This study confirms that smokers and nonsmokers achieve a highly significant short-term benefit from endoscopic sinus surgery using a clinically-validated symptom severity scale in a prospective study. Interestingly, smokers achieved a greater short-term benefit than nonsmokers did. This study calls into question the notion that current smokers are poorer candidates for endoscopic sinus surgery. Further prospective studies to confirm these results and provide long-term analysis should be performed.

Objectives The purpose of this study is to report on long-term outcomes in a prospective study comparing the quality of life outcomes in smokers and non-smokers undergoing functional endoscopic sinus surgery. Study Design Prospective clinical trial. Methods A total of 235 patients were prospectively enrolled at a single tertiary academic center. Preoperative SNOT-20 scores and comprehensive demographic and smoking data were obtained. Preoperative SNOT-20 scores were compared to postoperative SNOT-20 scores. Results Long-term followup results were available in 111/185 nonsmokers (60%) and 26/50 smokers (52%). Non-smokers had a mean preoperative SNOT-20 score of 26.2, a short-term followup score of 10.1 (mean 3.1 months) and a long-term followup score of 11.4 (mean 44.2 months). Smokers had a mean preoperative SNOT-20 score of 27.8, a short-term followup score of 5.7 (mean 3.1 months) and a long-term followup score of 8.3 (mean 40.3 months). The mean improvement in SNOT-20 scores for smokers was significantly greater than non-smokers in short-term followup (p=.044), however no significant difference in improvement was seen between smokers and non-smokers at long-term followup. Conclusions Both smokers and non-smokers continue to maintain a highly significant improvement in SNOT-20 scores following endoscopic sinus surgery at long-term followup. While smoking remains a well documented cause of medical morbidity, smokers maintained an improvement in quality of life after long-term followup from endoscopic sinus surgery in this prospective study.

Patients with asthma, particularly those using daily inhaled corticosteroids, may have a more clinically aggressive RRP course. The cause of this association is unclear, and clinical recommendations should not yet be made based on these data.

ConclusionAs experience with endoscopic sinus surgery has grown, so have its extended applications. Endoscopic management of transnasal intracranial foreign bodies can be successfully performed in selected patients and yields an improved cosmetic outcome and a decreased risk in complications.The patient was a 21 year old male who was driving intoxicated and sustained a motor vehicle accident. Patient was ejected from his vehicle and launched toward a tree. Patient presented to our institution with a tree branch which had entered the left aspect of his oral cavity piercing through his gingival labial sulcus, traveling into his left nasal cavity, penetrating through the septum into the right nasal cavity, traveling intracranially and piercing white matter. There was no evidence of a CSF leak at time of presentation.CT Head was performed which showed the skull base defect produced by penetrating organic foreign body.Penetrating intracranial foreign bodies were removed using endoscopic sinus equipment. The resulting CSF leak was repaired at the same time.In the literature there are three other patients with transnasal intracranial penetrating foreign bodies managed endoscopically. Of these patients, one had an organic substance, whereas the other two patients had metallic foreign bodies. Endoscopic removal was successful in all patients and the CSF leak was repaired in all patients with a multi-layered closure following retrieval of the foreign body. One patient had a lumbar drain placed at time of retrieval whereas one patient had endoscopic removal with assistance of image guidance. None of the patients suffered complication including meningitis, CSF leak, brain abscess, hydrocephalus, neural/vascular injury or death, which are all associated with craniotomy.Intracranial foreign bodies generally require a craniotomy approach which is associated with a significant risk of perioperative morbidity. Whereas the transnasal endoscopic approach is a minimally invasive technique with lower associated morbidity/mortality. One may still need to manipulate surrounding brain parenchyma although there is no added potential risk, as there is with a craniotomy where the frontal lobe is retracted.Recommendations for endoscopic management of intracranial penetrating foreign bodies includes: use of Image guidance, neurosurgical consultation, and angiography to assess for intracranial vascular injury which should be considered a contraindication to the endoscopic approach, as vigorous bleeding would compromise endoscopic visualization.

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