Clinical Analysis of Modified Extended Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps and Allergic Rhinitis
Abstract
Extended endoscopic sinus surgery (EESS) can reduce the recurrence rate of chronic rhinosinusitis (CRS). The purpose of this study was to investigate the effect of the application of modified “protective middle turbinate-EESS” (mEESS) on patients with CRS with nasal polyps (CRSwNP) and allergic rhinitis (AR).
Forty-three patients with CRSwNP and AR were classified into 2 groups, the mEESS group (n=23) and the functional endoscopic sinus surgery (FESS) group (n=20), and were followed up for 6 months and 1 year after surgery. The disease severity was assessed by the Lund-Mackay score, the Lund-Kennedy score, and the visual analog scale (VAS) score. The patency rate of the frontal sinus was evaluated by endoscopy. Patient satisfaction was also followed up.
No preoperative differences or postoperative complications were found between the 2 groups. The VAS score and Lund-Kennedy score of the 2 groups were lower at 6 months and 1 year after surgery. The olfactory function of the mEESS group was significantly better than that of the FESS group at 6 months post-operative. The patency rate of the frontal sinus orifice in the mEESS group was significantly higher than that in the FESS group at 6 months and 1 year post-operative. Patient satisfaction in the mEESS group was relatively higher than that in the FESS group.
mEESS improves frontal sinus drainage, olfactory sense, and patient satisfaction in the short term.
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8. Zhou B, Huang Q, Wang CS, Cui SJ, Wang GS, Zhang LL, et al. Analysis of follow-up outcomes of endoscopic modified Lothrop procedure. Chin J Otorhinolaryngol Head Neck Surg. 2012;47(9):728–34.
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11. Dalgorf DM, Harvey RJ. Chapter 1: Sinonasal anatomy and function. Am J Rhinol Allergy. 2013;27(11):S3–S6.
12. Georgalas C, Hansen F, Videler WJM, Fokkens WJ. Long terms results of Draf type III (modified endoscopic Lothrop) frontal sinus drainage procedure in 122 patients: a single centre experience. Rhinology. 2011;49(2):195–201.
13. Thompson CF, Kern RC, Conley DB. Olfaction in endoscopic sinus and skull base surgery. Otolaryngol Clin North Am. 2015;48(14):795–804.
14. Eloy JA, Marchiano E, Vázquez A. Extended endoscopic and open sinus surgery for refractory chronic rhinosinusitis. Otolaryngol Clin North Am. 2017;50(8):165–82.
15. Weber RK, Werner H. Comprehensive review on endonasal endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:S64–S142.
16. Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of allergic rhinitis. Chin J Otorhinolaryngol Head Neck Surg. 2016;51(9):6–24.
17. Mattos JL, Rudmik L, Schlosser RJ, et al. Symptom importance, patient expectations, and satisfaction in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2019;9:593–600.
18. Hull BP, Chandra RK. Refractory chronic rhinosinusitis with nasal polyposis. Otolaryngol Clin North Am. 2017;50(11):61–81.
19. Byun JY, Lee JY. Middle turbinate resection versus preservation in patients with chronic rhinosinusitis accompanying nasal polyposis: baseline disease burden and surgical outcomes between the groups. J Otolaryngol Head Neck Surg. 2012;41(8):259–64.
20. Hudon MA, Wright ED, Fortin-Pellerin E, Bussieres M. Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized FESSled trial. J Otolaryngol Head Neck Surg. 2018;47:67.
21. Dolci RLL, de Carvalho ACM, Rickli JCK, de Souza JL, Encinas WE, Dolci JEL, et al. Relationship between the bilateral removal of the middle nasal turbinate and the olfactory function in endoscopic skull base surgery. World Neurosurg. 2020;142:e337–e343.
22. Knížek Z, Vodička J, Brothánková P, Shejbalová H. Olfactory function in patients undergoing FESS for chronic rhinosinusitis. Cas Lek Cesk. 2017;156:187–191.
23. Delarestaghi MM, Rajaeih S, Firouzabadi FD, Jamali M, Roomiani M, Firouzabadi MD, et al. Evaluation of the effect of endoscopic partial middleturbinectomy surgery on the quality of life of patients with chronic rhinosinusitis and nasal polyps. Rhinology. 2020;58(3):208-12.
24. Wong EH, Do TQ, Harvey RJ, Orgain CA, Sacks R, Kalish L. Patient-reported olfaction improves following outside-in Draf III frontal sinus surgery for chronic rhinosinusitis. Laryngoscope. 2019;129(12):25–30.
