Surgical management of chronic rhinosinusitis and nasal polyposis: A review of the evidence
Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, University of Pennsylvania, 3400 Spruce Street, 5 Ravdin, Philadelphia, PA, 19104, USA. Current Allergy and Asthma Reports
(Impact Factor: 2.77).
12/2004; 4(6):486-9. DOI: 10.1007/s11882-004-0016-2
Functional endoscopic sinus surgery is a common adjunct to medical therapy in the management of chronic rhinosinusitis and nasal polyposis. As with most surgical procedures, there is a paucity of randomized, controlled clinical trials examining the use of functional endoscopic sinus surgery in the management of chronic rhinosinusitis and nasal polyposis. This is primarily a result of the physical and ethical conundrums faced in performing a study that involves comparing a surgical procedure with a placebo. However, there is documentation of the marked impact that chronic rhinosinusitis can have on the overall quality of life and evidence that this improves following combined surgical and medical intervention. There are many case series with large patient populations that have shown significant improvement in short- and long-term patient symptoms following surgery. These outcomes are expected to improve with even greater refinement of technology, experience, and instrumentation, and the quality of future studies may be improved by determining and using objective measures of success and, possibly, by the use of control groups.
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- "Short-and long-term investigations worked on FESS results, elucidated development in sinus symptoms and reduced recurrent infections (Kennedy 1992; Senior and Kennedy 1998). Endoscopic sinus surgery has been established as a safe method and complications prevalence is indicated to be less than 1% (Chiu and Kennedy 2004). Numbers of complications include blindness, intracranial injury, orbital hematoma, stroke and cerebrospinal fluid leak (Luong and Bradley, 2006). "
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- "Postoperatively the majority of the patients experience significant reduction of headache, nasal obstruction, post nasal drip and are improved in Quality of Life scores (Damm et al 2002; Chiu et al 2004; Iro et al 2004). In patients with asthma, FESS improves peak expiratory flow and reduces the use of inhaled and systemic glucocorticosteroids (Dhong et al 2001; Palmer et al 2001; Dunlop et al 1999; Goldstein et al 1999; Ikeda et al 1999; Senior et al 1999). "
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ABSTRACT: Chronic rhinosinusitis (CRS) is a group of multifactorial diseases characterized by inflammation of the mucosa of the nose and paranasal sinuses with a history of at least 12 weeks of persistent symptoms despite maximal medical therapy. The precise role played by infection and immunoglobin E (IgE)-mediated hypersensitivity remains unclear. Diagnosis of CRS is based upon medical history, nasal endoscopy and computed tomography scan of the sinuses. The CRS with polyps visible in the middle meatus must be distinguished from the CRS without polyps. Based on the current knowledge about the pathogenesis of CRS, it is admitted that an optimal medical treatment must consider all favorizing factors and control efficaciously the inflammation process. In case of failure of medical treatment, endoscopic sinus surgery should be proposed. However, some well-validated data and scientific evidences are missing, even for the most frequently used medications. After a review of the actual definitions and classifications, a short description of the current knowledge about pathogenesis of CRS is provided in order to justify the actual therapeutic rationales and identify the needs for an effective treatment of CRS.
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ABSTRACT: Functional endoscopic sinus surgery (FESS) is a recent addition to the treatment armmentarium of sinus disease. Performed through the nasal cavity using endoscopes and inciting no external scars, these advantages have renewed an interest in the surgical intervention of various sinus diseases. With minimal risk and complications associated with FESS, the temptation exists to lower the threshold and expand the indications for sinus surgery. However, regardless of the reduced risk, FESS should be pursued only when the goals are attainable and the limitations of surgery are understood for each specific disease.
Chronic rhinosinusitis (CRS), affecting more than 31 million people a year, represents a treatment challenge. The challenge stems from evidence that CRS can result from different etiologies including bacteria, virus, fungi, superantigens, and unfavorable anatomy. With an unclear pathogenesis, success of medical therapy is often limited. Individuals failing medical therapy are candidates for surgical intervention. The controversy, indications, and goals of surgery in CRS are reviewed.
Other indications for FESS are less controversial. Nasal polyps, which can interfere with medical therapy and obstruct airflow, often require surgical intervention. In addition, recent data has suggested a link between surgery and a reduction in inflammatory markers. Repair of skull base defects, and resection of benign and limited malignant nasal masses are also indications for FESS.
This article reviews the indications of sinus surgery. In addition, it addresses some of the controversies, limitations, and advances in FESS.
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