A retrospective study on long-term efficacy of intranasal lysine-aspirin in controlling NSAID-exacerbated respiratory disease

Purpose Aspirin treatment after desensitization (ATAD) represents an effective therapeutic option suitable for NSAID-exacerbated respiratory disease (N-ERD) patients with recalcitrant disease. Intranasal administration of lysine-aspirin (LAS) has been suggested as a safer and faster route than oral ATAD but evidence for its use is less strong. We investigated nasal LAS therapy long-term efficacy based on objective outcomes, smell function, polyp recurrence and need for surgery or rescue therapy. Clinical biomarkers predicting response to intranasal LAS, long-term side effects and consequences of discontinuing treatment have been evaluated. Methods A retrospective analysis of a database of 60 N-ERD patients seen between 2012 and 2020 was performed in March 2021. They were followed up at 3-months, 1-, 2- and 3-years with upper and lower airway functions assessed at each follow-up. Results Higher nasal airflow and smell scores were found at each follow-up in patients taking LAS (p < 0.001 and p = 0.048 respectively). No influence of LAS on pulmonary function measurements was observed. Patient on intranasal LAS showed a lower rate of revision sinus surgery when compared to those who discontinued the treatment (p < 0.001). None of the variables studied was found to influence LAS treatment response. Conclusion Our study demonstrates the clinical effectiveness of long-term intranasal LAS in the management of N-ERD in terms of improved nasal airflow and olfaction and a reduced need for revision sinus surgery. Intranasal LAS is safe, being associated with a lower rate of side effects when compared to oral ATAD. However, discontinuation of the treatment at any stage is associated with a loss of clinical benefit.

Computed Tomography and Anatomical Findings Encountered During Revision Endoscopic Sinus Surgery

Background and Objectives: Functional endoscopic sinus surgery (FESS) is a well-established strategy for the treatment of rhinosinusitis. However, some patients do not respond to primary surgery and may require revision surgery. Anatomic alterations due to prior sinus surgery, scarring and adhesions as well as associated chronic mucosal inflammation can make revision procedures challenging. In order to shed more light on the difficulties faced by surgeons performing revision FESS, a study was performed to identify areas of recurrent disease on computed tomography in patients undergoing revision surgery, as well as to evaluate intraoperative findings during revision FESS.Materials and Method: A hospital-based, interventional, non-randomized study was undertaken in 40 patients who underwent revision FESS. Multiple clinical parameters were recorded including number and type of previous surgeries, latest CT scans of the nose and paranasal sinuses, as well as intraoperative findings.Results: Our findings demonstrated the diffuse nature of mucosal disease on CT in our patient population. Fibrosis and adhesion formation were the most common intraoperative findings on revision sinus surgery along with residual air cells, polypoid mucosal regrowth, and middle meatal antrostomy stenosis.Conclusion: A careful evaluation of the patient is needed while contemplating revision surgery. A recent high-resolution CT scan is of paramount importance. The most common areas of disease recurrence are the ostiomeatal complex and residual ethmoids, and these areas should be given careful attention.

Visualized Ethmoid Roof Cerebrospinal Fluid Leak during Frontal Balloon Sinuplasty

Balloon sinus dilation (BSD) is generally accepted as a safe alternative to traditional sinus surgery. It is a unique technique designed to potentially minimize complications associated with traditional functional endoscopic sinus surgery (FESS). We present a case in which a 65-year-old man experienced a cerebrospinal fluid (CSF) leak in the ethmoid roof that was visualized instantly after balloon dilation in a revision sinus surgery. In this case report, we discuss the causes of CSF leaks and explain in detail the immediate endoscopic repair with a collagen matrix. Also, literature is reviewed on the safety of BSD versus traditional FESS. Postoperative-ly, the patient has been without CSF leak and remains symptom free. CSF leak is a rare but major complication during both FESS and BSD. As BSD use increases, its complication profile will become clearer when used alone, in conjunction with FESS, and/or during revision surgery. Although BSD is considered a benign procedure, one should be cautious when using it in revision sinus surgery.

