Department of Otolaryngology-Head and Neck Surgery, CHU de la Miletrie, Hopital Jean Bernard, Universite de Poitiers, France.
Diffuse nasal polyposis remains a challenge despite recent improvements in endonasal surgery.
The purpose of this study is to evaluate the results after a radical complete sphenoethmoidectomy with peroperative and postoperative frontal irrigation in cases of diffuse nasal polyposis.
In this prospective study, we include 50 consecutive patients with diffuse nasal polyposis suffering from nasal obstruction, anosmia, and other symptoms of chronic sinusitis.
All patients were refractory to medical therapy.
In each patient an endoscopic complete sphenoethmoidectomy including total excision of all diseased ethmoid mucosa was performed.
Preoperative and postoperative frontal irrigation was performed systematically.
The patients were followed closely with serial endoscopic examination, and CT scanning was performed between 2 and 3 years after surgery.
There were no complications.
Thirty-nine of the 50 patients regained satisfactory olfaction.
Partial nasal obstruction persisted in four of the 50 patients.
Endoscopically, polyp recurrence was noted in 3% of posterior ethmoids, 23% of anterior ethmoids, and 50% of frontal recesses.
We conclude that in cases of refractory and extensive nasal polyposis, a total sphenoethmoidectomy with perioperative frontal irrigation followed by long-term postoperative topical steroid therapy provides excellent improvement or cure with safety and reliability.
BACKGROUND: Cleaning of the nose with saline solution after endonasal sinus surgery is very often used for postoperative treatment.
But the efficiency and acceptance of this method has not been examined thoroughly until now.
METHODS: Performance, effectiveness and acceptance of the postoperative treatment was evaluated in a questionnaire.
One hundred thirty-four of 180 patients answered.
RESULTS: One hundred twenty-one patients (66.1%) cleaned their nose with Ems brine; 28.1% of the patients used saline solution.
The nasal douche was the cleaning device used by 39.7% of the patients, whereas 53.7% sniffed the solution from their hand.
Ninety-five percent found that this kind of treatment was easy to do; 84.7% found it equally pleasant.
There was no difference between using Ems brine or NaCl solution nor between using the nasal douche or sniffing out of the hand.
Fifty-one point four percent of the patients with an follow-up of 27 to 36 months rinsed their nose up to now; 55.9% resumed nasal irrigation after an interval.
CONCLUSIONS: Rinsing of the nose after endonasal sinus surgery is judged positively by most of our patients and is integrated well in the daily routine.
Although it is most common to sniff saline solution out of the hand, existing research recommends usage of warm Ems brine in combination with the nasal douche.
[Revision endoscopic sinus surgery--long-term follow up and operative findings]
[Article in Japanese]
Hinohira Y, Yumoto E, Hyodo M, Joko H.
Department of Otolaryngology, Ehime University School of Medicine.
Among 170 cases (301 sides) with chronic sinusitis who underwent endoscopic sinus surgery, 15 cases (25 sides) were reoperated on because of unsatisfactory results.
We examined 12 such cases, periodically, with an endoscope following the first operation.
Postoperative endoscopic management, including removal of polyps in the middle nasal meatus and irrigation of the maxillary sinus with sterilized saline water through the enlarged opening, had been done if necessary.
However, stenosis of the middle nasal meatus had gradually progressed and mucous or purulent discharge had increased despite postoperative endoscopic treatment.
The middle nasal meatus in 17 of the 25 sides had been closed by polyps or/and adhesion at the time of reoperation.
The adhesion occurred between the lateral wall of the anterior ethmoid cavity and the middle turbinate.
As a result, the opening of the frontal sinus became narrow or even closed, and pus retention was noted in 14 frontal sinuses during revision surgery.
In contrast, only seven maxillary sinuses had pus retention.
We concluded that adhesion in the middle nasal meatus holds the key to control of inflammatory changes in the paranasal sinuses.
Publication Types:
Clinical Trial
PMID: 7472766 [PubMed - indexed for MEDLINE]
42: Zhonghua Er Bi Yan Hou Ke Za Zhi. 1995;30(5):270-2.
[Endoscopic sinus surgery for chronic sinusitis in children]
[Article in Chinese]
Yang J, Yu N, Yang J.
China-Japan Friendship Hospital, Beijing.
Anatomical features show maxillary sinus to be most commonly involved during childhood chronic sinusitis.
Fifty-one cases who failed to respond to medications and irrigation were selected to undergo the middle meatal antrostomy under endoscopy.
The majority of them had maxillary sinusitis.
10 cases had middle turbinate edema and polyps.
6 had ethmoiditis.
After operations, signs of headache eliminated in 20 cases, nasal obstruction in 43 cases and yellowish discharge in 37 cases.
The operative results were satisfactory.
It is demonstrated that endoscopic sinus surgery is an ideal therapy for the treatment of childhood chronic maxillary sinusitis at present.
Antral washout with nasal polypectomy: should both be combined?
Shehab Z, Dowell M, Pahor AL.
Sandwell District General Hospital, Birmingham, United Kingdom.
Two hundred and sixteen patients with nasal polyps were studied. All patients had antral washouts performed at the same time as nasal polypectomy. Two hundred and sixty aspirates were sent for culture and microscopy; bacteria were cultured from 58 of these specimens in 38 patients. One hundred and one patients had pre-operative sinus radiographs of which 94 were reported as abnormal with a 52% false-positive result. It is concluded that antral washouts should be routine in all patients having nasal polypectomy. Sinus radiographs are an unnecessary pre-operative investigation in patients with uncomplicated nasal polyps.
Nasal polypectomy: should antral washout be a routine?
Dowell M, Pahor AL.
ENT Department, Dudley Road Hospital, Birmingham.
Seventy patients with nasal polyps were studied. Forty-seven of these had pre-operative sinus radiographs and all seventy patients had antral washouts at the time of nasal polypectomy. One hundred and seventeen antral aspirates were sent for culture and microscopy. The naked eye appearance of aspirates were turbid in 34 patients. Bacteria were cultured from 15 of the specimens in 10 patients. It was concluded that antral washout should be recommended in all patients who have nasal polypectomy and that there is no need for sinus radiographs in those patients who have uncomplicated nasal polyps.
Use of a Foley catheter for short-term drainage in frontal sinus surgery.
Ijaduola TG.
Department of E.N.T., University College Hospital, Ibadan, Nigeria.
Frontal sinus surgery for chronic disease presents a variety of problems, in particular that of drainage.
No matter how successful the surgical technique is in clearing disease from the sinus, it is still important that the fronto-nasal duct is kept patent unless the procedure is an obliterative one.
Usually a tube is inserted for drainage and has to be kept in place for several weeks or months.
This paper presents a study of 16 patients, suffering from frontal sinus disease, in whom a short-term drainage technique using a Foley catheter was employed between 1979 and 1988 at Lagos University Teaching Hospital, Nigeria.
This type of drainage allows effective anchorage and irrigation with a decongestant.
It has been found to give satisfactory results after 14 days in place and has had no unusual complications.
It is therefore recommended for use in such cases.
PMID: 2715691 [PubMed - indexed for MEDLINE]
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