pp. 162-169
Author(s):  
Jesse R. Qualliotine ◽  
Aria Jafari ◽  
Sarek Shen ◽  
Jeffrey D. Bernstein ◽  
Adam S. DeConde
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Multivariable Analysis ◽  
Domain Score ◽  
Sinus Surgery ◽  
Concha Bullosa ◽  
Clinically Significant ◽  
Snot 22 ◽  
Domain Scores

Background Concha bullosa (CB) is a prevalent anatomic variant and frequent surgical target in endoscopic sinus surgery (ESS). However, whether CB impacts quality-of-life (QOL) in chronic rhinosinusitis (CRS) is not well established. The purpose of this study was to investigate baseline and post-ESS QOL differences in patients with medically recalcitrant CRS with and without CB. Methods Demographic and surgical characteristics, baseline and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores for 137 patients with CRS who underwent primary ESS at our institution were recorded. Computed tomography (CT) scans were reviewed for Lund–Mackay score and presence of CB. Multiplanar CT was used to measure CB dimensions and estimate volume. Multivariable analysis was performed to identify differences in SNOT-22 overall and symptom-domain scores between patients with upper quartile (≥0.8 mL) CB and without CB. Results CB was found in 37% of patients with mean volume of 0.67 mL. There were no significant differences in distribution of clinicodemographic variables by large CB status. At baseline, large CB was associated with higher SNOT-22 extranasal-rhinologic domain score (9.8 vs 6.0, P < .01). Following ESS, patients with large CB reported greater improvement in SNOT-22 extranasal-rhinologic domain score (multivariable mean absolute improvement 3.8, P = .01; relative 56% vs 30%). Conclusion Patients with medically recalcitrant CRS and concomitant large CB have higher SNOT-22 extranasal-rhinologic domain scores at baseline, but also report greater intradomain improvement exceeding the subdomain’s mean clinically important difference. To our knowledge, this is the first demonstration that CB has a clinically significant impact on QOL in CRS, and surgical intervention may be helpful to address these symptoms.

Chronic rhinosinusitis assessment using the Adelaide Disease Severity Score

2013 ◽  
Vol 127 (S2) ◽  
pp. S24-S28 ◽  
Author(s):  
Y Naidoo ◽  
N Tan ◽  
D Singhal ◽  
P J Wormald
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Disease Severity ◽  
Severity Score ◽  
Facial Pain ◽  
The Other ◽  
Sinus Surgery ◽  
Disease Severity Score ◽  
Spearman Coefficient

AbstractAim:This study aimed to validate the use of the Adelaide Disease Severity Score for the assessment of chronic rhinosinusitis.Study design:A prospective cohort study supplying level 2b evidence.Methods:Forty-eight patients, scheduled for endoscopic sinus surgery for failed management of chronic rhinosinusitis, completed the Sino-Nasal Outcome Test 22 and the Adelaide Disease Severity Score tool (the latter assessing symptoms (i.e. nasal obstruction, rhinorrhoea, post-nasal drip, headache or facial pain, and olfaction) and quality of life). Lund–Mackay computed tomography scores and Lund–Kennedy endoscopic scores were also recorded. The Adelaide Disease Severity Score results were then compared with those of the other three tools to assess correlation.Results:Mean scores (95 per cent confidence intervals) were 22.31 (21.47–24.15) for the Adelaide Disease Severity Score and 30.6 (27.15–34.05) for the Sino-Nasal Outcome Test 22; there was a statistically significant correlation (Spearman coefficient = 0.45; p = 0.0015). A statistically significant correlation was also noted with the Lund–Mackay score (p = 0.04) and with the Lund–Kennedy score (p = 0.03).Conclusion:The Adelaide Disease Severity Score is a simple, valid tool for clinical assessment of chronic rhinosinusitis, which correlates well with the Sino-Nasal Outcome Test 22, Lund–Mackay and Lund–Kennedy tools.

scholarly journals Study of the effect of balloon sinuplasty in patients with rhinosinusitis

2020 ◽  
Vol 6 (11) ◽  
pp. 2007
Author(s):  
Tanya Singh ◽  
Arjun Singh ◽  
Sarbjeet Singh
Keyword(s):  
Chronic Rhinosinusitis ◽  
Sinus Surgery ◽  
Saline Irrigation ◽  
Balloon Sinuplasty ◽  
Positive Biopsy ◽  
Intravenous Antibiotics ◽  
Nasal Steroids ◽  
Frontal Sinuses ◽  
A New Technique

<p class="abstract"><strong>Background:</strong> A new technique which has revolutionized sinus surgery recently is balloon sinuplasty. The vast majority of patients with chronic rhinosinusitis improve with medical management, including antibiotics, saline irrigation, nasal steroids, antihistamines, allergy therapy, and asthma control. This study was conducted to study the effect of balloon sinuplasty in patients affected with rhinosinusitis.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in all the patients visiting our hospital. Medical treatment included oral and sometimes intravenous antibiotics, nasal steroids, decongestants, systemic steroids, and allergy management. Those who had a positive biopsy were excluded from this study. The selected cohort of 20 patients, were prepared for balloon sinuplasty surgery in the same way as for conventional functional endoscopic sinus surgery (FESS) and were operated by our surgical team.  </p><p class="abstract"><strong>Results:</strong> 20 patients were included in the study, 70% men and aged 30±12 years. Sinuplasty was performed in 32 sinuses of 20 patients (22 maxillary, 4 sphenoid and 8 frontal sinuses).</p><p class="abstract"><strong>Conclusions:</strong> Sinuplasty with balloon catheterization is effective in reducing symptoms and improving quality of life in selected patients with chronic rhinosinusitis. The results are beyond reported symptoms and confirm the benefit of balloon sinuplasty.</p><p class="abstract"> </p>

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