Comparison of direct monocular endoscopic,two- and three-dimensional display systems on surgical task performance in functional endoscopic sinus surgery

The operating endoscope has been an important advance in nasal and sinus surgery. Most surgeons describing the technique have used direct monocular vision, though some have recently been using videoendoscopic technology. Video monitoring offers the possibility of bimanual instrument handling and 3D visualization, with the appropriate equipment. We performed a study involving 10 surgeons, in which performance in simulated FESS was evaluated for direct endoscopic vision and compared with 2D and 3D video monitor display systems. There was a statistically significant difference in task performance time (visualizing or removing three small rings placed in the nasal cavity) between the three techniques. The direct technique was performed most slowly, participants taking longer with this technique than with the other two to perform the tasks. The 2D technique was more rapid, with the 3D technique taking the shortest time (P < 0.05). We feel that there is a place for further evaluation of video monitor controlled endoscopic sinus surgery.     

改良中鼻甲部分切除术在功能性鼻内镜手术中的应用

目的探讨改良中鼻甲部分切除术在功能性鼻内镜手术中的应用及其对慢性鼻窦炎症状改善和疗效的影响。方法选择中鼻甲垂直部长度≥25mm的慢性鼻窦炎患者60例,随机分为试验组和对照组,各30例。两组患者术前各项观察指标（鼻塞、流涕、头痛、嗅觉VAS评分,鼻内镜检查Lund Kennedy评分、CT Lund Mackey评分）差异无统计学意义（P>0.05）。试验组实施经鼻内镜鼻窦、鼻息肉手术并清除中鼻甲本身病变（泡甲、肥厚、息肉样变等）后,根据CT测量结果,以保留中鼻甲垂直部长度约21mm为参考值,切除多余的中鼻甲垂直部游离缘（即切除长度＝CT测量长度-21 mm）;对照组完成鼻窦、鼻息肉手术,按传统理念处理中鼻甲病变和变异,需要时切除中鼻甲前下部1/2~2/3。术后随访10~12个月,观察主观症状（鼻塞、流涕、头面痛及嗅觉障碍）、内镜检查Lund Kennedy评分、病情控制及疗效。结果两组术后各种症状VAS评分和内镜Lund Kennedy评分均明显优于术前（P均<0.05）;术后试验组的各项观察指标及总疗效均优于对照组,两组鼻塞及头痛的改善、鼻内镜Lund Kennedy评分及疗效差异具有统计学意义（P均<0.05）;而流涕、嗅觉改善方面,两组差异无统计学意义（P>0.05）;鼻窦炎伴鼻息肉、鼻窦炎伴中鼻甲病变者,试验组的疗效优于对照组（P<0.05）。结论“改良部分切除”主要针对过长的中鼻甲垂直部,必须是在处理中鼻甲病变（泡甲、肥厚、息肉样变等）、保证中鼻道一定宽度后才予切除,有助于术后鼻部症状的改善和减少术腔粘连,提高鼻内镜手术疗效。     

The role of functional endoscopic sinus surgery (FESS) in patients with asthma with chronic sinusitis

25 patients of bronchial asthma with chronic sinusitis were operated with the aim to evaluate the efficacy of functional endoscopic sinus surgery (FESS) on asthma symptoms. The mean postoperative daytime asthma symptom scores, nocturnal asthma symptom scores, mean postoperative nocturnal awakening scores and number of asthma attacks reduced significantly (p<0.001). The mean FEV₁ observed postoperatively showed significant increase (p<0.001). 21 patients reported overall significant improvement in the asthma. 6 patients were completely taken off from all sort of anti-asthmatic drugs [inhalational corticosteroids (ICS) + long acting β₂ agonist (LABA) ]. In 3 patients there was significant / substantial decrease in the dosage of anti-asthma drugs. It is concluded that FESS is a viable option for improving the control of asthma.     

