Clinical outcomes after endoscopic sinus surgery

Objective To investigate the causes, clinical features, treatment and prognosis of chronic sinusitis and nasal polyps with endoscopic sinus surgery. Methods A total of 10 patients (10 eyes) from clinic of Xi’an No.4 Hospital between January 2001 and December 2016 due to vision loss caused by endoscopic sinus surgery were prospectively examined. All patients were enrolled and administered visual acuity testing, ophthalmic examinations, color photography, and other clinical observations. Results Ten cases of ocular complications occurred, including central retinal artery occlusion in 1 case, optic nerve injury in 6 cases, orbital hemorrhage in 2 cases, and orbital infection in 1 case. Conclusions The complications of endoscopic sinus surgery in patients with chronic rhinosinusitis and nasal polyps are complex, and the preparation, familiarity with nasal endoscopic resection and skilled operation can reduce the occurrence of complications. Timely detection of eye complications can reduce the risk of serious consequences. Visual impairment caused by endoscopic sinus surgery is difficult to treat and result in poor prognosis. Key words: Nasosinusitis; Nasal polyp; Endoscopic surgery; Eye; Complication

Objective To investigate the value of endoscopic sinus surgery for improving the sense of smell and the quality of life in patients with chronic sinusitis and nasal polyps (CSNP). Methods One hundred and fourteen CSNP patients were selected and grouped according to the different operation methods, with 57 cases in each group. The control group was treated by traditional Wigand operation, the observation group was treated by endoscopic sinus surgery. Both groups were followed up for 3 months. The clinical efficacy and the incidence of perioperative complications in the two groups were statistically analyzed. The scores of olfactory function, negative emotion (HAMA, HAMD) and quality of life were compared before and after surgery. Results The total effective rate of observation group was 96.49%, compared with the control group (84.21%), the difference was statistically significant (P 0.05). One month and 3 months after surgery, the difference was significant (P 0.05). The HAMA or HAMD scores in the observation group were lower than those in the control group at 3 months after operation (P 0.05). The quality of life of the observation group was significantly higher than that of the control group at 3 months after operation (P<0.05). Conclusions Endoscopic sinus surgery for CSNP patients, the clinical result is significant, with high safety.And it can effectively promote the recovery of patients with olfactory function, and relieve adverse emotions. And thus it is conducive to the improvement of quality of life. Key words: Chronic sinusitis with nasal polyps; Endoscopic sinus surgery; Olfactory function; Negative emotion; Quality of life

Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease. Endoscopic sinus surgery is recommended as a standard method when medical treatment fails. The effectiveness of various complementary surgical methods such as endoscopic partial middle-turbinectomy is controversial in the improvement of CRS symptoms in these patients. This study aimed to investigate the effect of endoscopic partial middle-turbinectomy on the quality of life (QOL) of patients with chronic rhinosinusitis and nasal polyps (CRSwNP) in Iran. Ninety patients with CRSwNP of grades 3 and 4 were randomly assigned to either an intervention (45 patients) or control group (45 patients). In the control group, endoscopic sinus surgery without middle turbinectomy was performed and in the intervention group, endoscopic partial middle-turbinectomy was performed in addition to endoscopic sinus surgery. To evaluate the outcomes, the SNOT-22 QOL questionnaire was used, and the results were analyzed using SPSS version 24. Most of the patients were male and had a mean age of 39 years. The mean SNOT-22 QOL questionnaire scores were 49.13 ± 16.72 and 52.51 ± 16.95 before surgery in the control and intervention groups respectively, which did not show any significant difference. In contrast, after endoscopic surgery these scores changed to 28.46 ± 12.38 and 11.13 ± 5.55 in the control and intervention groups, respectively and there was a significant difference between both groups. Although there was a significant improvement in both groups, the patients in the intervention group experienced more improvement than the control group (41.4 (± 16.46)) vs 30.7 (±18.27), respectively CONCLUSION: According to this study, it appears that the use of endoscopic partial middle-turbinectomy in addition to endoscopic sinus surgery improves CRS symptoms and the QOL of patients compared with endoscopic sinus surgery alone.

