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Effectiveness of extensive sinus surgery with post-operative medical management for chronic rhinosinusitis

Published online by Cambridge University Press:  20 February 2017

A J Wood
Affiliation:
Department of Surgery, University of Auckland, Auckland, New Zealand
L Zhou
Affiliation:
Waitemata District Health Board, Auckland, New Zealand
S Wilkinson
Affiliation:
Department of Surgery, University of Auckland, Auckland, New Zealand
R G Douglas*
Affiliation:
Department of Surgery, University of Auckland, Auckland, New Zealand
*
Address for correspondence: Dr Richard Douglas, Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand Fax: +64 9 377 9656 E-mail: [email protected]

Abstract

Objective:

To prospectively assess treatment outcomes of chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery and post-operative medical treatment over a prolonged follow-up period.

Methods:

Patients undergoing functional endoscopic sinus surgery in the tertiary referral practice of a single surgeon were studied prospectively. Symptoms were scored by patients pre-operatively and over a minimum follow-up period of 12 months.

Results:

The study comprised 200 non-consecutive patients. The median pre-operative symptom score was 16 (out of a maximum of 25) (95 per cent confidence interval = 15 to 17). Symptom scores reduced to a median of 7 (95 per cent confidence interval = 6 to 8) after 12 months of follow up (p < 0.0001). The median symptom score improved for all symptoms and across all patient subgroups.

Conclusion:

Extensive functional endoscopic sinus surgery offers significant and durable symptom improvement in patients with chronic rhinosinusitis refractory to medical treatment. This improvement extends to all patient subgroups. Prolonged medical therapy is recommended after functional endoscopic sinus surgery.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2017 