The effects of functional endoscopic sinus surgery on chronic obstructive pulmonary disease (COPD) and asthma: A comparative study

PurposeChronic Rhinosinusitis (CRS) can be accompanied by asthma and, rarely by chronic obstructive pulmonary disease (COPD). Functional endoscopic sinus surgery (FESS) is the most common surgical approach for CRS which also improves asthma symptoms, but little is known about its effects on COPD. This study investigates the effects of FESS on COPD and asthma symptoms in CRS patients referred to a university hospital in northern Iran.Materials and methodsIn a prospective study, patients with COPD or asthma and CRS who were candidates for FESS underwent endoscopic examination, spirometry, and evaluation of symptoms of CRS, COPD, and asthma before, and 2 and 6 months after FESS. Statistical analyzes were performed using SPSS software version 21 and the level of significance was considered as P < 0.05.ResultsEighty-two CRS patients (45 with asthma/ mean age: 49.24 ± 12.75 years and 37 patients with COPD/ mean age: 61.43 ± 6.93 years) enrolled. In asthmatic patients, the mean FEV1 and FVC, and ACT (Asthma Control Test) score increased significantly after FESS (P < 0.001). In COPD cases, spirometry indices decreased, but CAT (COPD Assessment Test) score improved significantly (from 15.70 to 32.11) after FESS (P < 0.001). The mean SNOT score in both groups was significantly reduced.ConclusionsIn CRS patients with COPD, FESS improves the condition of SNOT-22 and CAT, although does not increase spirometry parameters. In asthmatic patients, FESS improves pulmonary function and asthma symptoms. So both patient groups (i.e. CRS with COPD and with asthma) will benefit from FESS.     

Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery

The aim of this study was to evaluate the analgesic efficacy of sphenopalatine ganglion block performed under general anesthesia in patients undergoing functional endoscopic sinus surgery (FESS) with operative blood loss and postoperative complications (headache, visual disturbances, nausea, vomiting, sore throat, swallow difficulty). Forty-five consenting patients were randomized to receive bilateral sphenopalatine ganglion block with saline (Group S, n = 15), bupivacaine 0.5% (Group B, n = 15), or levobupivacaine 0.5% (Group L, n = 15) immediately following induction of general anesthesia. Esmolol was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate. Postoperative pain scores were checked on arrival at the postanesthesia care unit, 2, 6, and 24 h after surgery and diclofenac was administered intramuscularly for pain score ≥4. A statistically significant reduction was present in postoperative Visual Analog Scale scores between Group S and the block Groups B and L (p < 0.05). In Group L and B, fewer patients required additional analgesics in the postoperative 24 h (p < 0.0001). The comparison of postoperative complications was not statistically significant among the groups (p > 0.05). Sphenopalatine ganglion block with bupivacaine or levobupivacaine improved postoperative analgesia associated with better surgeon and patient satisfaction after FESS.     

Impact of the Endoscopic Sinus Surgical Simulator on Operating Room Performance

Objectives/Hypothesis The aim of this study is to evaluate an endoscopic sinus surgical simulator (ESS) as a training device and to introduce a methodology to assess its impact on actual operating room performance. Study Design Prospective evaluation of the endoscopic sinus surgical simulator as a trainer. Methods Ten junior and senior ear, nose and throat residents served as subjects, some of whom had prior training with the simulator. The evaluation team collected several measures, which were analyzed for a statistical correlation, including simulator scores, operating room performance rating, ratings of videotaped operating room procedures, and surgical competency rating. Results These findings suggest the ESS simulator positively affects initial operating room performance across all measures as judged by senior surgeons rating anonymous videotapes of those procedures. The two simulation‐trained residents were rated consistently better than the other two residents across all measures. These differences approached statistical significance for two items: anterior ethmoidectomy (P = .06;P <.05) and surgical confidence (P = .09;P <.05). In addition, the 3 subjects with the highest overall scores on the competency evaluation also had 3 of the 4 highest cumulative simulation times. Conclusions The endoscopic sinus surgical simulator is a valid training device and appears to positively impact operating room performance among junior otolaryngology residents.     

