Socioeconomic Status Impacts the Prognosis of Chronic Rhinosinusitis Treated by Endoscopic Sinus Surgery:An Observational Cohort Study in Northeast China

Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.

Endoscopic sinus surgery plays an essential role in systematic treatment of odontogenic maxillary sinusitis

Purpose:Odontogenic maxillary sinusitis(OMS)is frequently encountered in otorhinolaryngologists'clinical practice.Endoscopic sinus surgery(ESS)instead of surgeries in intraoral approach has been widely applied among OMS.However appropriate treatments due to the causes of the OMS as well as the outcome have been less investigated,meanwhile the inherent incidence of OMS may be still on the rise.This study was designed to conclude our systematic treatment within follow-up examination.Materials and methods:In this retrospective study patients confirmed diagnosis of OMS who had systematic follow-up examinations were analyzed.Medical histories of otorhinolaryngologists and dentists were reviewed as well as preoperative examination protocols.Result:Consecutive 29 Patients(10 women,19 men)were included.41.4%(12/29)patients experienced facial pain as the most frequent symptom.69.0%(20/29)patients admitted firstly to otorhinolaryngologists,13 patients were treated with surgical procedure while 7 patients lacking of surgical indication were transferred to dentists.31.0%(9/29)patients were advised by dentist for being suspected of maxillary sinusitis,including 7 patients suffered from sinonasal complications of dental treatment(SCDT).Conventional dental treatment(root planning,root end surgery,extraction)was the most common cause.Follow up for a mean of 15.1(ranges from 6 to 96)months showed 29 patients maintaining open maxillary ostium on endoscopic examination or improving on CT except recurrence in one patient with SCDT.Conclusion:Patients should be inspected by dentists carefully when the patient has symptoms rather than sinusitis-like symptoms,the possibility of OMS should always be considered.Dental examination can help to determine whether a maxillary sinusitis has a dental origin,periodontitis and odontogenic radicular cysts still are the most common causes comparing with iatrogenic factors.Patients treated with ESS showed better tolerance and fewer postsurgical complications.Not all patients with OMS including SDCT need definitely surgery whether ESS or intraoral approach,removing dental focus followed with antibiotics would be optimistic choice.

A randomized controlled trial on triamcinolone versus saline impregnated merocel post endoscopic sinus surgery:Our experience in a tertiary care centre

Purpose:To assess the potential benefit of impregnating Merocel(a non-absorbable nasal dressing)with a topical steroid solution,for use as a direct and slow local delivery system of steroids after sinus surgery to improve postoperative wound healing.Methods:In this randomized controlled trial,40 patients with bilateral chronic rhinosinusitis with nasal polyposis were subjected to functional endoscopic sinus surgery.Following the completion of the surgery,Merocel packs were inserted in the bilateral nasal cavities and infiltrated with 4 mL triamcinolone(40 mg/mL)in one nasal cavity(treatment group)and 4 mL normal saline in the other(control group).Nasal packs were removed on the third postoperative day and postoperative healing assessment was done on postoperative Weeks 1,2,4,and 12.The findings were noted as per Lund Kennedy(LKES)and perioperative sinus endoscopy(POSE)scores and compared on both sides.Results:Significant(P<0.05)improvement was noted in Lund Kennedy score for crusting and polyp at Week 12,for edema at Week 1,and nasal discharge at Weeks 1 and 12,but there was no significant improvement in scarring at any week.Overall,the difference between the treatment and control arms was statistically significant at all postoperative visits except at Week 4.Also,there was a significant improvement in POSE scores at Weeks 1,2,and 12 but not at Week 4.Conclusion:This study positively concludes that the nasal cavity packed with drug-soaked packs had less scarring and edema in the postoperative period and the overall wound healing was much better as compared to saline-soaked packs.

