Evaluating Long Term Outcomes In Endoscopic Sinus Surgery For Chronic Rhinosinusitis Crs

INTRODUCTION Endoscopic sinus surgery (ESS) improves quality of life but previous studies show high recurrence rates. We aim to assess long-term outcomes of tailored ESS. METHODOLOGY Patients undergoing ESS in 2010-2 at a tertiary centre were sent questionnaires at 5 years including SNOT-22, asthma control and medication use. Of 226 patients, 135 (59.7%) responded. RESULTSu202f Patients reportedu202frecurrenceu202fof nasal polyps in 3.9%, revision surgery in 3% and 1 post-operative complication. Compliance with topical medications was 62%. SNOT-22 scores were significantly reduced (p

INTRODUCTION Endoscopic sinus surgery (ESS) improves quality of life but previous studies show high recurrence rates. We aim to assess long-term outcomes of tailored ESS. METHODOLOGY Patients undergoing ESS in 2010-2 at a tertiary centre were sent questionnaires at 5 years including SNOT-22, asthma control and medication use. Of 226 patients, 135 (59.7%) responded. RESULTSu202f Patients reportedu202frecurrenceu202fof nasal polyps in 3.9%, revision surgery in 3% and 1 post-operative complication. Compliance with topical medications was 62%. SNOT-22 scores were significantly reduced (p

In "Revision Sinus Surgery" the world’s most prominent rhinologists illustrate their experience in diagnosing and managing recurrent sinus disease and skull base lesions. Starting with preoperative planning and medical management, these challenging cases are well-illustrated with the relevant surgical techniques. This invaluable resource is designed to prevent complications and improve the outcomes of revision sinus surgeries. Both practicing and in-training otolaryngologists can use this comprehensive volume as an all-in-one source for the evaluation and management of recurrent sinus disease and skull base pathology.

This issue will focus on treatments for Chronic Rhinosinusitis. Dr. Wyste Fokkens guest edits topics such as: "Inflammatory mechanisms in chronic rhinosinusitis with or without nasal polyposis," "European versus Asian Chronic rhinosinusitis. What did it teach us and what do we want to know," "Epithelium, cilia and mucus, their importance in chronic rhinosinusitis Noam Cohen Noam," "Aspirin intolerance: does desensitization alter the course of the disease," "Anti-inflammatory effects of macrolides: applications in CRS," and more!

"Background: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases in the developed world, with a significant proportion of patients remaining refractory to the standard of care treatment. This difficult-to-treat population is often left with few therapeutic options that provide low-morbidity, low-cost, and long-term meaningful symptomatologic improvement. Objectives: Evaluate the efficacy of a low-dose, long-term macrolide in a high-risk and carefully selected CRS population, refractory to appropriate medical (budesonide irrigations [BNI]) and surgical therapy (endoscopic sinus surgery [ESS]). Evaluate factors associated with treatment response following low-dose, long-term macrolide. Evaluate the effect of low-dose, long-term macrolide in modulating the sinonasal microbiome. Methodology: Patients at high-risk of disease recurrence following ESS+BNI were enrolled in a prospective clinical trial (Phase 1) at a tertiary care center. Serologic samples, microbial swabs, and patient-reported outcomes measures (PROM) were completed on the day of surgery (Visit-1) and four months postoperatively (Visit-2). Outcomes were evaluated using the Lund-Kennedy endoscopic score. If disease persisted on Visit-2, they were randomized (Phase 2) to receive 250gm azithromycin or a placebo three times per week for 16 weeks (Visit-3). Results: A total of 128 patients were enrolled in the Phase 1 prospective trial. At the first four-month follow-up, 48 patients showed disease persistence and were randomized to azithromycin or placebo. Overall, azithromycin did not show a statistically significant difference in disease clearance at Visit-3 compared to placebo (54% vs. 33%, respectively; p=0.146). When patients with aspirin-exacerbated respiratory disease (AERD) were excluded from the analysis, azithromycin showed a significant improvement in disease clearance compared to placebo (71% vs. 35%, respectively; p=0.031), with a number needed to treat of 3 (2.8). In a subgroup analysis looking at all patients with disease clearance, those on azithromycin reported significantly better PROM improvements than patients on placebo (p=0.046). Twenty patients received azithromycin in an open-label setting, either at Visit-2 or following failure of placebo, with 14 of 20 (70%) showing disease clearance. When analyzing the sinonasal microbiome, patients on azithromycin demonstrated a significant log-fold decrease in 29 different operational taxonomic units (OTUs) of Staphylococcus aureus compared to patients on placebo, while also showing a significant difference in beta diversity (p

This state-of-the-art text addresses surgery of the frontal sinus, and the challenges that come along with it. It provides a comprehensive overview of the anatomy of the frontal sinus and a systematic method of approaching and executing sinus surgery, as well as tools, tips, and strategies in optimizing success. Additional chapters include the management of acute and chronic frontal sinus inflammation, trauma of the frontal sinus, tumors in the frontal sinus, and pediatric frontal surgery. Perioperative care and management of complications are also discussed. Chapters are richly illustrated with fi gures and surgical videos, replete with practical pearls and tips. Frontal Sinus Surgery: A Systematic Approach will be an invaluable resource for general otolaryngologists and rhinologists interested in the frontal sinus.