Hypotensive anaesthesia and bleeding during endoscopic sinus surgery: an observational study

Significant bleeding during functional endoscopic naso-sinusal surgery (FESS) impairs recognition of anatomical references and may negatively affect surgical outcome. Through their hypotensive effect, adjuvant anaesthetic agents may influence intraoperative bleeding. The present study compared intraoperative bleeding in patients undergoing FESS administered a clonidine-based anaesthetic regimen and in patients receiving other an anaesthetic combination with higher acquisition costs. Prospective observational study included 37 subjects undergoing FESS in 2011. Assessment of intraoperative bleeding was according to type of anaesthesia (clonidine vs. opioid derivatives). Patients receiving clonidine (N = 11; 29.7 %) presented significantly lower surgical field bleeding scores than those receiving opioid derivatives (N = 26; 70.3 %) [mean (SD) Boezaart scores 1.91 (0.53) vs. 2.92 (0.79), p < 0.0001]. The multivariate analysis including baseline characteristics and risk factors related to bleeding intensity showed that the type of drug used for controlled hypotensive anaesthesia was the best predictor of bleeding during FESS, with an OR of 0.03 for clonidine based vs. opioid based anaesthesia (p = 0.014). The anaesthetic combination including clonidine for controlled hypotensive anaesthesia produces lower levels of surgical field bleeding during FESS. Compared with other hypotensive anaesthetics, clonidine is inexpensive and associated with better surgical conditions during FESS. If confirmed through randomized clinical trials, the use of clonidine during FESS can reduce surgical time and improve surgical results through a less bloody field, resulting in lower patient morbidity and improvement of operating room resources.     

Wound healing in endoscopic sinus surgery: Phase 1 clinical trial evaluating the role of Chitogel with adjuvants

Objectives

This study aimed to determine the safety and efficacy of Chitogel, with and without Deferiprone (Def) and Gallium Protoporphyrin (GaPP), as a promoter of wound healing to improve surgical outcomes after endoscopic sinus susgery.

Design

A double-blinded, randomised control human clinical trial was conducted in patients undergoing ESS as a treatment for chronic rhinosinusitis. Participants underwent functional ESS or FESS with drill out as required and were randomised to receive test product Chitogel, Chitogel in combination with Def or Def-GaPP versus no packing (control).

Setting

Ostial stenosis and persistent inflammation are the main reasons for revision endoscopic sinus surgery (ESS). Post-operative (PO) dressings can improve PO wound healing and patient outcomes after ESS.

Participants

Eighty two patients were included in this study with 79 patients completing the study with 40 undergoing full house FESS and 39 FESS plus frontal drillout.

Main Outcome Measures

Patients were followed up at 2, 6 and 12 weeks PO, and outcome scores such as SNOT-22, VAS and LKS, pre and post-surgery (12 weeks) were compared.

Results

Seventy nine patients completed the study, there was a significant reduction in SNOT-22 score and improvement of VAS at 12 weeks in patients treated with Chitogel compared to control (p < .05). In those patients, the mean ostium area for the Chitogel and the Chitogel + Def + GaPP groups was higher across all three sinuses compared to the no-treatment control group, without statistical significance. Sphenoid sinus ostium was significantly more patent in patients treated with Chitogel compared to the control at the 12-week time point (p < .05).

Conclusion

Chitogel as a PO dressing after ESS results in the best patient-reported symptom scores and objective measurements. The combination of Def and GaPP to Chitogel though proving safe, had no effect on the ostium patency or mucosal healing.     