Tomographical Findings in Adult Patients Undergoing Endoscopic Sinus Surgery Revision

Introduction Many patients undergoing functional endoscopic sinus surgery still have an uncontrolled clinical disease in the late post-operative period. Up to 11.4% of the patients will require a revision surgery. Findings such as the residual uncinated process and the lateralization of the middle turbinate were considered by some studies as being responsible for failure in the primary surgery. Objectives To describe the tomographical findings in adult patients undergoing revision endoscopic sinus surgery, the profile of those patients, and verify the mucosal thickening level of the paranasal sinus. Methods Data were collected from medical records and computed tomography reports of 28 patients undergoing revision sinus surgery on a private service in the city of Blumenau between 2007 and 2014. The score of Lund-Mackay was used to verify the mucosal thickening level. Results Among the 28 patients, 23 were reoperated once, 3 were reoperated twice, and 2 were reoperated 3 times. The most relevant findings were mucosal thickening of the maxillary sinus (89.28%), deviated septum (75%), thickening of the ethmoid (50%) and sphenoidal sinuses (39.28%), and pneumatization of the middle turbinate (39.28%). The average obtained in the Lund-Mackay score was 5.71, with most patients classified in the lower range of punctuation. Conclusion The analysis of the computed tomography scans showed persistent structures that may be responsible for the failure of the primary surgery. Computed tomography is a useful tool to plan the surgery and quantify the post-operative success.

EVALUATE THE RESULTS OF REVISION SINUS SURGERY FOR RECURRENT SINUSITIS AFTER FUNCTIONAL ENDOSCOPY SINUS SUGERY IN ADULTS

Objectives: To clarify the causes and risk factors for recurrent sinusitis after FESS in order to contribute to reducing the proportion of revison sinus surgery. Materials and methods: Cross sectional and descriptive study with clinical intervention in 35 patients with recurrent sinusitis after FESS from 3/2014 to 6/2016. Results: The common risk factors related to recurrent sinusitis after FESS are: no follow up 52,7%, smoking 37,1%, GERD 28,65%, chemical fumes exposure 25,7%. Clinical findings during operation: nasosinus polyp 65,7%, blocked osteomeatal complex 97,1%, blocked maxillary ostium 97,1%, blocked frontal recess 68,6%, blocked sphenoid ostium 45,7%, ulcinate process remnant 31,4%, ethmoidal air cells remnant 48,6%. Surgical results according to functional symptoms after 3 months and 6 months: after 3 months: good 80% , fair 20%. After 6 months: good are 83,3%. Endoscopic sinus surgical results: after 3 months: good 71,4%, after 6 months: good 66,6% CT scan imaging shows clear sinuses: after 3 months good and 6 months are good at 57,1% and 44,4% respectively. Conclusions: Recurrent sinusitis when surgery to comprehensive evaluation. Proposed a complete surgical methods to help patients from recurrent sinus. Surgeons must complete surgical manipulation. Ensure all patient get built and reconstructted draining sinus. Make sure to follow for all patients after operation. Key words: recurrent sinusitis, FESS (Functional Endoscopy Sinus Sugery)

Using postoperative SNOT-22 to help predict the probability of revision sinus surgery

Background: There is a need to develop a patient-level strategy to identify those at higher risk of requiring revision ESS since this may assist clinicians in tailoring their postoperative management. This study evaluated whether identifying changes in the post- operative 22-item Sinonasal Outcome Test (SNOT-22) can help identify patients at increased risk of needing revision sinus surgery for refractory chronic rhinosinusitis (CRS). Methods: 668 CRS patients undergoing primary ESS with complete 60-month follow-up were evaluated in this prospective, longitudinal cohort study. Outcomes were evaluated in an unselected cohort and a low-risk cohort, which was comprised of patients without a history of asthma or aspirin sensitivity. Results: Failing to achieve an improvement of greater than one minimal clinically important difference (MCID; 9 points) at 3 months after primary ESS and a deterioration of greater than one MCID (ie. >9 points) from the 3- to 12-month follow-up periods was associated with an increased risk of revision ESS in both the unselected and low-risk CRS cohorts. Conclusion: Outcomes from this study suggest that identifying MCID changes in the SNOT-22 score within 12 months after primary ESS can identify patients at increased risk for needing revision surgery.