The eosinophil density of nasal polyps can be used to get an estimate of the postoperative recurrence risk. Eosinophil-rich nasal polyps have a higher postoperative recurrence rate.
Assuming an adequate repair, other factors such as the cause, the size of the defect, the technique and material used to repair the defect, and perioperative management do not affect the surgical outcome significantly. Untreated high-pressure hydrocephalus can lead to a recurrence or persistence of the leaks and should be suspected in patients with posttraumatic, idiopathic, or recurrent CSF leaks.
Endoscopic sinus surgery with polypectomy significantly improves sleep quality, including snoring and daytime sleepiness in patients with chronic nasal obstruction due to nasal polyposis. However, it has a limited benefit on apnea-hypopnea index scores.
Headache due to the pressure on nasal mucosa of anatomical variations, nasal polyps, or mucosal swelling in the absence of inflammation of the paranasal sinuses is a clinical entity that has gained wide acceptance. In this paper, the outcomes of surgical treatment in 30 patients whose headaches were believed to be the result of intranasal contact points are presented. Total relief of the headache and significant improvement were achieved in 43% and 47% of the patients, respectively, after endoscopic endonasal surgery. The intensity of the headache was the same as preoperatively in 10% of the patients. In the absence of any other identifiable etiological factors, intranasal mucosal contacts must be kept in mind as a cause of the headache.
Transnasal endoscopic approach for the repair of choanal atresia (CA) has gained favor in recent years. However, the studied cohorts are too small to make a comprehensive comment on this approach. The aim of this study was to evaluate the effects of different techniques, used for the removal of CA under endoscopic guidance, on surgical outcome and effectiveness of transnasal endoscopic approach in these patients as a whole. We present the results of transnasal endoscopic repair of CA in 13 patients and made a meta-analysis of similar studies in the literature. Mean success rate with transnasal endoscopic repair was 85.3% in a total of 238 cases in 20 studies that met the inclusion criteria. Only the history of previous surgery for CA seemed to significantly decrease the postoperative success rate (P = 0.029). Rate of revision surgery did not significantly differ between mixed, bony, or membranous atresia (P = 0.395). Likewise, simple perforation or complete excision of the atretic plate under endoscopic view (P = 0.513), use or no use of mucosal flap to seal the denuded bone of the choana (P = 0.472), and postoperative stenting or no stenting (P = 0.252) have proved not to considerably have influence on the surgical outcome. Death of perioperative bleeding was the single major complication in 1 case among all of the study groups. In conclusion, types of CA, excision method, and stenting have no significant effect on surgical outcome of CA. Irrespective of the technique used for the excision and the repair of atretic plate, transnasal endoscopic approach with higher success rate and minimal postoperative morbidity is a good choice for the repair of CA.
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