Effect of Zhu-yuan decoction in patients with chronic rhinosinusitis after functional endoscopic sinus surgery

OBJECTIVE: To investigate the effectiveness and safety of Zhu-yuan decoction(ZYD) in patients after functional endoscopic sinus surgery(FESS).METHODS: A total of 85 patients were randomized into two groups: 44 were treated with intranasal corticosteroids(INC), and 41 were given Chinese herbal medicine(CHM). Patients with chronic rhinosinusitis(CRS) who underwent FESS were prospectively enrolled in the study. Before surgery, they were evaluated by visual analog scale(VAS), nasal endoscopy, computed tomography(CT), and routine blood test. After surgery, they were randomized to take ZYD or INC for 12 weeks and revaluated by VAS; nasal endoscopy at 4, 8, and 12 weeks;and CT at 12 weeks after surgery.RESULTS: In the both groups, VAS and endoscopyscores decreased significantly at 4, 8, and 12 weeks,and CT scores after treatment declined at 12 weeks compared with baseline scores. No significant differences were observed with regard to postoperative VAS, endoscopy, or CT scores between groups.ZYD, combined with surgery, can reduce VAS, nasal endoscopy, and CT scores and has the same efficacy and safety profile as INC in post-FESS management.No fatalities or major adverse events occurred in either group.CONCLUSION: Our findings suggest that ZYD has similar effects and safety profiles in patients after FESS compared with INC.

Systematic review of outcomes for endoscopic sinus surgery and subsequent aspirin desensitization in aspirin-exacerbated respiratory disease

Objective:To review and evaluate outcomes of patients with aspirin-exacerbated respiratory disease(AERD)following endoscopic sinus surgery and subsequent aspirin desensitization.Methods:Electronic searches of OVID MEDLINE(1948 to September 10,2019),EMBASE(1980 to September 10,2019),and PubMed were performed on September 10,2019.A systematic review of the literature was performed using the 2009 PRISMA guidelines.Studies with both preoperative and postoperative data for patients with AERD who underwent sinus surgery and aspirin desensitization were considered appropriate for inclusion.Publications were written in English and included patients aged 18 years or older.Results:Six studies met inclusion criteria for this systematic review.The primary outcome measure was change in symptom profile measured by patient-reported quality of life scores.The results demonstrate statistically significant improvement in symptoms following endoscopic sinus surgery,with sustained improvement following aspirin desensitization.Revision surgery rates were significantly lower in patients maintained on aspirin therapy.Conclusion:This review suggests that surgery followed by aspirin desensitization results in improvement in both subjective and objective outcome measures.The adjunctive use of aspirin desensitization allows for long-term stability in symptom scores.Recurrence of polyps and worsening symptoms requiring revision surgery occurs when aspirin maintenance therapy is inter-rupted.

The effect of functional endoscopic sinus surgery on nasal resonance

Background and objective: Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.Methods: The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.Results: In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But theP value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.Conclusion: Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.

Impact of endoscopic sinus surgery on otologic symptoms associated with chronic rhinosinusitis

Objective:To evaluate improvements in otologic symptoms after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS),and identify differences in symptoms,if any,between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyposis.Material and methods:This is a prospective multi-center observational cohort study.Adults with medically recalcitrant CRS who elected ESS were enrolled in a prospective,multicenter,observational cohort study between March,2011 and October,2014.Preoperative evaluation of subjects included assessment of clinical characteristics,measures of disease severity,and quality of life evaluation using the 22-item SinoNasal Outcome Test (SNOT-22).Postoperative improvement in otologic symptoms (ear fullness,dizziness,ear pain) scores were evaluated and compared between CRSwNP and CRSsNP subgroups.Results:Three hundred and ninety-five study patients completed both preoperative and postoperative evaluations,with an average follow-up of 13.9 months after ESS.The prevalence of patients reporting at least one otologic symptom preoperatively (87％) significantly decreased after ESS (63％,P ＜ 0.001).Significant postoperative improvement across all otologic scores was also reported (P ＜ 0.001).Relative mean improvement in otologic symptom severity was similar for both CRSwNP and CRSsNP,except patients with CRSwNP reported significantly greater postoperative improvement in ear fullness compared to CRSsNP (54％ vs.41％,P =0.039).A total of 61％,44％,and 43％ of patients reported experiencing improvement in 'ear fullness','dizziness' and 'ear pain',respectively.Conclusion:Sinus surgery significantly improves otologic symptoms associated with CRS.CRSwNP patients reported slightly greater relief of ear fullness than CRSsNP patients following ESS.

