* In patients undergoing endoscopic sinus surgery for chronic rhinosinusitis, there is a lack of a universally accepted system for the evaluation of outcome. * This makes critical comparison between results less meaningful. * To determine the most suitable sinonasal outcome scoring system for use in our own practice, we reviewed the available literature and known systems in existence. * We analysed 15 known disease-specific sinonasal outcome indices with emphasis on reliability, validity and responsiveness. * We concluded by choosing one quality of life outcome tool for our departmental use, the Sinonasal Outcome Test-22, due to its reliability, validity, responsiveness and ease of use. * It has been validated to distinguish between disease-affected patient groups and those without rhinosinusitis, demonstrate a worse score if the condition gets worse and show an appropriateness of items and scales in the questionnaire. This has been demonstrated in 3128 British patients.

Conventional methods of arterial ligation in persistent epistaxis often involve significant surgical morbidity, as well as failure due to arterial anastomosis.We have performed endoscopic intranasal end ligation or diathermy of 11 sphenopalatine arteries in 10 patients with no complications and with no further episodes of epistaxis, with an average follow-up period of nine months.

The endonasal endoscopic approach to the paranasal sinuses is no longer exclusively practised by a small number of dedicated super-specialists and has gained widespread acceptance in the UK. We have audited the practice of the Consultant members of the BAO-HNS via a confidential postal questionnaire with regards to the consent of their patients prior to surgery, and to the complications they have experienced. The overall rate of complications following endoscopic sinus surgery (ESS) was 0.69%, with the incidence of major complications 0.25% and of minor complications 0.44%. Wide variations in the practice of informed consent were found to exist, and this is discussed with reference to a suggested template for preoperative discussion with the patient.

We have prospectively analysed the outcome of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in relation to the Lund and Mackay system of scoring the preoperative computerized tomography scan for extent of disease, and also investigated the possible links of outcome to the presence or absence of systemic respiratory tract conditions which may relate to the pathogenesis of chronic rhinosinusitis. Statistical analysis of the data by chi 2 test, unpaired t-test and logistic regression analysis has shown significant correlation between outcome at 2 years and preoperative computerized tomography scan score, but that the most statistically significant factor determining the success or failure of surgery is the presence of a systemic disease known to predispose to chronic rhinosinusitis.