Faculty Opinions recommendation of Sinus preservation management for frontal sinus fractures in the endoscopic sinus surgery era: a systematic review.

Objective Up to 75% of patients with chronic rhinosinusitis (CRS) suffer with poor sleep quality and reduced quality of life. Endoscopic sinus surgery has demonstrated encouraging results in improving sleep function. The aim of this systematic review is to assess the change in sleep quality after surgery for CRS. Data Sources PubMed, Web of Science, EMBASE. Review Methods An electronic search was conducted with the keywords “sinusitis” or “rhinosinusitis” and “sleep.” Studies were included only when adults underwent endoscopic sinus surgery and were evaluated pre- and postoperatively by the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), the Apnea-Hypopnea Index (AHI), the sleep domain of Sino-Nasal Outcome Test–22, or the sleep domain of Rhinosinusitis Disability Index. Results The database search yielded 1939 studies, of which 7 remained after dual-investigator screening. The standardized mean differences (95% CI) for the ESS, PSQI, and AHI were −0.94 (−1.63 to −0.26), −0.80 (−1.46 to −0.14), and −0.20 (−0.32 to −0.07), indicating large, moderate to large, and small improvements, respectively. All analyses displayed high heterogeneity ( I2 = 95%-99%). Conclusion Sleep quality, as measured by the ESS and PSQI surveys, shows substantial improvement after surgery for CRS, with smaller improvement seen for AHI. Generalizability of our results is limited by high heterogeneity among studies and by broad confidence intervals that cannot exclude small to trivial changes. The findings of this meta-analysis provide insight into the effect of CRS-related endoscopic sinus surgery on sleep quality, which should guide future research direction and counseling of patients in the clinical setting.

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Hyaluronic acid for post sinus surgery care: systematic review and meta-analysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215116009269 ◽

2017 ◽

Vol 131 (S1) ◽

pp. S2-S11 ◽

Cited By ~ 8

Author(s):

E Fong ◽

M Garcia ◽

C M Woods ◽

E Ooi

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Adhesion Formation ◽

Sinus Surgery ◽

Current Evidence ◽

Secondary Outcome ◽

Control Group ◽

Patient Reported

AbstractBackground:Wound healing after endoscopic sinus surgery may result in adhesion formation. Hyaluronic acid may prevent synechiae development. A systematic review was performed to evaluate the current evidence on the clinical efficacy of hyaluronic acid applied to the nasal cavity after sinus surgery.Methods:Studies using hyaluronic acid as an adjunct treatment following endoscopic sinus surgery for chronic rhinosinusitis were identified. The primary outcome was adhesion formation rates. A meta-analysis was performed on adhesion event frequency. Secondary outcome measures included other endoscopic findings and patient-reported outcomes.Results:Thirteen studies (501 patients) met the selection criteria. A meta-analysis of adhesion formation frequency on endoscopy demonstrated a lower risk ratio in the hyaluronic acid intervention group (42 out of 283 cases) compared to the control group (81 out of 282) of 0.52 (95 per cent confidence interval = 0.37–0.72). Hyaluronic acid use was not associated with any significant adverse events.Conclusion:Hyaluronic acid appears to be clinically safe and well tolerated, and may be useful in the early stages after sinus surgery to limit adhesion rate. Further research, including larger randomised controlled trials, is required to evaluate patient- and clinician-reported outcomes of hyaluronic acid post sinus surgery.

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Endoscopic Surgery for Frontal and Ethmoid Sinus Mucoceles

American Journal of Rhinology ◽

10.2500/105065894781874386 ◽

1994 ◽

Vol 8 (3) ◽

pp. 107-112 ◽

Cited By ~ 3

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.