KTP‐532 laser‐assisted endoscopic nasal sinus surgery

KTP‐532 laser‐assisted endoscopic nasal sinus surgery The present study is meant to give an overview of the application of KTP lasers in endoscopic sinus surgery and to give an account of the experience gained in the course of 24 operations. Laser‐assisted FESS was performed in 24 patients (13 on the right side and 11 on the left side). Sixteen men and eight women were treated for chronic maxillary sinusitis. Diagnostic criteria of chronic maxillary sinusitis included at least 3 months history of intermittent or persistent facial pain, intermittent or persistent fever, tenderness or headache over the areas of the maxillary, ethmoid or frontal sinuses, purulent discharge from nasal passages or nasopharynx, and radiographic evidence of opacification on CT scans. Traditional FESS surgery was performed on the one side and KTP laser‐assisted surgery on the other side. CT was performed in each case. The operations were carried out under local anaesthesia. The KTP laser was delivered via an optical fibre (0.6 mm) and was used for bone ablation, incision, vaporization and coagulation. Patient symptoms were recorded using a self‐administered questionnaire preoperatively, and postoperatively on weeks 1, 4, 12 and 24. Blood loss on the laser‐assisted operations' side was minimal. The improvement of the symptoms (pain, sensation of fullness, discharge) during weeks 1 and 4 proved to be significant (P < 0.05) in the case of both techniques. The cumulated average of the point scores on the laser‐assisted side was higher: especially postoperative week 1. Of the parameters assessed in the course of healing, oedema prevailed on the laser‐assisted side, while crusting was characteristic in the traditional operation site. We conclude that laser‐assisted FESS surgery is as effective as traditional endonasal sinus surgery. Its advantage is that it offers excellent haemostasis, as the use of ‘star pulse’ mode allows accurate bone work. No complications were observed. The disadvantage of the laser‐assisted procedure is that the instrument is expensive and it is time consuming.     

A prospective study of olfaction following endoscopic sinus surgery with adjuvant medical treatment

Few studies on the outcome of endoscopic sinus surgery have assessed the effect of this treatment on the sense of smell. We have collected data prospectively on 115 patients, before and 6 weeks after surgery. All patients had bilateral chronic rhinosinusitis. Visual analogue and a 4-grade, patient-rated symptom score related to olfaction was collected. Patients were also asked after surgery whether their sense of smell was normal, better, a little better, the same, a little worse or worse. Paired phenylethyl methyl ethyl carbinol olfactory detection thresholds were determined for 102 of the patients. All parameters showed a statistically significant improvement (P < 0.001). Acoustic rhinometry was performed pre- and postoperatively in 96 patients. The improvement in all olfactory symptom scores was found to correlate with the increase in nasal volume (Spearman rank correlation: visual analogue score, P < 0.005; 4-grade scale, P = 0.03; ‘better, same, worse’ scale, P = 0.001).     

Comparative analysis of the outcome of external and endoscopic frontal sinus surgery in children

Abstract

Background: Both open and functional endoscopic sinus surgery (FESS) are performed in the case of pediatric frontal rhinosinusitis. However, data from comparative analysis of these surgery types are insufficient.

Objective: Prospective randomized trial for comparison of open and endoscopic surgery outcome in pediatric chronic rhinosinusitis.

Material and methods: The cohort included 30 pediatric patients (7–17?years) with open frontal sinus surgery and 34 patients who underwent FESS using DrafIIa. Lund‐Kennedy and Lund-Mackay scores, as well as Sino-Nasal Outcome Test-20 (SNOT-20)questionnaire was used for pre- and postoperative assessment.

Results: Open surgery and FESS resulted in a significant improvement in total Lund‐Kennedy, Lund-Mackay, and SNOT-20 scores, being more profound in FESS group. Using FESS significantly reduced surgery duration by 15% as compared to open surgery. In addition, open surgery was associated with a higher rate of scar formation, reduced local sensitivity, as well as local soreness, lacrimation, and psychological discomfort. In regression models FESS was negatively associated with postoperative total Lund‐Kennedy, Lund-Mackay, and SNOT-20 scores.

