Abstract
Ethmoidal polyposis (EP) is a frequent form of chronic rhinosinusitis. Medical therapy is the main modality of treatment. Non responders to medical treatment require surgical removal of polyps by Endoscopic Sinus Surgery (ESS). Many studies showed worsening of the lung function following ESS whereas few studies showed improvement in the symptoms and better quality of life. Hence this study is an attempt to assess the effect of ethmoidal polyps on the pulmonary function and also the change in the lung function in the patients with ethmoidal polyps post ESS.
Methods: A prospective observational study was conducted in a tertiary care hospital on 50 subjects with ethmoidal polyposis who were unresponsive to medical treatment and hence underwent ESS. Pulmonary function tests were assessed using spirometry and nasal symptoms were scored as per TNSS system prior to surgery and 3 months post surgery and compared with the pre op values and analysed.
Results: There were 30 males and 20 females with majority of them in the age group of 41-50 yrs. The mean pre op FVC, FEV1, MEFR were 2.94liters, 2.41 liters and 2.51 liters respectively whereas the mean post operative values were 2.95 liters, 2.39 liters and 2.49 liters respectively.. The ratio of FEV1 and FVC was more than 0.7 in 98 % patients pre operatively and 94% post operatively. There was no statistically significant change in lung function tests following ESS. Pre operatively majority (35) had TNSS value between 6-9 where as post operatively the score was reduced to 2-3 in many patients (38). The mean TNSS was 7.24 before surgery which declined to 2.82 after surgery with a p value <0.0001indicating a statistically significant improvement in the nasal symptoms post ESS.
Conclusion: Our study shows that ESS benefits patients with nasal polyps by improving the symptoms and there by the quality of life without any adverse effects on the lower airways.
Keywords: Ethmoidal Polyps (EP), Endoscopic Sinus Surgery (ESS), Pulmonary Function Tests (PFT), Total Nasal Symptom Score (TNSS).
References
- P L Dhingra, Shruti Dhingra “Diseases of Ear, Nose and Throat & Head and Neck Surgery” 6th edition, New Delhi, Elsvier publication 2014,Page no.152-198.
- Paraya Assanasen, and Robert M. Naclerio. Medical and surgical management of nasal polyps. Current Opinion in Otolaryngology & Head and Neck Surgery 2001;9:27–36.
- Scott-Brown’s Otolaryngology and Head and Neck Surgey. Vol. 2; Seventh Edition
- C Lamblin, I Tillie-Leblond, J Darras, F Dubrulle, D Chevalier, E Cardot, T Perez, B Wallaert, J J Piquet, and A B Tonnel "Sequential evaluation of pulmonary function and bronchial hyper responsiveness in patients with nasal polyposis: a prospective study." American Journal of Respiratory and Critical Care Medicine, Vol. 155, No. 1 (1997), pp. 99-103.
- Van der Veer.A. The Asthma problem. N. Y. Med .J. 1920;112:392-399.
- Young jinAhn, Soo-Youn An, Tae-Bin Won, Jeong-Whun Kim, Chul Hee Lee, Yang-Gi Min et al. Nasal polyps: An independent risk factor for bronchial hyperresponsiveness in patients with allergic rhinitis. 2Am J Rhinol Allergy 2010;24:359–363.
- Gillian Dunlop, Glenis K Scadding, and Valerie J. Lund. The Effect of Endoscopic Sinus Surgery on Asthma: Management of Patients With Chronic Rhinosinusitis, Nasal Polyposis, and Asthma. American Journal of Rhinology.July-August 1999, Vol. 13, NO.4.
- Marleen Vleming, Anton E. Stoop, Rene J. Middelweerd, and Nico de Vries Results of Endoscopic Sinus Surgery for Nasal Polyps. American Journal of Rhinology 5:173-176,1991
- R. Miller, J. Hankinson, V. Brusasco, F. Burgos, R. Casaburi, A. Coates et al. Standardisation of spirometry. EurRespir J 2005; 26: 319–338
- Global Initiative for Chronic Obstructive Lung Disease. Spirometry for health care providers.(Updated 2010). Available at https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=2ahUKEwjL7ZLy9NzjAhUl6nMBHdivB7cQFjACegQIAhAC&url=https%3A%2F%2Fgoldcopd.org%2Fwp-content%2Fuploads%2F2016%2F04%2FGOLD_Spirometry_2010.pdf&usg=AOvVaw0yOPN0N01fSjfmSLTB_6IY
- Harpreet Ranu, Michael Wilde, Brendan Madden. Pulmonary Function Tests. Ulster Med J 2011;80(2):84-90
- North West ENT & Allergy “Total Nasal Symptom Score” Portland accessed on 11-02-2019. Available at
- https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=2ahUKEwil8Nve9tzjAhXB4nMBHUlqCtMQFjACegQIBBAC&url=https%3A%2F%2Fwww.nwentallergy.com%2Fdocs%2FTotal_Nasal_Symptom_Score.pdf&usg=AOvVaw3IdzSj-RRLl4lFg4j04553
- Sridevi Karuthedath , Ishwar Singh, Shelly Chadha, Impact of Functional Endoscopic Sinus Surgery on the Pulmonary Function of Patients with Chronic Rhinosinusitis: A Prospective Study Indian J Otolaryngol Head Neck Surg (Oct–Dec 2014) 66(4):441–448.
- Alexander J. Osborn, MD, PhD; Randy Leung, MD; Felix Ratjen, MD; Adrian L. James, MA, DM “Effect of Endoscopic Sinus Surgery on Pulmonary Function and Microbial Pathogens in a Pediatric Population With Cystic Fibrosis” Arch Otolaryngol Head Neck Surg. 2011;137(6):542-547.
- Ahmed M. Youssef, MD1, Osama G. Abdel-Naby Awad, MD, Mohamed Taha, MD, “Pulmonary Function of Patients with Chronic Rhinosinusitis and the Impact of Endoscopic Sinus Surgery” Egypt J Otolaryngol 2018;34:167-72
- Slavin RG. Sinus disease and asthma. Ear Nose Throat J. 1984 Feb;63(2):45, 49-50, 53-4.
- Liao H, Shen Y, Wang P. “Clinical analysis of nasal resistance and pulmonary function testing in patients with chronic nasal-sinusitis and nasal polyps” Journal of clinicalotorhinolaryngology, head, and neck surgery, 2015 May;29(9):784-7, 799.
- Pan S, He H, Guan B, Liu T, Yuan X, Ma W and Xie Y: The effect of endoscopic sinus surgery on pulmonary function of chronic rhinosinusitis patients with asthma. Lin Chung Er Bi Yan HouTou Jing WaiKe ZaZhi. 28:1118–1121. 2014. PubMed/NCBI
- Pete S. Batra MD , Robert C. Kern MD, Anju Tripathi MD , David B. Conley MD , A. M. Ditto MD , G. K. Haines III MD , et al, “Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and Asthma” The Laryngoscope 03 September 2010 / Volume 113, Issue 10, Pages 1703-1706.
Corresponding Author
Dr D. Sampath Rao
Assistant Professor of E.N.T, Government Medical College, Mahabubnagar
DOI: https://dx.doi.org/10.18535/jmscr/v7i9.123