The Endonasal Endoscopic Management of Paranasal Sinuses Mucoceles

Introduction: Paranasal sinuses mucoceles are benign, epithelial lined, mucus filled lesions, causing destruction of the adjacent sinus walls, and with further gradual extension to adjacent structures, serious morbidities and mortalities may occur. Objective: To emphasize on the efficacy of endonasal endoscopic marsupialization in the treatment of paranasal sinus mucoceles. Method: Retrospective descriptive study on paranasal sinus mucocele cases operated on endoscopically by the author (AAM), in the 10-year-period from to 2009-2019. Result: Total of 23 cases were included, 16 were males and 7 females, age ranging between 14 - 76 years, with a mean age of 45 years Location of mucoceles varied between: Frontal 7 cases (30%), Fronto-ethmoidal 6 cases (26%), Isolated Ethmoidal accounted for 3 cases (13%), sphenoidal 4 cases (17%), maxillary were 3 cases (13%) all of the 23 cases underwent endonasal endoscopic complete marsupialization, none of them required combination with external approach in-spite of different locations and complications, with no recurrence in a mean follow up period of 2.4 years. Conclusion: Endonasal endoscopic approach is a safe, efficient approach in the treatment of most paranasal sinus mucocele case in their different presentations and locations.

Ethmoidal Polyposis, Adenoid Hypertrophy and Tympanic Membrane Perforation—A Case Report

Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perforation is a rare condition in otolaryngological practice. Evidences have shown that antrochoanal polyp often times coexists with adenoid enlargement especially in the young which was in sharp contrast to ethmoidal polyposis occurring in the presence of adenoid enlargement. Moreover, the hidden location of nasopharynx housing the adenoids, coupled with the masking effect of bilateral sinonasal polyps, leads to inadvertent misdiagnosis of this complex pathology with subsequent difficulty in providing effective management. Case Presentation: A 24 year-old lady presented with recurrent bilateral nasal obstruction that became persistent associated with nasal discharge and anosmia. She also had recurrent right otorrhoea with associated hearing loss. Diagnostic rigid nasal endoscopy revealed mucoid discharge with bilateral polypoid masses filling both nasal cavities. Otoendoscopic finding revealed a small (about 5%) central tympanic membrane perforation. A clinical assessment of chronic rhinosinusitis with nasal polyposis complicated by chronic suppurative otitis media (CSOM) was made. A non-contrast CT scan of the paranasal sinuses showed isodense lesions in the nasal cavities, all paranasal sinuses and the entire nasopharynx. She had endoscopic sinus surgery and a nasopharyngeal clearance biopsy. The nasal, paranasal and nasopharyngeal masses had histologic confirmation of inflammatory nasal polyps and lymphoid (adenoid) hyperplasia respectively. Her condition improved remarkably with subsequent medical treatment. She was followed up for 8 months and no recurrence was observed. Conclusion: Sinonasal polyposis can coexist with adenoid hypertrophy and middle ear disease as a single pathological condition. Hence, a high index of suspicion and thorough evaluation become necessary for making timely diagnoses and instituting effective management.

A Possible Association of Staphylococcus Enterotoxin B-induced Asthma and Sinusitis

In order to gain insight into a possible association between chronic sinusitis and asthma, 85 patients with sinusitis and asthma underwent functional endoscopic sinus surgical treatment and serum antibodies and cytokines were measured. The results showed that 51 out of 85 patients with high serum anti-Staphylococcus enterotoxin B （SEB） antibody before treatment obtained satisfactory results for both sinusitis and asthma. The high level of Th2 cytokine IL-4 was down regulated to the levels of normal controls after sinus surgery. Thirty-four out of 85 patients did not show high serum anti-SEB antibody before sinus surgery and did not show much improvement in their asthmatic symptoms although sinusitis symptoms were resolved by sinus surgery. It was concluded that bacterial superantigen SEB （in the sinuses） might play a crucial role in the pathogenesis of lower airway hypersensitivity.