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In-office Balloon Dilation and Drainage of Frontal Sinus Mucocele

Allergy & Rhinology ◽

10.2500/ar.2013.4.0041 ◽

2013 ◽

Vol 4 (1) ◽

pp. ar.2013.4.0041 ◽

Cited By ~ 5

Author(s):

Jean Anderson Eloy ◽

Pratik A. Shukla ◽

Osamah J. Choudhry ◽

Jean Daniel Eloy ◽

Paul D. Langer

Keyword(s):

Patient Satisfaction ◽

Operating Room ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Balloon Dilation ◽

Sinus Surgery ◽

Surgical Drainage ◽

Sinus Disease ◽

The Past ◽

Office Procedures

Treatment of frontal sinus disease represents one of the most challenging aspects of endoscopic sinus surgery. Frontal sinus mucocele drainage may be an exception to the rule because in many instances, the expansion of the mucocele widens the frontal sinus recess and renders surgical drainage technically undemanding. Recently, there has been an increased interest in in-office procedures in otolaryngology because of patient satisfaction and substantial savings of time and cost for both patients and physicians. Similarly, the past few years have witnessed an increased use of balloon dilation devices in sinus surgery. Previously, we have described the in-office use of this device in treating patients who failed prior conventional frontal sinusotomy in the operating room. In this report, we describe our step-by-step in-office experience using this tool for drainage of a large frontal sinus mucocele.

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Frontal sinus osteoma: Complete removal via endoscopic sinus surgery and frontal sinus trephination

American Journal of Otolaryngology ◽

10.1016/0196-0709(93)90015-y ◽

1993 ◽

Vol 14 (1) ◽

pp. 67

Keyword(s):

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Complete Removal ◽

Sinus Surgery

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The Effectiveness of Intravenous Tranexamic Acid on Blood Loss and Surgical Time During Endoscopic Sinus Surgery: A Systematic Review

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v31i2.221 ◽

2018 ◽

Vol 31 (2) ◽

pp. 8-12

Author(s):

Jona Minette E. Ligon ◽

Natividad A. Almazan

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Tranexamic Acid ◽

Endoscopic Sinus Surgery ◽

Saline Solution ◽

Mean Difference ◽

Sinus Surgery ◽

Surgical Time ◽

Surgical Field ◽

Standardized Mean Difference

Objective: To review the effectiveness of intravenous tranexamic acid in reduction of blood loss, surgical time and field visualization among patients who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Methods: Data Sources: MEDLINE (PubMed), EMBASE, ScienceDirect, HERDIN, and the Cochrane Library. Eligibility Criteria: Randomized controlled trials (RCT) between 2005-2014 that evaluated the effects of tranexamic acid or placebo in patients undergoing ESS for CRS. Appraisal and Synthesis Methods: Articles were selected by 2 independent reviewers and methodological quality was blindly evaluated using a Jadad scale. Data were compiled in tables for analysis of outcome measures (estimated blood loss, length of surgery and intraoperative surgical field visualization). Results: Two trials were included in the study, enrolling 128 patients. One arm of the study had been given tranexamic acid while the other arm was given placebo (saline solution). Results varied for both studies. The summary of the observed difference for blood loss had a standardized mean difference of -51.20 (CI95 [-59.44, -42.95]) showing that the blood loss in milliliters was less in the tranexamic group compared to saline solution. The summary of the observed difference in surgical time had a standardized mean difference of -19.32 (CI95 [-24.21, -14.43]) showing that the surgical time in minutes was shorter in the tranexamic group compared to saline solution. The secondary outcome on surgical field visualization was not pooled together because the studies used different measurement scales. Limitations: The most important weaknesses of the 2 included studies were the differences in dose of tranexamic acid, scales of measurement of field visibility and age groups of the patients. Conclusion: Tranexamic acid reduced blood loss and shortened surgical time after ESS among patients with CRS. However, the additional benefit of tranexamic acid for better field visualization was not clear. Adverse effects were not considered in this study, however results support the use of intravenous tranexamic acid intraoperatively as an option for ESS with blood loss as a concern. Further randomized clinical trials and an update on the systematic review will strengthen the evidence on the effectivity of tranexamic acid for ESS. Keywords: tranexamic acid, endoscopic sinus surgery, bleeding time

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Systematic review of endoscopic sinus surgery for nasal polyps

Health Technology Assessment ◽

10.3310/hta7170 ◽

2003 ◽

Vol 7 (17) ◽

Cited By ~ 56

Author(s):