25. Choby GW, Hobson CE, Lee S, Wang EW. Clinical effects of middle turbinate resection after endoscopic sinus surgery: a systematic review. Am J Rhinol Allergy. 2014;28(4):502–7.
26. Pinther S, Deeb R, Peterson EL, Standring RT, Craig JR. Complications are rare from middle T urbinate resection: a prospective case series. Am J Rhinol Allergy. 2019;33(8):657–64.
27. Fiorini FR, Nogueira C, Verillaud B, Sama A, Herman P. Value of septoturbinal flap in the frontal sinus drill-out type IIb according to draf. Laryngoscope. 2016;126:2428–2432.
28. Ninan S, Goldrich DY, Liu K, Kidwai S, McKee S, Williams L, et al. Long term olfactory outcomes following frontal sinus surgery in chronic rhinosinusitis. Laryngoscope. 2021;131(10):2173–8.
29. Hauser LJ, Chandra RK, Li P, Turner JH. Role of tissue eosinophils in chronic rhinosinusitis-associated olfactory loss. Int Forum Allergy Rhinol. 2017;7(2):957–962.
30. Wu D, Bleier BS, Wei Y. Temporary olfactory improvement in chronic rhinosinusitis with nasal polyps after treatment. Eur Arch Otorhinolaryngol. 2018;275:2193–2202.
31. Rouyar A, Classe M, Gorski R, Bock MD, Le-Guern J, Roche S, et al. Type 2/Th2-driven inflammation impairs olfactory sensory neurogenesis in mouse chronic rhinosinusitis model. Allergy. 2019;74(3):549–59.
32. Jankowski R, Rumeau C, Nguyen DT, Gallet P. Updating nasalisation: From concept to technique and results. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(14):327–34.
2. Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery. Guidelines for diagnosis and treatment of chronic rhinosinusitis (2012, Kunming). Chin J Otorhinolaryngol Head Neck Surg. 2013;48(2):92–4.
3. Sedaghat AR, Gray ST, Wilke CO, Caradonna DS. Risk factors for development of chronic rhinosinusitis in patients with allergic rhinitis. Int Forum Allergy Rhinol. 2012;2(5):370–5.
4. Chen FH, Deng J, Hong HY, Xu R, Guo JB, Hou WJ, et al. Extensive versus functional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps and asthma: a 1-year study. Am J Rhinol Allergy. 2016;30(2):143–8.
5. Dai J, Huai D, Xu M, Cai J, Wang H. Revision endoscopic frontal sinus surgery for refractory chronic rhinosinusitis via modified agger nasi approach. J Int Med Res. 2021;49:300060521995273.
6. Anderson P, Sindwani R. Safety and efficacy of the endoscopic modified Lothrop procedure: a systematic review and meta-analysis. Laryngoscope. 2009;119:1828–1833.
7. Turner JH, Vaezeafshar R, Hwang PH. Indications and outcomes for Draf IIB frontal sinus surgery. Am J Rhinol Allergy. 2016;30(7):70–3.
8. Zhou B, Huang Q, Wang CS, Cui SJ, Wang GS, Zhang LL, et al. Analysis of follow-up outcomes of endoscopic modified Lothrop procedure. Chin J Otorhinolaryngol Head Neck Surg. 2012;47(9):728–34.
9. Patel VS, Choby G, Shih LC, Patel ZM, Nayak JV, Hwang PH. Equivalence in outcomes between Draf 2B vs Draf 3 frontal sinusotomy for refractory chronic frontal rhinosinusitis. Int Forum Allergy Rhinol. 2018;8(1):25–31.
10. Georgalas C, Detsis M, Geramas I, Terzakis D, Liodakis A. Quality of life outcomes in frontal sinus surgery. J Clin Med. 2020;9(3):2145.
11. Dalgorf DM, Harvey RJ. Chapter 1: Sinonasal anatomy and function. Am J Rhinol Allergy. 2013;27(11):S3–S6.
12. Georgalas C, Hansen F, Videler WJM, Fokkens WJ. Long terms results of Draf type III (modified endoscopic Lothrop) frontal sinus drainage procedure in 122 patients: a single centre experience. Rhinology. 2011;49(2):195–201.
13. Thompson CF, Kern RC, Conley DB. Olfaction in endoscopic sinus and skull base surgery. Otolaryngol Clin North Am. 2015;48(14):795–804.