Treatment of Allergic Fungal Sinusitis：a Report of 31 Cases

Objective: To evaluate the effects of different surgical procedures on allergic fungal sinusitis. Methods: Thirty-one patients with allergic fungal sinusitis under endoscopic sinus surgery(24 cases) and Caldwell-Luc operation(7 cases) after medical treatment were investigated. Results: No complication was observed during one year's follow-up. No patient who conducted endoscopic sinus surgery reacurred and 3 patients who received traditional surgery required a second operation. Conclusion: This confirmed endoscopic sinus surgery provided a mini-traumatic and effective treatment. Combined treatment of surgical and medical ways was useful to the development of allergic fungal sinusitis.

鼻咽部髓外浆细胞瘤1例

1临床资料患者,女,54岁,主因渐进性鼻塞1年余入院。患者夜间睡眠时张口呼吸伴打鼾,偶有头痛,无发热、血涕、耳鸣及听力下降。鼻内镜检查:右侧鼻咽部淡红色新生物,表面不光滑,质韧,堵塞全部右侧后鼻孔及大部分、左侧后鼻孔,基底位于右侧咽隐窝处(图1A)。耳内镜检查发现右耳鼓膜内陷,入院诊断为鼻咽部肿物。

Open label,interventional,single arm multicentric clinical study to analyze the potency of VELNEZ nasal pack,post-nasal surgery

Background:Nasal packs are central to nasal surgeries.Primarily,these packs function by controlling bleeding,modulating pain and reducing adhesions post-surgery.However,the major setback of the currently used conventional nasal packs is the unbearable pain the patient undergoes upon removal of these packs.To overcome this shortcoming a variety of biodegradable packs have emerged.This study was aimed at evaluating the safety,efficacy and tolerability of VELNEZ nasal packs.VELNEZ,a patented Datt Mediproducts Pvt.Ltd.nasal pack,is one of its kind biodegradable composite that fragments within a few days of application.Methods:Eighty patients were included in an open label,interventional,single arm clinical study using clinical endpoints to investigate the safety and efficacy of nasal pack VELNEZ.The patients were questioned using a visual analog scale from discharge day to 28th postoperative day(9 follow-up visits)at regular intervals.The standardized questionnaires for hemorrhage control,relief from postoperative pain,moderate obstruction,and pain were used.Results:A total of 76 patients were enrolled in the study and 74 patients completed the study.VELNEZ nasal pack played a significant role in controlling hemorrhage and reducing postoperative pain.The average hemorrhage control time was 7.49±3.90 min with only 34.24%of population complaining of pain on the sixth day of surgery(follow-up 4).Forteen days postsurgery only 10.95%of subject population complained of postoperative pain.This biodegradable composite has an average fragmentation time of 4.7 days in the nasal cavity.In addition,this study did not observe any postoperative adverse events or serious adverse events.Conclusion:VELNEZ,a fragmentable nasal pack,is comfortable,safe,and effective against postsurgery bleeding and pain.

The evolution of sinus surgery in England in the last decade - An observational study

Background and objective::Sinus surgery has seen significant changes over the years with advancements in instruments,endoscopes and imaging.This study aimed to use Hospital Episode Statistics(HES)data to review the total number of sinus related procedures performed in both adults and children across England and identify whether there were any trends across the study period.We predicted an increase in endoscopic sinus procedures with a decline in open approaches to the paranasal sinuses.Methods::Data from HES was extracted for the years 2010-2019.The operative(OPCS-4)codes relevant to all sinus procedures between E12.1 and E17.9 were analysed.After examination of overall sinus related procedures,further subgroup analysis was performed with regards to open or endoscopic techniques.Results::The total number of sinus procedures performed between 2010 and 2019 was 89,495.There was an increase in endoscopic surgeries by 21.1%and a decrease of open surgeries 35.3%during this time.There was an overall increase in maxillary,frontal and sphenoid sinus procedures,with a decrease in ethmoid sinus and lateral rhinotomy operations.There was an increase in the proportion of endoscopic cases overall by 5.7%and for all sinuses individually.Conclusion::Overall,we see an increase in sinus surgery over the last 9 years from 2010 to 2019.These findings are in keeping with our initial hypotheses.Although our data set is limited by coding,and lack of patient factors,it represents most,if not all,of the data in England over a large study period.It is therefore useful to add to previous studies when demonstrating the increasing popularity of endoscopic sinus surgery over open procedures.