Background Asthma is a significant comorbidity of eosinophilic chronic rhinosinusitis (CRS). Type2-driven biomarkers such as sinus tissue eosinophilia and fractional nitric oxide (FeNO) may be utilized to detect high risk patients who develop asthma symptoms after endoscopic sinus surgery (ESS) in CRS patients. Methods Thirty-six CRS patients without asthma who agreed to undergo ESS between October 2015 and December 2017 were prospectively observed for 12 months following ESS. They were monitored for the development of typical asthma symptoms including dyspnea, wheezes, and cough which responded to anti-asthma medication. Biomarkers were compared between patients who developed asthma symptoms after ESS (asthma symptoms group) and those who did not (non-asthma group). Biomarker changes following ESS intervention were also evaluated. Results Six patients were lost to follow after ESS. Thus, 30 CRS patients [16 with nasal polyps (NPs) proved by surgery] were followed. Seven (23%) newly complained of asthma symptoms during follow-up. Levels of FeNO and the prevalence of eosinophilic NPs (eosinophils ≥ 70/high power fields) were significantly higher in the asthma symptom group than in non-asthma group [50.7 ppb vs 22.4 ppb for FeNO levels, and 100% (n = 3) vs 23% (n = 3) for eosinophilic NP prevalence, both p < 0.05]. Levels of sputum periostin decreased significantly by ESS in the non-asthma group. However, changes of biomarkers after ESS were comparable between the two groups. Conclusions Eosinophils in NPs (≥70/high power fields) and preoperative FeNO may be significant biomarkers for predicting the development of asthma symptoms after ESS.

Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS. The RAND/UCLA appropriateness methodology was performed. An international, multi-disciplinary panel of 10 experts in CRS was formed and completed two rounds of a modified Delphi ranking process along with a face-to-face meeting. A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score ≥ 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score ≥ 20. This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment option during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment option and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high quality, patient-centered care to patients with CRS.

BackgroundChronic rhinosinusitis with nasal polyps is a chronic disease frequently seen in otorhinolaryngological practice. Along with its chronic disease burden it creates high societal costs. Therapy consists of long-term use of medication and, if insufficient, endoscopic sinus surgery. No consensus exists on the right timing and extent of disease that warrants surgery. Furthermore, there is lack of clinical knowledge about the benefit of surgery over medication only. The current trial evaluates the clinical effectiveness and cost-effectiveness of endoscopic sinus surgery in addition to drug treatment versus medication exclusively in the adult patient group with nasal polyps.MethodsA prospective, multicentre, superiority, randomised controlled (PolypESS) trial in 238 patients aged 18 years or older selected for primary or revision endoscopic sinus surgery by the otorhinolaryngologist was designed. Patients will be randomised to either endoscopic sinus surgery in addition to medication or medical therapy only. Relevant data will be collected prior to randomisation, at baseline and 3, 6, 12, 18 and 24 months after start of treatment. Complete follow-up will be 24 months. Primary outcome is disease-specific Health-related Quality of Life quantified by the SNOT-22 after 12-month follow-up. Secondary outcomes are generic Health-related Quality of Life, cost-effectiveness, objective signs of disease and adverse effects of treatment. Subgroup analyses will be performed to verify whether treatment effects differ among patient phenotypes.DiscussionThe PolypESS trial will investigate tailored care in adult patients with chronic rhinosinusitis with nasal polyps and will result in improved clinical pathways to help to determine in which circumstances to perform surgery.Trial registrationDutch Trial Register, NTR4978. Registered on 27 November 2014.

