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.

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.

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 impact of endoscopic sinus surgery and aspirin desensitization on psychological burden in aspirin-exacerbated respiratory disease

Background:Aspirin-exacerbated respiratory disease(AERD)is an aggressive inflammatory disorder of the upper and lower respiratory tract.Corticosteroids,leukotriene modifiers,endoscopic sinus surgery(ESS),aspirin(ASA)desensitization,and biological immu-nomodulators are currently used to treat the disorder.Objective:The objective of this study was to determine the psychosocial impact of ESS and ASA desensitization on AERD patients.Methods:All AERD patients who underwent complete ESS were divided into two cohorts based on ASA desensitization status.The psychosocial metrics of the SNOT-22 were collected and analyzed at the following time points:pre-operative,1-month,3-month,6-month,and 12-month after ESS.Results:One hundred and eighty-four AERD patients underwent ESS from November 2009 to November 2018.From this group,130 patients underwent ASA desensitization(AD cohort)and 54 patients remained non-desensitized(ND cohort).AD patients showed a significantly greater reduction in total SNOT-22 scores over the study period compared to ND patients(p=0.0446).Analysis of SNOT-22 psychosocial metrics showed a significantly greater improvement in patient productivity in the AD cohort when compared to the ND cohort(p=0.0214).Further,a sub-group analysis accounting for subject attrition showed a significantly greater improvement in both productivity and concentration in AD patients when compared to the ND cohort(productivity:p=0.0068;concentration:p=0.0428).Conclusions:ESS followed by ASA desensitization decreases the overall psychosocial burden in AERD patients with a significant improvement in perceived productivity and concentration.This has significant implications given the psychosocial impact of chronic diseases.

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.

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.

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.

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.

Analysis of pathogenetic process of fungal rhinosinusitis: Report of two cases

BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. However, its physiological mechanism is not yet clear.Not every patient colonized by fungi develops a fungal infection. To a large extent, the immune status of the patient determines the nature of fungal disease in the nasal passages. The pathologic process of progression from harmless fungal colonization to fungal rhinosinusitis is unclear and has not been reported.CASE SUMMURY We report two patients, one who developed fungal rhinosinusitis 1.5 years after surgery performed to treat an inverted papilloma, and the other with a history of hypertension and cerebral infarction. Both patients recovered from their surgeries. An average time of 2.5 years elapsed from the development of maxillary sinus cysts to the development of fungal rhinosinusitis.CONCLUSION According to these case reports, we speculate that the progression of fungal rhinosinusitis from harmless colonization to disease onset requires approximately one to three years and that the length of the process may be related to underlying diseases, surgical treatment, deficient autoimmune status,and abuse of hormone antibiotics and hormones. Additional data are needed to conduct relevant studies to appropriately prevent and treat fungal rhinosinusitis.

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.

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.

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.