Objective and Subjective Evaluation of Endoscopic Nasal Surgery Outcomes

Giger, Roland; Landis, Basile Nicolas; Zheng, Chenguang; Malis, Didier-David; Ricchetti, Alma; Kurt, Anne-Marie; Morel, Denis R.; Lacroix, Jean‐Silvain

doi:10.1177/194589240301700603

Cited by 14 publications

(14 citation statements)

References 26 publications

(4 reference statements)

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“…Subjective perception of nasal obstruction is one of the hallmark symptoms that drives patients to seek treatment, while relief of the perceived obstruction is crucial to a patient's evaluation of a successful therapeutic outcome [31,32]. However, there is controversy over whether the total nasal airflow measured by techniques such as rhinomanometry are well correlated with subjective nasal patency [33,34], and whether such measurements have any clinical value [35].…”

Section: Airflow Modeling: Implications For Clinical Outcomesmentioning

confidence: 99%

The way the wind blows: Implications of modeling nasal airflow

Zhao¹,

Dalton

2007

Curr Allergy Asthma Rep

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Nasal airflow is important for the many physiological functions of the nose, which include the warming and humidifying of inspired air; the filtration of airborne pollutants; and the sense of smell and nasal pungency. Until recently, airflow properties in the nose could only be understood using qualitative in vitro models of humans or in vivo studies in rodents. Recent advances in constructing three-dimensional geometric models of human nasal passages from CT scans, coupled with computational fluid dynamic modeling, has been a valuable tool for quantifying airflow and transport of gases, heat, particles, and aerosols in the human nose. Additionally, these techniques hold significant promise for evaluating and predicting the impact and successful remediation of a variety of clinical conditions on olfaction and nasal patency and setting guidelines for safe levels of exposure to inhaled materials.

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Section: Airflow Modeling: Implications For Clinical Outcomesmentioning

confidence: 99%

The way the wind blows: Implications of modeling nasal airflow

Zhao¹,

Dalton

2007

Curr Allergy Asthma Rep

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“…Nasal turbinates are believed to play a critical role in determining laminar airflow, efficient mixing of air for air conditioning, and nasal resistance (LaMear, Davis, Templer, McKinsey, and Del, 1992;Weinhold and Mlynski, 2004;Lindemann, Brambs, Keck, Wiesmiller, Rettinger, and Pless, 2005;Kelly, Prasad, and Wexler, 2000). Nasal obstruction often accompanies CRS, and the improvement of this symptom is crucial to a patient's perception of a successful therapeutic outcome (Damm, Quante, Jungehuelsing, and Stennert, 2002;Giger, Landis, Zheng, Malis, Ricchetti, Kurt, Morel, and Lacroix, 2003;Bhattacharyya, 2004a;Bhattacharyya, 2004b). Concerns about altering airflow and nasal resistance from middle turbinectomy has led some surgeons to preserve this structure, for fear of developing postoperative crusting and bleeding (Bhattacharyya, 2004a;LaMear, Davis, Templer, McKinsey, and Del, 1992;Cook, Begegni, Bryant, and Davis, 1995) or even paradoxical nasal obstruction.…”

Section: Introductionmentioning

confidence: 99%

Computational Fluid Dynamics as Surgical Planning Tool: A Pilot Study on Middle Turbinate Resection

Zhao

Malhotra

Rosen

et al. 2014

The Anatomical Record

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Controversies exist regarding the resection or preservation of the middle turbinate (MT) during functional endoscopic sinus surgery (FESS). Any MT resection will perturb nasal airflow and may affect the mucociliary dynamics of the osteomeatal complex. Neither rhinometry nor computed tomography (CT) can adequately quantify nasal airflow pattern changes following surgery. This study explores the feasibility of assessing changes in nasal airflow dynamics following partial MT resection using computational fluid dynamics (CFD) techniques. We retrospectively converted the pre- and post-operative CT scans of a patient who underwent isolated partial MT concha bullosa resection into anatomically accurate three-dimensional numerical nasal models. Pre- and post-surgery nasal airflow simulations showed that the partial MT resection resulted in a shift of regional airflow towards the area of MT removal with a resultant decreased airflow velocity, decreased wall shear stress and increased local air pressure. However, the resection did not strongly affect the overall nasal airflow patterns, flow distributions in other areas of the nose, or the odorant uptake rate to the olfactory cleft mucosa. Morever, CFD predicted the patient's failure to perceive an improvement in his unilateral nasal obstruction following surgery. Accordingly, CFD techniques can be used to predict changes in nasal airflow dynamics following partial MT resection. However, the functional implications of this analysis await further clinical studies. Nevertheless, such techniques may potentially provide a quantitative evaluation of surgical effectiveness and may prove useful in preoperatively modeling the effects of surgical interventions.

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“…There is evidence that a patients’ subjective symptomatic experience correlates with improved HRQOL following sinus surgery 1,2. However, a patients’ symptomatic experience has been shown, at best, to be weakly associated with objective findings such as computed tomography (CT) results 3,4.…”

Section: Introductionmentioning

confidence: 99%

Correlations Between Endoscopy Score and Quality of Life Changes After Sinus Surgery

Mace¹,

Michael²,

Carlson³

et al. 2010

Arch Otolaryngol Head Neck Surg

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Objective To assess whether change in endoscopy score correlates with change in health-related quality of life (HRQOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Setting Tertiary rhinology clinic Patients One hundred two adult patients, with and without nasal polyposis, who elected to undergo ESS and were followed for 12 ± 2 months postoperatively. Intervention Patient characteristics and Lund-Mackay computed tomography scores were recorded preoperatively. Lund-Kennedy endoscopy scores and 2 HRQoL surveys, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were examined before and after surgery. Main Outcome Measures Postoperative changes in endoscopy score and HRQOL were examined using bivariate and multivariate analyses. Results Statistically significant improvements were found in endoscopy score (p<0.001) and for all total and subscale HRQoL measures (p<0.001). After controlling for baseline status and comorbid factors, improvement in endoscopy score significantly correlated with 12 month improvement on the total RSDI (p=0.01), the physical (p=0.01) and functional (p=0.02) subscales of the RSDI, and the symptom subscale of the CSS (p=0.003), but could explain only 25.5–36.6% of the linear variation for these HRQOL improvements. Conclusions For most patients, endoscopy scores and disease specific HRQOL significantly improved after endoscopic sinus surgery. Changes in endoscopy scores explain a portion of the improvement in HRQOL. For patients with CRS, improvements in disease specific HRQoL outcomes are complex, multidimensional constructs that cannot be entirely explained by surgical changes measured by endoscopic examination.

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Objective and Subjective Evaluation of Endoscopic Nasal Surgery Outcomes

Abstract: The degree of inflammation seems to be a good prognostic indicator regarding CRS recurrence. Long-term outcome after ENS for CRS showed significant improvement in subjective rhinosinusitis-specific symptoms, objective NAR, and rhinosinusitis disability.

Cited by 14 publications

References 26 publications

The way the wind blows: Implications of modeling nasal airflow

The way the wind blows: Implications of modeling nasal airflow

Computational Fluid Dynamics as Surgical Planning Tool: A Pilot Study on Middle Turbinate Resection

Correlations Between Endoscopy Score and Quality of Life Changes After Sinus Surgery

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