Endoscopic sinus surgery (ESS) is a safe and reliable procedure for the treatment of chronic rhinosinusitis (CRS) and nasal polyposis (NP). Although most cases of CRS with NP occur bilaterally, we occasionally encounter patients with unilateral sinus disease with NP. Because no study has been conducted on the surgical outcomes between unilateral and bilateral CRS with NP after ESS, we evaluated subjective and objective outcomes between patients with unilateral and bilateral CRS with NP. A total of 181 patients diagnosed with CRS with NP were enrolled. Twenty-three patients had unilateral CRS with NP and 158 patients had bilateral disease. The extent of NP, Lund-Mackay score, and involved sinuses were evaluated with nasal endoscopy and preoperative computed tomography (CT). Objective and subjective surgical outcomes were assessed 6 months after ESS, using endoscopic findings, the Sino-Nasal Outcome Test 20 (SNOT-20), and visual analog scales. The extent of NP and Lund-Mackay score did not differ significantly between the two groups. The SNOT-20 and six main symptom scores included in the questionnaire were significantly improved 6 months postoperatively in both groups, with no significant difference between the groups. However, the unilateral group showed significantly better objective outcomes than the bilateral group. Unilateral CRS with NP showed more favorable objective surgical outcomes than bilateral disease. We suggest that the developmental mechanisms of the two disease entities may be different and that bilateral CRS with NP may be more intimately associated with a patient's innate tendency to develop NP.

Potential of biologics to alter the need for repeated surgery in patients with chronic rhinosinusitis with nasal polyps.

Background: Chronic rhinosinusitis with sinonasal polyps (CRSwNP) is a prevalent condition associated with olfactory dysfunction, nasal obstruction, and facial pain. Endoscopic sinus surgery (ESS) is a common treatment option for patients with CRSwNP, but the effect of ESS on olfactory function remains under debate. Objective: This study aims to evaluate the changes in olfactory function before and after ESS in patients with CRSwNP and sinonasal polyps. Methods: This Descriptive case series was conducted in the department of ENT, Lahore General Hospital, Lahore, from September 2024 to January 2025. Data were collected through the Non-probability consecutive sampling technique. The participant was admitted to the ENT ward for surgery. Functional endoscopic sinus surgery was performed under GA in each case with the standard anterior-to-posterior approach. Post-operative follow-up was carried out at the 3rd month. Results: A total of 69 patients were added in the study and the mean age was 45.2 ± 9.3 years, with 52% males and 48% females. The duration of symptoms ranged from 12.5 ± 6.4 months on average, with no significant gender differences. 25% of the patients were smokers, and 40% had a history of allergies. All patients included in the study had a preoperative olfactory score of 0, indicating complete anosmia before undergoing functional endoscopic sinus surgery (FESS). At the three-month follow-up, 68.1% of patients demonstrated improvement in olfactory function, scoring 1 on the olfactory test, indicating the ability to identify phenyl ethyl alcohol (50%). However, 31.9% of patients remained anosmic, unable to distinguish between the odorless substance and the test solution. Conclusion: ESS significantly improves olfactory function and alleviates other sinonasal symptoms in patients with CRSwNP. The degree of polyp removal correlates with olfactory recovery, and ESS enhances overall quality of life.

Background: Endoscopic sinus surgery (ESS) has recently become a popular procedure. Its indication has been extended from chronic sinusitis to many other conditions, including orbital decompression, inverted papillomas, etc. Methods: ESS was performed for many conditions in our department begin-ning in April 1988. As of March 1988, 1500 cases were available for analy-sis of indications, operative procedures, complications, and prognosis by file and questionnaire review. Results: During this period, 1353 patients received ESS 1500 times in our department. Of these patients, 834 were male and the other 519 were female. Their ages ranged from 3 to 81 years old, with a mean age of 41.6 years. The indications were classified into 17 categories. The most common indication was chronic sinusitis without nasal polyps, and the second most common was nasal polyps. The surgeries included 1323 primary ESS cases and 177 revision ESS cases. Complications occurred in 148 cases, but most were minor complications. After ESS, 77.7% of our chronic sinusitis patients with or without polyposis felt they had improved. Conclusions: ESS is effective and safe for treating many disorders with low resulting morbidity.