Conclusion and significance: Generally, FESS resulted in better surgery outcome as compared to open surgery, although both approaches resulted in a significant improvement in chronic rhinosinusitis.     

Effect of functional endoscopic sinus surgery on bronchial asthma outcomes

BACKGROUND: For more than 70 years, the coexistence of asthma and paranasal rhinosinusitis has been noted in the medical literature. Causal relationships have been proposed but not proved. To date, limited evidence exists suggesting that asthma improves after surgical correction of rhinosinusitis. OBJECTIVE: To determine whether asthma control improved after first-time functional endoscopic sinus surgery (FESS). PATIENTS AND METHODS: A retrospective medical record analysis was performed on 13 patients with chronic bronchial asthma who underwent FESS for medically refractory chronic rhinosinusitis. Patients received comprehensive asthma care before and after FESS (mean, 19.3 and 33.1 months, respectively). Outcomes analyzed included pre- and post-FESS individual and group mean asthma symptom scores, medication use scores, pulmonary function test results, and emergency department visits or hospital admissions for asthma. Patient medical records were obtained from a private allergy-immunology practice affiliated with a medical school. The surgical procedure was performed at a tertiary care teaching hospital by a single ear, nose, and throat surgeon (R.L.). RESULTS: Following FESS, there was no statistically significant change in group mean asthma symptom scores, asthma medication use scores, pulmonary function test results, and the number of emergency department visits or hospital admissions. Only a few patients demonstrated statistically significant improvement after FESS in asthma symptom scores (1 patient), medication use scores (1 patient), or pulmonary function test results (2 patients). CONCLUSIONS: The data do not support the hypothesis that first-time FESS for medically refractory chronic rhinosinusitis in adult patients with chronic asthma leads to reduced postoperative asthma symptoms or asthma medication use or improved pulmonary function. Based on this limited study, a reexamination of the benefits of sinus surgery to coexisting asthma is in order.     

Comparison of endoscopic transcanal and microscopic approach in Type 1 tympanoplasty

IntroductionEndoscopic tympanoplasty is a minimally invasive surgery that may be performed via a solely transcanal approach. The use of endoscopes in otologic procedures has been increasing worldwide. The endoscopic approach facilitates the transcanal tympanoplasty, even in patients having the narrow external ear canal with an anterior wall protrusion.ObjectivesThe present study aimed to compare the surgical and audiological outcomes of endoscopic transcanal and conventional microscopic approach in Type 1 tympanoplasty.MethodsThe graft success rates, hearing outcomes, complications, and duration of surgery in patients who underwent endoscopic and microscopic tympanoplasty between October 2015 and April 2018 were retrospectively analysed.ResultsGraft success rates were 94.8 per cent and 92.9 per cent for the endoscopic and microscopic group, respectively (p > 0.05). Postoperative air-bone gap values were improved significantly in both groups (p < 0.001). The average duration of surgery was significantly shorter in the endoscopic group (mean 34.9 min) relative to the microscopic group (mean 52.7 min) (p < 0.05). The average hospitalization period was 5.2 h (range 3–6 h) in Group I whereas it was 26.1 h (range 18–36 h) in Group II (p < 0.05).ConclusionThe endoscopic transcanal tympanoplasty approach is a reasonable alternative to conventional microscopic tympanoplasty in the treatment of chronic otitis media, with comparable graft success rates and hearing outcomes.     

Benefit of combined endoscopic sinus surgery and aesthetic rhinoplasty

Introduction

Rhinoplasty is one of the most commonly performed aesthetic procedures today. Although nasal airway obstruction is frequently treated concomitantly with the aesthetic procedure, chronic sinusitis has typically postponed until full resolution of inflammatory symptoms.

Aim of the study

To investigate the feasibility of combining FESS with septorhinoplasty by measuring different outcomes including operative time, blood loss, post-operative edema of the upper and lower eyelids, periorbital ecchymosis, patient discomfort and complication rates.