K Dalziel ◽

K Stein ◽

A Round ◽

R Garside ◽

P Royle

Keyword(s):

Systematic Review ◽

Endoscopic Sinus Surgery ◽

Nasal Polyps ◽

Sinus Surgery

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Endoscopic sinus surgery in patients with cystic fibrosis: a systematic review and meta-analysis of pulmonary function

Rhinology Journal ◽

10.4193/rhino11.271 ◽

2012 ◽

Vol 50 (4) ◽

pp. 360-369

Author(s):

K.I. Macdonald ◽

A. Gipsman ◽

A. Magit ◽

M. Fandino ◽

E. Massoud ◽

...

Keyword(s):

Systematic Review ◽

Cystic Fibrosis ◽

Pulmonary Function ◽

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Pulmonary Function Tests ◽

Sinus Surgery ◽

Intravenous Antibiotics

Introduction: The role of endoscopic sinus surgery (ESS) in patients with cystic fibrosis (CF) is not clearly defined. Objective: TO perform a systematic review of subjective and objective outcomes of ESS in CF. Methods: A systematic review was performed using the keywords 'sinusitis,' 'sinus surgery,' 'nasal polyps' and 'cystic fibrosis.' The quality of papers was assessed using the NICE scoring scale. Outcomes included safety, subjective symptoms, objective endoscopy scores, days spent in hospital, courses of antibiotics, and pulmonary function tests (PFTs). Results: Nineteen studies involving 586 patients were included in the review. There were four prospective cohort trials, and three were rated as good quality. There were no major complications attributable to ESS. There was consistent evidence in four cohort studies of improved sinonasal symptoms, including nasal obstruction, facial pain, headaches, rhinorrhea and olfaction. Three studies reported conflicting results in post-operative endoscopy scores. Three studies showed a decrease in days spent in hospital, and two showed a significant decrease in courses of intravenous antibiotics. A recent study, however, did not show a difference in either days spent in hospital or courses of antibiotics. Pulmonary function tests were not improved by ESS in six cohort trials, and one small study found significant improvement. A meta-analysis of FEV1 scores confirmed no significant difference. Conclusion: THE most consistent findings of this review were that ESS in patients with CF is safe, produces symptomatic benefit, and does not consistently improve PFTs. There were more conflicting results with regards to endoscopy scores, days spent in hospital, and courses of intravenous antibiotics. Future prospective studies, utilizing validated quality of life, symptom and endoscopy scales, are needed to further elucidate the role of ESS in the management of chronic rhinosinusitis in CF patients.

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The Horizon Sign and Frontal Bar: Two Topographic Landmarks to Confirm Endoscopic Frontal Sinusotomy

Otolaryngology ◽

10.1177/0194599818825472 ◽

2019 ◽

Vol 160 (4) ◽

pp. 740-743

Author(s):

Evan S. Walgama ◽

Andrew Thamboo ◽

Navarat Tangbumrungtham ◽

Noel Ayoub ◽

Zara M. Patel ◽

...

Keyword(s):

Computed Tomography ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Case Series ◽

Acute Angle ◽

Sinus Surgery ◽

Consecutive Case ◽

Landmark Identification ◽

Frontal Sinuses ◽

Anterior Posterior

Confirming a thorough dissection of the frontal sinus during endoscopic sinus surgery can be challenging, and some surgeons would benefit from reliable topographic landmark identification to ensure completion of this sinus dissection. We defined (1) the “horizon sign” as the curvilinear shadow of the posterior table cast superiorly upon the anterior table of the frontal sinus at the acute angle of their meeting point and (2) the “frontal bar” as a sagittal septation at the union of the anterior/posterior tables. A cadaveric study, followed by an intraoperative consecutive case series, was performed to evaluate these 2 landmarks as indicators of complete dissection. The horizon sign was extremely reliable, identified in 100% of cadaveric frontal sinuses and intraoperative frontal sinuses. The frontal bar was present in only 67% of frontal sinuses by computed tomography. In live patients, the sensitivity and specificity of the frontal bar were 62% and 95%, respectively.

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