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Medical Forum / Diseases and Disorders / Sinusitis / February 2008Long-term outcome analysis of endoscopic sinus surgery for chronic sinusitis.
1: Am J Rhinol. 2007 Nov-Dec;21(6):743-7.Click here to read Links Long-term outcome analysis of endoscopic sinus surgery for chronic sinusitis. Young J, Frenkiel S, Tewfik MA, Mouadeb DA. McGill University, Montreal, Quebec, Canada. jonathan.young@mail.mcgill.ca BACKGROUND: The purpose of this study was to determine long-term subjective outcome of endoscopic sinus surgery (ESS) for chronic sinusitis (CS) and to evaluate prognostic indicators for surgical treatment failure. METHODS: This is a prospective study of patients who underwent ESS for CS. Symptom assessment was performed using a visual analog scale at a pretreatment interview and then at regular intervals post-ESS for up to a 3-year period. The indicators for symptom scoring were nasal obstruction, facial pain, postnasal drip, anterior discharge, and anosmia/hyposmia. RESULTS: Data analysis indicates that ESS improves symptom scoring early on, but the effects begin to dissipate over time. Anosmia/hyposmia is the most severe symptom overall for all patient subgroups and recurs to a greater degree 3 years postoperatively in Samter's Triad sufferers (p = 0.006), asthmatic patients (p = 0.002), and those with a worse CT scan at presentation (p = 0.04). In addition, Triad sufferers who complain of nasal obstruction and anterior nasal discharge have a significant recurrence of their symptoms postoperatively (p = 0.04 and 0.001, respectively). CONCLUSION: Individuals must be warned that ESS may not be a long-term solution for CS because of its chronic nature. Patients are relieved of their symptoms initially; however, these tend to recur over a 3-year period. Samter's Triad is the strongest determinant of long-term treatment failure. Asthma also is a determinant of treatment failure, which lends credence to the notion of combined airway disease. Allergy was not a strong determinant of treatment failure in our study. > 1: Am J Rhinol. 2007 Nov-Dec;21(6):743-7.Click here to read Links > Long-term outcome analysis of endoscopic sinus surgery for chronic [quoted text clipped - 29 lines] > disease. Allergy was not a strong determinant of treatment failure in > our study. So, the 80% + efficacy of FESS doesn't hold. No surprise, it was never clear exactly what criteria was used to define success. Judy > > 1: Am J Rhinol. 2007 Nov-Dec;21(6):743-7.Click here to read Links > > Long-term outcome analysis of endoscopic sinus surgery for chronic [quoted text clipped - 33 lines] > clear exactly what criteria was used to define success. > Judy Hi Judy: Yes the "criteria to determine success" is interesting. However when I look at the results of this study I see a few other things. When I look at sinus anatomy on x-ray, I see a an air intake system of fairly generous proportions. It take a LOT of layers of stuff to stop it up. To me it kind of validates my theory that once the gang is all there it takes about 3 years for the biofilm to acrete to the point where it again causes constant drainage and obstructs breathing even if the full compliment of species is already there. That could also mean that many years passed between the initial bout of flu that killed the cilia in the first place and the presentation of chronic sinusitis. Remember the thing about CT scans having a high number of "false positives"? About 60% or more of people who had CT scans for other reasons showed high density stuff in a thick blanket over at least some of their sinuses. Depending on the size of the nasal structures, I think that sooner or later these people will "suddenly" realize that they have sinusitis. So cold steel can reduce the bug burden, but is not going to keep the bugs from reclaiming the territory if something else is not done, because there are little tubes running all over the place that the surgeon can not scrape out will carry representatives from the whole biofilm community that was there, and will allow the `film to regrow. We need vaccines against Staph, e-coli, and psudeo, and we need phages that attack these bugs to get to the places where the immune system can not go. Antibotics are wayyyyyyy better than nothing, but phages seem to me to offer the best solution. I wonder if you could ask some of your Russian colleges about the incidence and treatment of sinusitis in Russia where phages are evidently used with considerable success. > > > 1: Am J Rhinol. 2007 Nov-Dec;21(6):743-7.Click here to read Links > > > Long-term outcome analysis of endoscopic sinus surgery for chronic [quoted text clipped - 70 lines] > incidence and treatment of sinusitis in Russia where phages are > evidently used with considerable success. The effect of bacterial biofilms on post-sinus surgical outcomes. Psaltis AJ, Weitzel EK, Ha KR, Wormald PJ. Department of Surgery-Otorhinolayrngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia. Am J Rhinol. 2008 Jan-Feb;22(1):1-6. BACKGROUND: Although the existence of biofilms on the sinus mucosa of patients with chronic rhinosinusitis (CRS) is now well established, the role that these structures play remains unclear. It is thought that biofilms may contribute to the recalcitrant and persistent nature that characterizes CRS, but little research exists documenting the effect that they have on postoperative mucosal outcomes. This article presents a retrospective analysis of sinus surgical patients and correlates the presence of biofilms with mucosal outcomes. This study was performed to evaluate the role that bacterial biofilms have on post-sinus surgical outcomes. METHODS: A retrospective analysis of prospectively collected data was performed on 40 patients undergoing endoscopic sinus surgery (ESS) for CRS. Preoperative demographic, clinical, and radiologic data were recorded from each patient and, intraoperatively, sinus culture specimens and mucosal samples were obtained for microbiological and microscopic examination. Biofilm determination was performed using confocal scanning laser microscopy. Postoperatively, patients were followed up for a minimum of 8 months with endoscopic evaluation of their sinonasal mucosa. The presence of ongoing symptoms was recorded also. RESULTS: Bacterial biofilms were found in 20 (50%) of the 40 CRS patients. Patients with biofilms had significantly worse preoperative radiological scores and, postoperatively, had statistically worse postoperative symptoms and mucosal outcomes. The only other factor that was statistically related to an unfavorable outcome was the presence of fungus at the time of surgery. In this study the presence of polyps, eosinophilic mucin, or pus was not related to poor outcomes. CONCLUSION: This retrospective study showed that bacterial biofilms and fungus were correlated with the persistence of postoperative symptoms and mucosal inflammation after sinus surgery for CRS. This provides evidence that biofilms indeed may play an active role in perpetuating inflammation in CRS patients and may explain the recurrent and resistant nature of this disease. Therapies targeted at removing biofilms may be important in the management of recalcitrant CRS PMID: 18284851 [PubMed - in process]
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