Chronic rhinosinusitis, Endoscopic sinus surgery, Outcomes, Quality of life
DOI: 10.5005/jp-journals-10013-1333 |
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Kurien R, Sunny E, Rupa V. Impact of Functional Endoscopic Sinus Surgery on Patients with Chronic Rhinosinusitis: A Prospective, Cohort Study among Indian Patients. Clin Rhinol An Int J 2018; 11 (1):1-6.
Aim: To study subjective and objective outcomes following functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis (CRS).
Materials and methods: We prospectively followed up 140 CRS patients after FESS for 6 months to 2 years. Demographic data was collected. Using the Lund–Kennedy endoscopic score (LKES) and the sinonasal outcome test (SNOT-22) score, we assessed the postoperative outcome.
Results: Patients with CRS with polyps (CRSwNP) were more likely to be asthmatic (p = 0.01) and have allergic rhinitis (p = 0.02). CRSwNP patients had higher LKES than those without polyps (CRSsNP) (p = 0.001). Postoperative improvement in LKES was significantly greater in CRSwNP patients (p < 0.001). Preoperative SNOT-22 scores were high in both groups, and postoperative scores showed significant improvement (p < 0.001). Patients who had revision surgery had a similar baseline and postoperative LKES and SNOT-22 scores to those who underwent primary surgery.
Conclusion: FESS improves both endoscopic and quality of life outcomes for patients with CRS with and without polyps.
Clinical significance: Our study highlights the improvement both in the overall quality of life and in each of the subdomains in patients with CRS after FESS especially in the Indian population. It is important to correlate the objective and subjective outcomes with standardized instruments postoperatively. This will help in monitoring the disease and aid in postoperative management
Aim: The advances in endoscopic sinus surgery have made it the procedure of choice for treatment of cerebrospinal fluid (CSF) rhinorrhea. The objective of this study was to study the etiological factors, the outcome of transnasal endoscopic repair, and limitations of the technique.
Materials and methods: Thirty-two cases of CSF rhinorrhea were evaluated. Patients underwent thorough clinicoradiological evaluation followed by transnasal endoscopic repair. Patients were followed up at monthly intervals.
Results: Out of 32 cases, 14 were due to the head injury, 12 were spontaneous, two were iatrogenic, two congenital defects, one was a case of tubercular osteomyelitis and one was idiopathic. CSF leak was successfully plugged in 29 patients. In one patient, the procedure had to be converted to an extracranial external approach. Two patients underwent successful revision endoscopic procedure. One patient was lost to follow-up.
Conclusion: Head injury remains the leading cause of CSF rhinorrhea. The spontaneous leak patients represent a distinct clinical group with a characteristic patient profile, clinical features, and radiology. The results of endoscopic repair are excellent, especially in nonspontaneous cases. We recommend it as the optimum surgical approach for both primary and revisional surgical management of CSF rhinorrhea.
Aims: Recurrent stenosis and closure of neostium are considered a major factor for surgical failure in endoscopic dacryocystitis (endo-OCR). The main objective of this study is to evaluate the role of silicon stent in maintaining the patency of neostium and compare it with the conventional mucosal flap technique.
Materials and methods: Endodacryocystorhinostomy (DCR) were done in 60 eyes. In 30 eyes only mucosal flap was created and in other 30 silicon stent tubes were used. All patients were taken under general anesthesia.
Results: In our study, 90% success in syringing patency was seen in the group with mucosal flap only and 100% success was seen in silicon stenting at 6 months of follow-up.
Conclusion: Significant difference in endo-DCR success rates were seen with the use of stenting in our study especially in revision cases.
Clinical significance: It is really important to provide success in revision cases of DCR surgery, and silicone stenting helps to obtain that according to our study.
Effect of deviated nasal septum and after its correction on nasal mucociliary clearance (NMC) values which was measured preoperatively and postoperatively using Anderson's method, was observed. Mucociliary clearance time in 20 patients suffering from deviated nasal septum was studied preoperatively and 2 months postoperatively. In the preoperative period, NMC values were significantly higher than the values measured after septoplasty. The NMC values of the control group and the NMC values of patients after septoplasty were not found different significantly. This study shows that deviated nasal septum affects NMC values which improve after septoplasty.
