Correlation between Radiological Staging of Chronic Rhinosinusitis and Revision of Endoscopic Sinus Surgery

Introduction: Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the sinonasal mucosa with duration of more than 12 weeks. Multifactorial aetiology contributes to its refractoriness. Functional endoscopic sinus surgery (FESS) is the most common surgical technique preferred in CRS not responding to medical management, showing high success rates. However, some failure has been noted, requiring revision FESS. CT (Computed Tomography) is a diagnostic tool for CRS, and aids in improving surgical outcomes. Combined with the Lund-Mackay scoring system, CT can help stage the CRS, predicting the need for revision surgery. Methods: In our paper, we aimed to study the relationship between severity of CRS using radiological staging and revision of functional endoscopic sinus surgery, assessing outcome after at least 1 year of follow-up. There was a single centre retrospective study involving 150 patients selected by random sampling, to study the correlation between the severity of chronic rhinosinusitis and revision of functional endoscopic sinus surgery (FESS). The study was conducted in the ENT department of King Hamad University Hospital, Bahrain for a time period of 6 months. Records were scanned and scored using Lund-Mackay system. Lund Mackay score of 10 and above was considered severe. The relation between increased severity with Lund Mackay score on the CT scan and the need for revision sinus surgeries was then determined. Results and Conclusion: This study concludes that LMS score in CT scans can be used to predict the outcomes of primary FESS procedure and the need for revision surgery in the management of CRS.

Therapeutic Efficacy of Diode Laser Turbinoplasty on Nasal Obstruction Estimated with Rhinomanometry

Objective: Diode-assisted laser turbinoplasty is a popular surgical technique that improves airflow during nasal obstruction. In this study, we aimed to evaluate the efficacy of a diode laser for turbinate hypertrophy by using rhinomanometry. Methods: This cross-sectional study included 199 patients for 13 months. Preoperative, intraoperative, and 6-week postoperative rhinomanometry values were measured. Results: The most common intraoperative symptoms were olfactory annoyance (barbecue smell) (76.4%) and a painful burning or stinging sensation (64.3%). The inspiratory and expiratory mean nasal airflow values increased both intraoperatively and postoperatively, illustrating the effect of decongestants and inferior turbinate surgery. Intraoperatively, inspiration improved by 262.73 ± 196.09 (p < 0.01) and expiration by 247.94 ± 180.05 (p < 0.01). Postoperative inspiration improved by 254.03 ± 199.08 (p < 0.01) and expiration by 244.05 ± 194.57 (p < 0.01). Postoperative snoring (22.6%, p = 0.026) and nasal obstruction (20.2%, p = 0.042) were significantly higher in female than in male patients. Conclusions: The therapeutic efficacy of using diode lasers in inferior turbinate resection was established in this study on the basis of rhinomanometric data with a follow-up of 6 weeks. Postoperative nasal obstruction was effectively decreased and the other symptoms displayed a female preponderance.