"Objectives: Evaluate factors associated with treatment failure following endoscopic sinus surgery (ESS) and budesonide nasal irrigations (BNI) in chronic rhinosinusitis (CRS). Methodology: Prospective clinical trial including 116 patients from a tertiary care center at high-risk of disease recurrence following ESS+BNI. Blood samples, microbial swabs, and SNSS/SNOT-22 taken on the day of surgery (Visit-1) and four months postoperatively (Visit-2). Outcomes were evaluated using the Lund-Kennedy endoscopic score. Results: Revision surgery was associated with a significantly higher rate of disease recurrence (82.8% vs. 55.2%; p=0.001). Allergy to non-steroidal anti-inflammatory drugs was significantly associated with disease recurrence (p=0.036). The presence of pre and postoperative Staphylococcus aureus (p=0.020; p

Chronic rhinosinusitis (CRS) is chronic inflammation of the sinonasal mucosa. It is a disease of significant impact on public health, one that affects about 10-15% of the population. Functional Endoscopic Sinus Surgery (FESS) is the "gold standard" surgical treatment for CRS; its original philosophy or concepts are based upon the sinonasal mucociliary clearance studies by Messerklinger and Stammberger, which emphasize the role of the osteo-meatal complex (OMC). However, although the success rate of FESS is about 90%, there is a subgroup of patients who exhibit no improvement, and thus require repeated surgeries. This subgroup of patients suffers from refractory chronic rhinosinusitis (rCRS), which is the main focus of this thesis. In this thesis the current understanding of the pathogenesis and causes of surgical failure in CRS are reviewed. This thesis presents the hypothesis that our understanding of the pathogenesis of CRS has advanced since the original concepts of FESS were put forward, and that patients who develop rCRS have other pathogenic features that cannot be addressed by these concepts. We revisit middle turbinate lateralization (MTL) as a surgery-related factor of rCRS in Chapter 6, and we pose the question: Is MTL a complication associated with worse surgical outcomes, or just a harmless sequela, of the surgical destabilization of the middle turbinate during sinus surgery? Our findings show that MTL plays a role in surgical failure and requiring revision surgery, but suggest that the clinical significance of MTL may be related to frontal sinus obstruction and not necessarily to the OMC. We then present two novel hypotheses: the inflammatory load hypothesis in Chapter 7, and the irreversible disease hypothesis in Chapter 8. In Chapter 9, we investigate nasal polyp recurrence in CRS with Nasal Polyposis (CRSwNP) as an important cause of rCRS. We study the patterns of polyp recurrence and the clinical factors associated with more aggressive recurrence. The findings show that firstly, comorbid factors such as asthma and aspirin sensitivity contribute to the disease load and rCRS; and secondly, that more aggressive surgical removal of that disease load and maximal opening of the sinuses through a frontal drillout procedure improve the surgical outcome and disease control for these rCRS patients. We then proceed to investigate the relevance of our two novel hypotheses to refractory CRSwNP through a histopathological study in Chapter 10. We also describe the evolution of the inflammatory load in patients with rCRS from first to second surgery, a topic rarely addressed in the literature. We found that a higher inflammatory load is present in patients who fail surgery and go on to develop refractory CRS, when compared to patients who respond to surgery, with a particular significance to the eosinophilic load. In summary, our findings suggest that the inflammatory load is associated with long-term surgical outcomes. The recommendation based upon findings in this thesis is that surgery offered for CRS should be viewed as a tool for addressing and controlling disease load, and not just for the conservative clearance of disease of the OMC.

This is the only book dedicated solely to frontal sinus disorders. It is a richly illustrated and comprehensive mine of information on the anatomy and management of these disorders. This updated second edition offers much new information. Additional topics include balloon dilation, frontal surgery as part of skull base surgery, and advances in endoscopic techniques and tools that have occurred since 2004 and have made open osteoplastic procedures almost obsolete. The anatomy and surgery of the supraorbital ethmoid cell and its significance in the pathology of frontal sinus disease are also covered. Throughout the book, particularly important areas of text are highlighted and core messages, emphasized. Videos of described procedures are available online.