Patients and methods

The study included 20 patients with deformed nose associated with chronic rhinosinusitis (CRS) not responding to medical treatment for at least 3 continuous months, irrespective to sex, of ages 20–60, and without any systemic diseases (study group), and 20 patients with deformed nose without any sinus problems (control group).

Results

There was no significant difference between the two groups in the different measured outcomes (P > 0.05) except for the operative time which was significantly less in the control group (P < 0.05).

Conclusion

Concurrent rhinoplasty and endoscopic sinus surgery may be performed safely and effectively with minimal risks. Proper patient selection and sound intraoperative judgment can avoid potential complications.     

Endoscopic outcomes of resorbable nasal packing after functional endoscopic sinus surgery: a multicenter prospective randomized controlled study

Nasal packings can aid in control of postoperative bleeding and healing following functional endoscopic sinus surgery (FESS), but traditional non-resorbable stents have several inherent drawbacks. We performed a randomized, controlled, multicenter clinical trial to assess efficacy of resorbable nasal packing in patients undergoing FESS for chronic rhinosinusitis. A total of 66 patients for 88 nasal cavities were randomized to receive either hyaluronan resorbable packing (MeroGel^®) or standard non-resorbable nasal dressing after FESS. All underwent preoperative rhinoscopy, CT of sinuses, and, after surgery, were reassessed by rhinoscopy at 2, 4, and 12 weeks in blinded fashion. A total of 44 nasal cavities (MeroGel^®-group) received resorbable packing, whereas the remaining 44 were packed with non-resorbable nasal dressing. At follow-up endoscopic visit, the presence of nasal synechia was evaluated as primary outcome. Moreover, the tolerability and surgical handling properties of MeroGel^® and its comfort were assessed by surgeons and patients. Preoperative severity of rhinosinusitis was similar in both groups. No significant adverse events were observed in all patients. Follow-up endoscopy showed a lower proportion of nasal adhesions in MeroGel^®-group at both 4 (P = 0.041) and 12 weeks (P < 0.001). Moreover, an improvement of other endoscopic nasal findings such as re-epithelialization, presence of granulation tissue, and appearance of nasal mucosa of nasal cavities after FESS was observed in the MeroGel^®-group. Tolerability and surgical handling properties of MeroGel^® were positively rated by clinicians and the overall patient judged comfort of MeroGel^® was favorable. In conclusion, MeroGel^® can be considered a valid alternative to standard non-resorbable nasal dressings. It is safe, well-accepted, well-tolerated, and has significant advantage of being resorbable. Moreover, it may favor improved healing in patients undergoing FESS and reduce formation of adhesions.     

Partial middle turbinectomy during endoscopic sinus surgery for extended sinonasal polyposis: short- and mid-term outcomes

Conclusions. The 23 patients with extensive sinonasal polyposis who had undergone partial resection of the middle turbinate during functional endoscopic sinus surgery (FESS) showed no differences in nasal airway resistance and in postoperative complication rate (1-year follow-up period) in comparison with the 25 patients who had FESS with middle turbinate preservation. Objective. The aim of the study was to investigate the outcomes of partial middle turbinectomy during FESS in patients with sinonasal polyposis. Patients and methods. A retrospective analysis of 48 consecutive patients who had undergone surgery for extended sinonasal polyposis was performed. Twenty-three patients underwent FESS with middle turbinate head resection; 25 patients underwent FESS with preservation of middle turbinate. We endoscopically scored polyposis extension and evaluated nasal airflow resistance (NAR) preoperatively and postoperatively. Results. We found an improvement of endoscopic score (high to low grade of polyposis extension) and a statistically significant reduction of NAR after both surgical techniques. There was no statistically significant difference in the mean NAR values before and after the two techniques.     

