Outcomes of chronic frontal sinusitis treated with ethmoidectomy: a prospective study

Abstract

Background In medically refractory chronic frontal sinusitis, ethmoidectomy without instrumentation of the frontal ostium may resolve frontal disease. Our aim was to determine the efficacy of ethmoidectomy alone for the treatment of chronic frontal sinusitis. Methods Adults with chronic rhinosinusitis prospectively enrolled in a multi-center study who demonstrated frontal sinusitis on computed tomography were divided into two groups: 1) endoscopic sinus surgery (ESS) incorporating ethmoidectomy, but excluding frontal sinusotomy; and 2) ESS incorporating frontal sinusotomy. The primary outcome was improvement in SNOT-22 scores. Secondary outcomes included endoscopic scores and use of corticosteroids and antibiotics. Results 196 cases undergoing frontal sinusotomy and 30 cases treated with ethmoidectomy without frontal sinusotomy were analyzed and were comparable demographically. The prevalence of nasal polyps, previous ESS, asthma, and aspirin intolerance was more common in the frontal sinusotomy group (p<0.050). Preoperative endoscopy and computed tomography scores were higher in the frontal sinusotomy group (p≤0.001). Postoperatively, both groups showed comparable SNOT-22 scores with worse endoscopy scores in the frontal sinusotomy group (p=0.038). Postoperative improvement in SNOT-22 total and subdomain scores was comparable between groups. Nasal endoscopy scores improved to a greater degree in the frontal sinusotomy group (p=0.023). Duration of postoperative topical steroid use was higher in the frontal sinusotomy group (p=0.007). Revision surgery was needed in 2.6% of frontal sinusotomy patients and 0% of patients without frontal sinusotomy. Conclusions The treatment of chronic frontal sinusitis through ethmoidectomy is a potential alternative to frontal sinusotomy achieving similar QOL improvements in patients manifesting less severe sinus disease.

Safe treatment of ethmoid sinusitis utilizing minimally invasive ethmoid punch sinusotomy in chronic rhinosinusitis without polyposis patients

“…Through EPS, using the approaches described, there is little conceivable risk of injury to the orbit or skull base. Interestingly, recent prospective data suggest that surgical treatment of ethmoid sinusitis alone may resolve frontal sinus disease without formal frontal sinusotomy . Given our findings presented herein, EPS may unexpectedly hold promise for impacting frontal sinusitis in some patients, while also avoiding the need for traditional complete ethmoidectomy under general anesthesia (and the inherent risk profiles of both interventions as previously discussed).…”

Sino‐Nasal outcome test‐22 outcomes after sinus surgery: A systematic review and meta‐analysis

“…Full‐length texts were then reviewed, and an additional 23 studies identified from references. A total of 31 studies were considered to be duplicates from the same cohort, and an additional 53 failed to meet inclusion/exclusion criteria. The final study list included 40 unique patient cohorts published from 2008 to 2016 and representing institutions from North America (n = 14), Europe (n = 12), Middle East (n = 6), Australia (n = 3), Asia (n = 3), and South America (n = 2) .…”

Patient and surgeon factors explain variation in the frequency of frontal sinus surgery

“…Becker et al found that anterior ethmoidectomy led to frontal sinus disease resolution in 89% of patients . In a group of patients with CRS and opacification of the frontal sinuses on imaging, Abuzeid et al compared those who underwent endoscopic frontal sinusotomy to those who underwent ethmoidectomy alone . They found that quality of life symptom scores and postoperative requirement for oral antibiotics improved with no significant difference between the two groups.…”

“…Over the past several years there has been a dramatic increase (76%–153%) in the number of patients receiving frontal sinus surgery . This increase comes despite a lack of evidence supporting a frontal sinus procedure as opposed to an anterior ethmoidectomy alone as an initial surgical option for patients with frontal sinusitis on imaging …”

“…9,22 This increase comes despite a lack of evidence supporting a frontal sinus procedure as opposed to an anterior ethmoidectomy alone as an initial surgical option for patients with frontal sinusitis on imaging. 23 We sought to identify the nonclinical factors associated with whether a patient receives frontal sinus surgery concurrent with anterior ethmoidectomy during ESS for CRS. We explored both patient and provider variables associated with utilization of frontal sinus surgery in patients with all insurance types by evaluating the outpatient surgical databases from three large states (Florida, Kentucky, and New Jersey).…”