Aim: Inflammatory myofibroblastic pseudotumor (IMT), part of the inflammatory pseudotumor (IPT) family, shares many presenting features with more common expansile sinonasal masses and is unlikely to be diagnosed without clinical suspicion.
Background: Inflammatory myofibroblastic pseudotumor (IMT) is histologically characterized by myofibroblasts with prominent small lymphocytes and plasma cells, often initially mistaken for other inflammatory processes. These lesions share characteristics of pseudotumors and neoplasms with possible malignant potential.
Case description: We present the case of a 57-year-old woman who was eventually properly diagnosed with IMT. She initially presented with several month histories of severe right-sided headache, facial pain, blurry vision, and right lid ptosis. The patient was diagnosed with invasive fungal sinusitis by another provider but proved nonresponsive to intravenous antifungal therapy. Repeat biopsy revealed an inflammatory process consistent with IMT. The lesion was rapidly responsive to intravenous steroid therapy.
Conclusion: A destructive sinonasal mass necessitates a wide differential diagnosis that should include IPT. Both medical and multimodal treatment strategies have proven highly efficacious with a high cure rate and a higher rate of tumor stabilization.
Clinical significance: IMT is an example of a commonly misdiagnosed pathology even with permanent section analysis by several pathologists. Early identification of this condition can lead to better treatment with medical therapeutic options and minimize unnecessary interventions.
Introduction: Angiomatous antrochoanal nasal polyp (AAP) is a rare and distinct variant of a sinonasal polyp, which mimics as a sinonasal malignancy or juvenile nasopharyngeal angiofibroma or a simple antrochoanal polyp owing its property of eroding the bone and causing epistaxis. It is constituting 4–5% of all nasal polyps
Typically, there is extensive vascular proliferation and ectasia with deposition of pseudoamyloid and presence of atypical stromal cells. The extensive reparative and reactive changes are the results of this pseudoneoplastic entity of these polyps. The lesion can often present late, therefore causing both diagnostic and management difficulties. AAP has tendency bleeding and eroding bone. Such rare cases are presented here with a review of the literature about its features and management.
Case report: We describe two cases of angiomatous antrochoanal polyp (AAP) which is a rare variant of sinochoanal polyp. Cases presented with complain of recurrent unilateral epistaxis and nasal obstruction. CT findings revealed erosion of bony walls. The mass in the nasal cavity was reddish pink in color. Endoscopic sinus surgery was performed and a final diagnosis of the angiomatous antrochoanal polyp was made based on the histopathology report.
Management: Complete resection was performed through an endoscopic medial maxillectomy approach while open lateral rhinotomy approach was kept a reserve in case the tumor is not dealt completely via an endoscopic approach. A preoperartive biopsy was taken which was reported as an inflammatory polyp but the surgical specimen was reported as an AAP.
Discussion and conclusion: Very few studies are available on this topic and hence we find little material in the textbook. Being a rare pathological entity, ANP can cause a significant diagnostic dilemma. Clinical, radiological and pathological data are usually complimentary and together provide a definitive diagnosis. The awareness of the existence of such tumors should always be there. Differential diagnosis includes antrochoanal polyp, juvenile angiofibroma, malignancy, papilloma, and hemangioma.
This case report discusses a case of mutilating injury of the tip nose caused by a softshell turtle bite. The patient was an aborigine who earned a living by catching and selling softshell turtles (Dogania subplana). He was bitten by one while trying to catch it. This case depicts the nature of this softshell turtle, the injuries it can cause, and the procedures for the reconstruction of the patient's nose. Softshell turtle bites have practically never been reported. However, softshell turtle bites on the nose, as with typical animal-inflicted injuries to the same area, can be treated using the same principles of managing a possibly-contaminated nasal wound.