Effect of the F508del genotype on outcomes of endoscopic sinus surgery in children with cystic fibrosis

Objective

Numerous authors have sought to describe genotype–phenotype correlations in cystic fibrosis (CF), notably to pancreatic insufficiency and lung disease. However, few studies have focused on the association between the F508del genotype and response to sinus surgery. The objective of this study is to assess the effect of the F508del genotype on sinonasal disease severity and outcomes following functional endoscopic sinus surgery (FESS) in a pediatric population.

Methods

A retrospective chart review of 153 children with CF seen at a tertiary care pediatric hospital from 1995 to 2008 was performed. Patients were classified into one of three groups according to F508del genotype, either as homozygous, heterozygous or not carrying a F508del mutation. The sinonasal disease phenotype of the three groups was compared based on clinical and radiological findings, extent of endoscopic sinus surgery and rate of revision surgery.

Results

The relationship between the F508del genotype and pancreatic insufficiency was confirmed (p < 0.05). There was no association between the F508del genotype and increased need for FESS (p = 0.75). Moreover, no association was established between F508del homozygosity and presence of nasal polyps, Lund–Mackay score, extent of surgery or length of postoperative hospitalization. The rates of revision surgery did not differ significantly among the three genotypes analyzed (p = 0.59).

Conclusion

There is no clear association between the F508del genotype and an increased need for FESS, extent of surgery, or revision surgery. Given the phenotypic variability of sinonasal disease in patients with CF, a prospective study is needed to better understand outcomes following FESS and the contribution of gene modifiers to this effect.     

Efficacy of posterior nasal neurectomy for allergic rhinitis combined with chronic rhinosinusitis with nasal polyps

Abstract

Background: Allergic rhinitis combined with chronic rhinosinusitis with nasal polyps (ARwCRSwNP) is very common clinically. Conventionally, the treatment for these patients is surgical method for CRSwNP followed by treatment with a nasal steroid spray or other antiallergic drugs to control AR. In recent years, some rhinologists introduced vidian neurectomy (VN) or posterior nasal neurectomy (PNN) into endoscopy to treat refractory AR and reported an encouraging outcome. Furthermore, we explore the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP.

Objective: To investigate the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP.

Methods: Eighty-five patients with ARwCRSwNP who were admitted to our hospital from November 2016 to July 2018 were enrolled in two groups. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN; group B underwent conventional FESS alone. VAS, RQLQ, SNOT-22 and postoperative nasal endoscopy were used to evaluate the improvement in symptoms and the recurrence of nasal polyps.

Results: The experimental group had better control of sneezing (p?<?.05) and rhinorrhea (p?<?.01) than the control group. For those who underwent surgery more than 6 months prior in both groups, the recurrence rate was 29.6% (8/27) in the experimental group and 44.4% (8/18) in the control group, and there was no significant difference (χ² = .483, p?=?.487).

Conclusion: FESS combined with PNN can improve the symptoms of sneezing and rhinorrhea caused by ARwCRSwNP more obviously than FESS alone, but there is no clear statistical advantage of this procedure for improving the overall symptoms and controlling the recurrence of nasal polyps.     

Revision functional endoscopic sinus surgery

Functional endoscopic sinus surgery (FESS) has recently become a popular procedure for treating chronic sinusitis. However, there is a 2% to 24% rate of primary FESS failure. Revision functional endoscopic sinus surgery (RESS) is indicated for patients who remain symptomatic after primary FESS and optimal medical therapy have failed. A retrospective study was conducted on all patients who underwent RESS in our department between April 1988 and March 1998. During this period, FESS was performed 1,227 times to treat chronic sinusitis; among those procedures, 142 were RESS. Complications occurred in 14 RESS procedures (9.9%). After RESS, 65% patients had improved. In this study, we concluded that although RESS is more difficult than primary FESS because of distorted or missing anatomic landmarks, complications did not increase with RESS if meticulous surgical procedures were performed. However, the 65% improvement rate with RESS was lower than that of primary FESS.