Effect of endoscopic sinus surgery on irradiation‐induced rhinosinusitis in patients with nasopharyngeal carcinoma

Abstract

Endoscopic sinus surgery is an effective treatment for irradiation-induced rhinosinusitis in NPC patients, improving ventilation and drainage of the paranasal sinuses, and facilitating regeneration of the sinus mucosa.

Endoscopic sinus surgery for chronic rhinosinusitis in patients previously treated for sinonasal malignancy

“…Specifics of the surgery, including complications and patient-reported symptom outcomes, were not detailed, but the study results suggest that ESS might actually help restore normal mucociliary clearance in radiation-affected mucosa. 60 Complications from ESS for the average nonirradiated CRS patient are rare, with an incidence of major complications reported to be between 0.4% and 3%, although these rates appear to be decreasing with time. 35,37,61,62 It has been noted that the incidence of complications after ESS is increased in patients with more significant sinus disease, marked by more severe polyposis and higher Lund-Mackay scores.…”

“…However, nasal symptoms remained in six of the seven patients who noted improvement . Hu et al similarly described the utility of ESS in 21 patients with postradiation CRS who completed treatment for NPC . Scanning electron microscopy of maxillary sinus mucosa was performed at the time of the original surgery and 1 year after ESS.…”

“…Saccharin transit time was also measured and was noted to be significantly decreased in the postoperative group. Specifics of the surgery, including complications and patient‐reported symptom outcomes, were not detailed, but the study results suggest that ESS might actually help restore normal mucociliary clearance in radiation‐affected mucosa …”

“…28 Hu et al similarly described the utility of ESS in 21 patients with postradiation CRS who completed treatment for NPC. 60 Scanning electron microscopy of maxillary sinus mucosa was performed at the time of the original surgery and 1 year after ESS. The ciliary area, calculated as the fraction of mucosa that was ciliated, showed statistically significant improvement after surgical intervention.…”

Distinct histopathologic features of radiation‐induced chronic sinusitis

“…Hu et al examined intra‐ and postoperative goblet cells, submucosal gland openings, ciliary area, and saccharin transit times in a group of 21 nasopharyngeal carcinoma patients with radiation‐induced rhinosinusitis who underwent sinus surgery. Baseline histologic changes included increased submucosal gland openings, decreased ciliary area, and increased saccharin transit times, all of which improved after FESS . In this study we build upon the findings of Gray et al by including additional histopathology variables and comparing CRSr to cohorts of patients with CRSsNP and CRSwNP to better understand the pathophysiologic mechanisms uniquely inherent in CRSr.…”