Title: Comparison of Outcomes of Management of Chronic Rhinosinusitis by Conservative Approach Vs Endoscopic Sinus Surgery with Review of Literature
Author: Dr Devendra M. Jain
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.165
Abstract
Chronic rhinosinusitis (CRS) affects 1 in 8 people in India; about 5-15% of urban population. The prevalence of sinusitis (146/1000 population) has been reported to exceed that of any other chronic condition and is apparently on the increase. Sinusitis is a common health problem that leads to frequent visits to primary care physicians and to ear, nose and throat specialists in all over the world. It contributes to a significant amount of health care expenditure due to direct costs arising from physician visits and antibiotics, as well as indirect costs related to missed days at work and a general loss of productivity due to a decrease in life-quality of those affected.
Many medical & surgical therapies have been used to treat CRS. Medical therapy includes antimicrobials, corticosteroids, decongestants, antihistamines, mast cell stabilizers, antileukotr-ienes, nasal douching, immunotherapy, and reduction of environmental factors. The documentation of medical treatment of CRS is deficient in the literature, apart from a few randomized, controlled trials investigating the role of corticosteroids in CRS with nasal polyposis.
On the other hand, Endoscopic sinus surgery has yielded excellent subjective and objective outcomes, with a very low complication rate. The high success rate, the low incidence of complications and the technological advances in optical instrumentation and imaging techniques in the presence of poor documentation of outcomes of medical therapy has made endoscopic sinus surgery the primary therapy for CRS in the absence of a well performed, prospective, randomized, controlled trial that fulfills level I statement of evidence based medicine. To address this deficiency, the present study has been designed to evaluate and compare surgical and medical treatment of CRS.
References
1. Parikh A, Scadding GK, Darby Y, Baker RC. Topical corticosteroids in chronic rhinosinusitis: a randomized, double-blind, placebo-controlled trial using fluticasone propionate aqueous nasal spray. Rhinology 2001 Jun; 39(2):75-9.
2. Lund VJ. Diagnosis and treatment of nasal polyps. BMJ 1995; 311: 1411-1414.
3. Kennedy DW. Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope. 1992; 102(Suppl 57): 1-18.
4. King JM, Caldarelli DD, Pigato JB. A review of revision functional endoscopic sinus surgery. Laryngoscope 1994; 104: 404-408.
5. Sobol SE, Wright ED, Frenkiel S. One-year outcome analysis of functional endoscopic sinus surgery for chronic sinusitis. J Otolaryngol 1998; 27; 252-257.
6. Lund VJ, Savy L, Lyoyd. Optimum imaging for endoscopic sinus surgery in adults. Journal of Laryngology and otology 2000, 114: 395-7.
7. Nayak SR, Kirtane MV, Ingle MV. Functional endoscopic sinus surgery--I (Anatomy, diagnosis, evaluation and technique). J Postgrad Med 1991;37
8. Khalil H, Nunez DA. Functional endoscopic sinus surgery for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004458. DOI: 10.1002/14651858. CD004458. pub2Keith P, Nieminen J, Hollingworth K, Dolovich J.
9. Lund VJ, Kennedy DW. Quantification for staging sinusitis in international confe-rence on sinus disease. Annals of otorhi-nolaryngology, supplement 167,1995;104: 17-21
10. McCorwich DP, John SD, Swischuk LE, Uchinda T. A double blind placebo controlled trial of decongestant antihistaminic for treatment of sinusitis in children. Clinical paediatrics (Philadelphia) 1996; 35: 457-60
11. Lund VJ, Evidence based surgery in chronic rhinosinusitis. Acta otolaryngo-logica 2001; 121: 5-9
12. Aukema AA, Mulder MG, Fokkens WS. Treatment of nasal polyposis and CRS with fluticasone propionate nasal drops reduces the need of sinus surgery. J. of allergy and clinical immunology. may 2005;115(5):1017-23-(medline)
13. Lund VJ, Neijens H, Clement P, Lusk R, Stammberger H. the treatment of CRS: a contrioversial issue. International journal of paediatric otorhinolaryngology, 1995; 32:521-35
14. Rowe-Jones J, Medealf M, Durham S, Richards D Mackary I. FESS : 5 year follow up and results of a prospective randomized stratified double blind placebo controlled study of post operative fluticasone propionate aqueoua nasal spray. Rhinology. 2005; 43: 2-10.
15. Fahmy FF, McCombe A, McKiernan DC. Sinonasal assessment questionnaire, a patient focused rhinosinusitis specific out-come measure. Rhinology. 2002; 40:195-7
16. Fred J. Lame1 and Wendy R. K. Smoker. The Ostiomeatal Unit and Endoscopic Surgery: Anatomy, Variations, and Imaging Findings in Inflammatory Diseases AJR 159:849-857.
17. Ragab S M, Lund V J, Scadding G. Evaluation of medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. Laryngoscope. 2004; 114: 923-30.
Dr Devendra M. Jain
MS ENT (Pune)