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References

1 Stammberger, H, Posawetz, W. Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 1990;247:6376 Google Scholar
2 Fokkens, WJ, Lund, VJ, Mullol, J, Bacchert, C, Alobid, I, Baroody, F et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 2012;50:112 Google Scholar
3 Hastan, D, Bokkens, WJ, Bachert, C, Newson, RB, Bislimovska, J, Bockelbrink, A et al. Chronic rhinosinusitis in Europe--an underestimated disease. A GA(2)LEN study. Allergy 2011;66:1216–23Google Scholar
4 Young, LC, Stow, NW, Zhou, L, Douglas, RG. Efficacy of medical therapy in treatment of chronic rhinosinusitis. Allergy Rhinol (Providence) 2012;3:e812 Google Scholar
5 Bhattacharyya, N, Orlandi, RR, Grebner, J, Martinson, M. Cost burden of chronic rhinosinusitis: a claims-based study. Otolaryngol Head Neck Surg 2011;144:440–5Google Scholar
6 Damm, M, Quante, G, Jungehuelsing, M, Stennert, E. Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis. Laryngoscope 2002;112:310–15Google Scholar
7 Hopkins, C, Slack, R, Lund, V, Brown, P, Copley, L, Browne, J. Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope 2009;119:2459–65Google Scholar
8 Kern, RC, Conley, DB, Walsh, W, Chandra, R, Kato, A, Tripathi-Peters, A et al. Perspectives on the etiology of chronic rhinosinusitis: an immune barrier hypothesis. Am J Rhinol 2008;22:549–59Google Scholar
9 Wabnitz, DA, Nair, S, Wormald, PJ. Correlation between preoperative symptom scores, quality-of-life questionnaires, and staging with computed tomography in patients with chronic rhinosinusitis. Am J Rhinol 2005;19:91–6Google Scholar
10 Georgalas, C, Cornet, M, Adriaensen, G, Reinartz, S, Holland, C, Prokopakis, S et al. Evidence-based surgery for chronic rhinosinusitis with and without nasal polyps. Curr Allergy Asthma Rep 2014;14:427 Google Scholar
11 Welch, KC, Stankiewicz, JA. A contemporary review of endoscopic sinus surgery: techniques, tools, and outcomes. Laryngoscope 2009;119:2258–68Google Scholar
12 Lund, VJ, Holmstrom, M, Scadding, GK. Functional endoscopic sinus surgery in the management of chronic rhinosinusitis. An objective assessment. J Laryngol Otol 1991;105:832–5Google Scholar
13 Litvack, JR, Mace, J, Smith, TL. Does olfactory function improve after endoscopic sinus surgery? Otolaryngol Head Neck Surg 2009;140:312–19Google Scholar
14 Briner, HR, Jones, N, Simmen, D. Olfaction after endoscopic sinus surgery: long-term results. Rhinology 2012;50:178–84Google Scholar
15 Rizk, H. Role of aspirin desensitization in the management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2011;19:210–17Google Scholar
16 Rudmik, L, Soler, ZM, Orlandi, RR, Stewart, MG, Bhattacharyya, N, Kennedy, DW et al. Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2011;1:417–30Google Scholar
17 Lund, VJ. Low priority procedures--a uniquely British concept. Rhinology 2011;49:1 Google Scholar
18 Wood, AJ, Douglas, RG. Pathogenesis and treatment of chronic rhinosinusitis. Postgrad Med J 2010;86:359–64Google Scholar
19 Naidoo, Y, Tan, N, Signal, D, Wormald, PJ. Chronic rhinosinusitis assessment using the Adelaide Disease Severity Score. J Laryngol Otol 2013;127(suppl 2):S24–8CrossRefGoogle ScholarPubMed
20 Chester, AC, Antisdel, JL, Sindwani, R. Symptom-specific outcomes of endoscopic sinus surgery: a systematic review. Otolaryngol Head Neck Surg 2009;140:633–9Google Scholar
21 Soler, ZM, Smith, TL. Quality-of-life outcomes after endoscopic sinus surgery: how long is long enough? Otolaryngol Head Neck Surg 2010;143:621–5Google Scholar
22 Smith, TL, Litvack, JR, Hwang, PH, Loehrl, TA, Mace, JC, Fong, KJ et al. Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg 2010;142:5563 Google Scholar
23 Clinger, JD, Mace, JC, Smith, TL. Quality-of-life outcomes following multiple revision endoscopic sinus surgery. Int Forum Allergy Rhinol 2012;2:444–52Google Scholar
24 Elmorsy, SM, Khafagy, YQ. Does asthma and aspirin hypersensitivity affect the outcome of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps. J Aller Ther 2011;S5:2 Google Scholar
25 Kim, JE, Kountakis, SE. The prevalence of Samter's triad in patients undergoing functional endoscopic sinus surgery. Ear Nose Throat J 2007;86:396–9Google Scholar
26 Fokkens, W, Lund, V, Mullol, J. EPOS 2007: European position paper on rhinosinusitis and nasal polyps. Rhinology 2007;45:1139 Google Scholar
27 Jain, R, Stow, N, Douglas, R. Comparison of anatomical abnormalities in patients with limited and diffuse chronic rhinosinusitis. Int Forum Allergy Rhinol 2012;3:493–6Google Scholar
28 Lund, VJ, Mackay, IS. Staging in rhinosinusitus. Rhinology 1993;31:183–4Google Scholar
29 Thomas, WW 3rd, Harvey, RJ, Rudmik, L, Hwang, PH, Schlosser, RJ. Distribution of topical agents to the paranasal sinuses: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2013;3:691703 Google Scholar
30 Liang, KL, Su, MC, Tseng, HC, Jiang, RS. Impact of pulsatile nasal irrigation on the prognosis of functional endoscopic sinus surgery. J Otolaryngol Head Neck Surg 2008;37:148–53Google Scholar
31 Kalish, L, Snidvongs, K, Sivasubramaniam, R, Cope, D, Harvey, RJ. Topical steroids for nasal polyps. Cochrane Database Syst Rev 2012;(12):CD006549 Google Scholar
32 Rudmik, LJ, Mace, J, Smith, T. Low-stage computed tomography chronic rhinosinusitis: what is the role of endoscopic sinus surgery? Laryngoscope 2011;121:417–21Google Scholar
33 DeConde, AS, Mace, JC, Alt, JA, Soler, ZM, Orlandi, RR, Smith, TL. Investigation of change in cardinal symptoms of chronic rhinosinusitis after surgical or ongoing medical management. Int Forum Allergy Rhinol 2014;5:3645 CrossRefGoogle ScholarPubMed
34 Siedek, V, Pilzweger, E, Betz, C, Berghaus, A, Leunig, A. Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients. Eur Arch Otorhinolaryngol 2013;270:141–8Google Scholar
35 Soler, ZM, Rudmik, L, Hwang, PH, Mace, JC, Schlosser, RJ, Smith, TL. Patient-centered decision making in the treatment of chronic rhinosinusitis. Laryngoscope 2013;123:2341–6Google Scholar
36 Liu, JJ, Davis, GE. The significance of response shift in sinus surgery outcomes. Int Forum Allergy Rhinol 2015;5:55–9Google Scholar