Context: Endoscopic sinus surgery is a minimally invasive and currently the treatment of choice for acute/intermittent and chronic/persistent rhinosinusitis (RS) unresponsive to conservative medical treatment. Aims: To evaluate the indications and outcomes of treatment of RS with or without nasal polyps. Methods and Material: This was a retrospective review of all cases of endoscopic sinus surgery done at the National Ear Care Centre. The information extracted from the case notes of patients included the demographic profile, clinical radiologic and endoscopic findings, the surgery offered and outcome of surgery. Statistical analysis used: All information was entered into SPSS version 20.0. Results: Out of 116 patients had endoscopic sinus surgery, only 107 (92%) had complete information for the analysis. Their age ranged from 9 to 72 years with a mean age of 35.9 ± 1.9 years. Up to 105 of the patients presented nasal discharge alternating with nasal obstruction while 65% (70) of them had bilateral disease. Computed tomography scan revealed abnormalities in 66.4% (71) patients. The preoperative diagnosis of chronic RS (CRS) with simple nasal polyp was made in 66 patients, had functional endoscopic sinus surgery with polypectomy in 64.5% (69) patients and intraoperative findings revealed a mixture of mucosal diseases with sinonasal polyps in 73.8% and fungal sinus diseases in 18 (16.8). Majority of the patients (53.3%) were discharged home on the 2nd postoperative day. About 71% of the patients had resolution of their disease after months of followup. Conclusion: Endoscopic sinus surgery is higher among young adult in third and fourth decades of life. There is female preponderance and preoperative radiology assessment and the intraoperative findings revealed strong relationship. The outcome of treatment revealed recurrent disease in 10.5% with nasal adhesion, epistaxis and excessive nasal crust formation.

Objectives: To determine the effect of a single intravenous dose of tranexamic acid on intraoperative bleeding, duration of surgery, and surgical field visualization during endoscopic sinus surgery.&#x0D; &#x0D; Methods:&#x0D; Study Design: Double-blind, randomized, placebo-controlled trial.&#x0D; Setting: Tertiary Government Hospital in Quezon City&#x0D; Participants: 10 patients aged 18-75 years old diagnosed with chronic rhinosinusitis with or without nasal polyposis and unresponsive to medical treatment, who underwent endoscopic sinus surgery from September 2016 to August 2017, were randomly allocated to treatment group and control group respectively. The “odd” numbers were assigned to the treatment group (intravenous Tranexamic acid) given 1 dose of 100mg/ml (500mg tranexamic acid per 5 ml) tranexamic acid slow intravenous drip 1 hour prior to the procedure, while the “even” numbers assigned to the control group received the same amount of normal saline solution.&#x0D; &#x0D; Results: The mean duration of surgery of the tranexamic group was 185 minutes (standard deviation, SD 55.23) and the control group was 122.6 minutes (SD 42.03) showing no significant difference (p=.08). The mean blood loss of the tranexamic group was less at 240ml (SD 108.39) compared with the control group at 290ml (SD 74.16), although there was no statistically significant difference (p=.42). Intraoperative surgical field assessed by the surgeon based on the Boezart grading scale showed that 2 (40%) of the tranexamic group had higher bleeding score compared with the placebo group. However, this was not found to be statistically significant (p=.460). Due to the small sample size, a type II error occurred with alpha level of 0.05 and estimated power of 0.0885, with not enough basis to refute that a single dose of intravenous tranexamic acid has no effect in improving surgical field visualization during endoscopic sinus surgery. No drug side effects were noted after administration until after surgery.&#x0D; &#x0D; Conclusion: Single dose intravenous tranexamic acid in functional endoscopic sinus surgery decreased mean intraoperative blood loss (but this was statistically insignificant), but its effect on surgical field visualization cannot totally be assessed due to small sample size. There was also no change in the observed duration of surgery. No untoward side effects associated were noted from administration of the drug until after the surgery finished.&#x0D; &#x0D; Keywords: Functional endoscopic sinus surgery, intravenous tranexamic acid, chronic rhinosinusitis

