Although much has been reported on the short-term outcomes of functional endoscopic sinus surgery (FESS), little has been reported with regard to its long-term impact on chronic sinusitis. The senior author (D.W.K.) previously reported detailed subjective and endoscopic follow-up on 120 patients at a mean of 18 months following surgery. This current study represents a long-term follow-up (average, 7.8 years) of 72 patients (60%) from the same cohort. Of patients responding to a question about overall symptoms, 98.4% (n = 66) reported improvement compared with before surgery. There was a trend toward continued subjective improvement in symptom scores with longer follow-up, but the changes did not reach statistical significance. Thirteen patients (18%) required subsequent surgical procedures. Preoperative stage, prior surgery, and other factors that might affect outcome were evaluated. The study demonstrates that excellent subjective results following FESS can be maintained in the long term with appropriate postoperative management. The study also validates the concept that patients in whom the cavity can be normalized following surgery are unlikely to require further surgery.

Using objective and subjective criteria, we performed a study to assess the long-term impact of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis and asthma at an average follow-up of 6.5 years. One hundred twenty patients who underwent FESS for chronic rhinosinusitis were followed up for an average of 6.5 years (range 6.0 to 10.6 years). Seventy-two (60%) patients responded to a follow-up questionnaire, and 30 (42%) of them reported a history of asthma. Subjective levels of improvement and assessments of medication need were evaluated and statistically assessed with parametric and nonparametric methods. Of these 30 patients, 27 (90%) reported that their asthma was better than it had been before FESS, 6.5 years ago. Average reported improvement increased from 49% at 1.1 years after surgery to 65% at 6.5 years after surgery. Asthma attacks declined in 20 of 27 (74.1%). Medication use for asthma showed similar improvement, with approximately half reporting less inhaler usage and nearly two thirds reporting less oral steroid use. This study demonstrates that a combination of FESS, careful postoperative care, and appropriate medical therapy for chronic rhinosinusitis has a favorable long-term effect on asthma in patients with symptomatic chronic sinusitis. In this study asthma severity, frequency of attacks, and medication need were all improved.

No abstract

A better understanding of the pathogenesis of chronic sinus disease has led to an increased performance of endonasal sphenoethmoid surgery. Approaching the sphenoid sinus via this route mandates that the surgeon be aware of the anomalies which may be encountered in this region, if injury to the related neurovascular structures is to be avoided. This study was therefore undertaken to evaluate a critical anatomic variation, the incidence of bony dehiscence over the carotid artery. Following cadaver sphenoethmoidectomy, the lateral wall of the sphenoid sinus was examined endoscopically and gently palpated in 188 sphenoid sinuses. An apparent dehiscence of bone was found over the carotid artery in 41 sinuses (22%), a significantly higher incidence than reported in other studies. In 3 specimens the carotid artery was exposed in the posterior ethmoid sinus. The study highlights the importance of considering this anatomic variation and of careful evaluation of the patient's computed tomographic scan, before this kind of surgery is attempted. Management of injury to the internal carotid artery in this area is also discussed.

No abstract

Twenty patients with recurrent nasal polyposis but without any history of aspirin sensitivity were given 2000 micrograms of intranasal lysine aspirin to one nostril and saline to the other once a week for periods of up to 15 months. Two patients had increased nasal obstruction following the initial test doses of lysine aspirin and were excluded from the trial proper. In the remainder symptomatic polyp recurrence was delayed compared with the previous experience while on intranasal steroids, with eight patients remaining symptom free at 15 months compared with an expected number of three (P = < 0.05, chi 2 test). Polyp recurrence was bilateral but there was a tendency for the lysine aspirin treated side to have less polyp tissue as assessed by nasendoscopy and by acoustic rhinometry.

The objective of our study was to investigate: the expression of vascular cell adhesion molecule-1 (VCAM-1) in diffuse sino-nasal polyps; the relation between VCAM-1 and selective eosinophilia in diffuse sino-nasal polyps; the effect of eosinophilia and VCAM-1 expression on recurrence of diffuse sino-nasal polyps following treatment. Fifty patients with diffuse sino-nasal polyps were included in the study. Biopsies were taken from the polyps and the inferior turbinate mucosa of each patient and were studied by immunohistochemical staining for detection of VCAM-1 expression on the blood vessels, as well as by hematoxylin and eosin (H&E) staining for detection of eosinophils. The percentage of blood vessels expressing VCAM-1 and the number of eosinophils in the polyps were detected and correlated and then compared to the corresponding numbers in the inferior turbinates. All patients were treated by endoscopic ethmoidectomies followed by local steroids for 1 year. Recurrence of polyps was monitored during the post-operative follow-up period. The quantitative expression of VCAM-1 and number of infiltrating eosinophils were compared in patients who developed recurrent polyps and those who did not. VCAM-1 was expressed in the polyps but not significantly higher than in the inferior turbinates of the patients or the controls. Eosinophils were significantly higher in the polyps compared to the inferior turbinates. No correlation was found between the expression of the VCAM-1 and the number of eosinophils. VCAM-1 expression was significantly higher in patients developing recurrent polyps. No significant difference was found in the number of infiltrating eosinophils between patients developing and those not developing recurrent polyps. VCAM-1 is expressed in polyps but not significantly higher than its expression in the inferior turbinate mucosa. VCAM-1 expression in diffuse sino-nasal polyps cannot on its own explain the selective eosinophilia detected in this disease. High VCAM-1 expression in diffuse sino-nasal polyps may be an indicator of a higher probability of polyps recurrence. Degree of eosinophilic infiltration cannot be taken as such an indicator.

No abstract