14. Eloy JA, Marchiano E, Vázquez A. Extended endoscopic and open sinus surgery for refractory chronic rhinosinusitis. Otolaryngol Clin North Am. 2017;50(8):165–82.
15. Weber RK, Werner H. Comprehensive review on endonasal endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:S64–S142.
16. Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of allergic rhinitis. Chin J Otorhinolaryngol Head Neck Surg. 2016;51(9):6–24.
17. Mattos JL, Rudmik L, Schlosser RJ, et al. Symptom importance, patient expectations, and satisfaction in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2019;9:593–600.
18. Hull BP, Chandra RK. Refractory chronic rhinosinusitis with nasal polyposis. Otolaryngol Clin North Am. 2017;50(11):61–81.
19. Byun JY, Lee JY. Middle turbinate resection versus preservation in patients with chronic rhinosinusitis accompanying nasal polyposis: baseline disease burden and surgical outcomes between the groups. J Otolaryngol Head Neck Surg. 2012;41(8):259–64.
20. Hudon MA, Wright ED, Fortin-Pellerin E, Bussieres M. Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized FESSled trial. J Otolaryngol Head Neck Surg. 2018;47:67.
21. Dolci RLL, de Carvalho ACM, Rickli JCK, de Souza JL, Encinas WE, Dolci JEL, et al. Relationship between the bilateral removal of the middle nasal turbinate and the olfactory function in endoscopic skull base surgery. World Neurosurg. 2020;142:e337–e343.
22. Knížek Z, Vodička J, Brothánková P, Shejbalová H. Olfactory function in patients undergoing FESS for chronic rhinosinusitis. Cas Lek Cesk. 2017;156:187–191.
23. Delarestaghi MM, Rajaeih S, Firouzabadi FD, Jamali M, Roomiani M, Firouzabadi MD, et al. Evaluation of the effect of endoscopic partial middleturbinectomy surgery on the quality of life of patients with chronic rhinosinusitis and nasal polyps. Rhinology. 2020;58(3):208-12.
24. Wong EH, Do TQ, Harvey RJ, Orgain CA, Sacks R, Kalish L. Patient-reported olfaction improves following outside-in Draf III frontal sinus surgery for chronic rhinosinusitis. Laryngoscope. 2019;129(12):25–30.
25. Choby GW, Hobson CE, Lee S, Wang EW. Clinical effects of middle turbinate resection after endoscopic sinus surgery: a systematic review. Am J Rhinol Allergy. 2014;28(4):502–7.
26. Pinther S, Deeb R, Peterson EL, Standring RT, Craig JR. Complications are rare from middle T urbinate resection: a prospective case series. Am J Rhinol Allergy. 2019;33(8):657–64.
27. Fiorini FR, Nogueira C, Verillaud B, Sama A, Herman P. Value of septoturbinal flap in the frontal sinus drill-out type IIb according to draf. Laryngoscope. 2016;126:2428–2432.
28. Ninan S, Goldrich DY, Liu K, Kidwai S, McKee S, Williams L, et al. Long term olfactory outcomes following frontal sinus surgery in chronic rhinosinusitis. Laryngoscope. 2021;131(10):2173–8.
29. Hauser LJ, Chandra RK, Li P, Turner JH. Role of tissue eosinophils in chronic rhinosinusitis-associated olfactory loss. Int Forum Allergy Rhinol. 2017;7(2):957–962.
30. Wu D, Bleier BS, Wei Y. Temporary olfactory improvement in chronic rhinosinusitis with nasal polyps after treatment. Eur Arch Otorhinolaryngol. 2018;275:2193–2202.
31. Rouyar A, Classe M, Gorski R, Bock MD, Le-Guern J, Roche S, et al. Type 2/Th2-driven inflammation impairs olfactory sensory neurogenesis in mouse chronic rhinosinusitis model. Allergy. 2019;74(3):549–59.
32. Jankowski R, Rumeau C, Nguyen DT, Gallet P. Updating nasalisation: From concept to technique and results. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(14):327–34.
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| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| Allergic rhinitis Chronic rhinosinusitis Endoscopic sinus surgery Extended frontal sinusotomy Olfaction | ||
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How to Cite
1.
Zou C, Guan D, Liu L, Chen Q, Ke X, Liu J, Shen Y, Yang Y. Clinical Analysis of Modified Extended Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps and Allergic Rhinitis. Iran J Allergy Asthma Immunol. 2024;:1-10.