Appropriate extent of surgery for aspirinexacerbated respiratory disease

The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal polyposis(CRSwNP),bronchial asthma,and aspirin/nonsteroidal anti-inflammatory drug intolerance.To further define the effectiveness of sinus surgery in treating AERD patients,this review article discusses current evidence regarding outcomes associated with more extensive surgery,the benefits of frontal sinus surgery on polyposis,and the role of Draf III intervention.Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies.Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.

Olfactory outcomes in the management of aspirin exacerbated respiratory disease related chronic rhinosinusitis

Patients with aspirin exacerbated respiratory disease(AERD)experience a severe and recalcitrant form of chronic rhinosinusitis with nasal polyposis(CRSwNP)and asthma,which are exacerbated by aspirin/NSAID ingestion.As compared with aspirin-tolerant CRSwNP,patients with AERD experience more severe olfactory dysfunction,which is one of the key contributors to the observed decrease in quality of life(QOL)in this disease.The objective of this paper is to review the published olfactory outcomes observed with various treatment modalities.

Odontogenic sinusitis:A state-of-the-art review

Odontogenic sinusitis(ODS)is more common than historically reported,and is under-represented in the sinusitis literature.ODS is distinct from rhinosinusitis in that it is infectious sinusitis from an infectious dental source or a complication from dental procedures,and most commonly presents unilaterally.ODS clinical features,microbiology,and diagnostic and treatment paradigms are also distinct from rhinosinusitis.ODS evaluation and management should generally be conducted by both otolaryngologists and dental providers,and clinicians must be able to suspect and confirm the condition.ODS suspicion is driven by certain clinical features like unilateral maxillary sinus opacification on computed tomography,overt maxillary dental pathology on computed tomography,unilateral middle meatal purulence on nasal endoscopy,foul smell,and odontogenic bacteria in sinus cultures.Otolaryngologists should confirm the sinusitis through nasal endoscopy by assessing for middle meatal purulence,edema,or polyps.Dental providers should confirm dental pathology through appropriate examinations and imaging.Once ODS is confirmed,a multidisciplinary shared decision-making process should ensue to discuss risks and benefits of the timing and different types of dental and sinus surgical interventions.Oral antibiotics are generally ineffective at resolving ODS,especially when there is treatable dental pathology.When both the dental pathology and sinusitis are addressed,resolution can be expected in 90%-100%of cases.For treatable dental pathology,while primary dental treatment may resolve the sinusitis,a significant percentage of patients still require endoscopic sinus surgery.For patients with significant sinusitis symptom burdens,primary endoscopic sinus surgery is an option to resolve symptoms faster,followed by appropriate dental management.More well-designed studies are necessary across all areas of ODS.

Three-hundred and sixty degrees of surgical approaches to the maxillary sinus

Objectives:To demonstrate three-hundred and sixty degrees of maxillary sinus(MS)surgical approaches using cadaveric dissections,highlighting the step-by-step anatomy of each procedure.Methods:Two latex-injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS.The procedures were documented with macroscopic images and endoscopic pictures.Results:Dissections were performed to approach the MS medially(endoscopic maxillary antrostomy and ethmoidectomy),anteriorly(Caldwell-Luc),superiorly(transconjunctival/transorbital approach),inferiorly(transpalatal approach),and posterolaterally(preauricular hemicoronal approach).Conclusion:A number of approaches have been described to address pathology in the MS.Surgeons should be familiar with indications,limitations,and surgical anatomy from different perspectives to approach the MS.This paper illustrates anatomic approaches to the MS with detailed step-by-step cadaveric dissections and case examples.