Impact of asthma severity on surgical outcomes in patients with chronic rhinosinusitis comorbid with asthma

The objective of this work was to describe the association between baseline clinical characteristics and attendance at follow-up visits after endoscopic sinus surgery (ESS). A retrospective review of chronic rhinosinusitis (CRS) patients electing ESS at a tertiary-care center (2011-2013) was conducted. Baseline characteristics were studied for association with clinic attendance at 3, 6, 12, and 24 months post-ESS. We identified 268 patients. Significant decline occurred in the number of patients following up after ESS (3 months: 246 patients [92%]; 6 months: 145 [54%]; 12 months: 94 [35%]; and 24 months: 90 [34%]). Older patients were more likely to follow up at 3 months (mean age 55.7 vs 48.4 years, p = 0.04) and 6 months (57.5 vs 52.3 years; p = 0.01) post-ESS. Those with higher preoperative sinus computed tomography (CT) (Lund-Mackay) scores were more likely to follow at 6 months (11.8 vs 10.3, p = 0.01), 12 months (12.6 vs 10.3, p < 0.001), and 24 months (12.2 vs 10.5, p = 0.01). At 12 months having asthma (p = 0.03), previous ESS (p = 0.04), nasal polyps (p < 0.0001), allergic fungal sinusitis (AFS) (p = 0.002), and granulomatosis with polyangiitis (GPA) (p = 0.01) were associated with clinic attendance. At 24 months asthma status (p = 0.003), previous ESS (p = 0.002), AFS (p = 0.04), GPA (p = 0.001), and aspirin-exacerbated respiratory disease (AERD) (p = 0.006) were associated with higher attendance. Geographical proximity did not impact attendance. The sharpest decline in patient follow-up occurred between 3-6 months after ESS. Higher preoperative sinus CT scores, previous ESS, presence of asthma, and diagnosis of recalcitrant CRS subtype (nasal polyps, AERD, AFS, GPA) were factors associated with increased long-term attendance.

Previous research have suggested that chronic rhinosinusitis (CRS) patients with lower symptomatic scores, demonstrated by a 22-item Sinonasal Outcome Test (SNOT-22) score <20, may not achieve meaningful quality of life improvement following endoscopic sinus surgery (ESS). However, indications for ESS are continuing to be defined and many low SNOT-22 scoring patients still undergo elective surgery for CRS and other benign sinonasal pathologies. The outcomes for these patients have not been previously studied. We sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS. We screened 2829 ESS procedures from 2010-2018 to identify patients with a preoperative SNOT-22 score <20. We reviewed disease characteristics, preoperative Lund-Mackay (LM) scores, and pre- and postoperative SNOT-22 scores in patients with at least 3 months' follow-up. Of all surgical ESS patients screened, 114 had low preoperative SNOT-22 scores (4.0%). Indications for these surgeries included CRS (50.0%), odontogenic sinus disease (11.4%), mucocele (10.5%), recurrent acute sinusitis (7.0%), fungal ball (5.3%), and silent sinus syndrome (4.4%). Specifically, among CRS patients, 45.6% had pulmonary comorbidities and/or systemic immunodeficiencies. Moreover, 100% of CRS patients with nasal polyps and 73.1% of CRS without polyps had LM scores >5. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction (P < .001) postoperatively, whereas those with scores between 10 and 14 had a 5.4 point reduction (P < .001), and preoperative scores <9 resulted in no significant decrease in postoperative symptom scores (P = .98). Overall, there was a 3.3 point SNOT-22 reduction among all patients at 3 months postoperatively (P < .001). Patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores.