Acute post-operative rhinosinusitis following endonasal dacryocystorhinostomy

Abstract

Purpose To investigate the incidence and risk factors for acute rhinosinusitis (ARS) following endoscopic dacryocystorhinostomy (EnDCR). Methods Retrospective single-surgeon interventional case series, including 196 consecutive patients undergoing 203 endonasal DCR, with clinical and radiological evidence of nasolacrimal duct or common canalicular obstruction. Pre-operative lacrimal and sinonasal clinical assessment and imaging, intraoperative endoscopic video recording, and postoperative clinical and endoscopic findings were analysed for cases of ARS occurring within the first 4 weeks following DCR among patients with and without a past history of chronic rhinosinusitis (CRS). Surgical complications and outcomes at 12 months and management of ARS are reported. Results Three patients (1.5%) developed ARS within the first 5 post-operative days, none of which had experienced perioperative complications and all had a past history of CRS. The rate of CRS in this cohort of 196 patients was 10.2% (n ¼ 20), of which 15% (n ¼ 3) developed ARS, although none had symptoms of CRS at the time of surgery; one had undergone previous sinus surgery. Presenting symptoms of ARS included facial pain, tenderness over the affected sinus, and nasal discharge; all patients responded to oral antibiotic therapy. Discussion The rate of ARS following EnDCR was 1.5%. In those with a prior history of CRS, it was 15% (P ¼ 0.009). ARS developed within the first post-operative week among patients with a past history of CRS, who were asymptomatic at the time of surgery, and responded to oral antibiotics. CRS may be a risk factor for the development of post-operative ARS.

Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis

“…Also patients with inflammation were checked more often at outpatient clinic after endonasal DCR. In our study, acute postoperative rhinosinusitis was found in two patients (6.9%) who had a history of CRS but no symptom at the time of surgery; this occurrence rate was slightly higher than that reported by Shams and Selva [ 17 ]. Considering all cases of DCR, occurrence rate was 2.0% and it is similar to the previous reports [ 18 19 ].…”

“…Preoperative inflammation is an important factor affecting surgical outcomes and complication rates. Shams and Selva [ 17 ] mentioned that CRS may be a risk factor for the development of postoperative acute rhinosinusitis. Our study had 71 patients with presurgical inflammation, 39 with CRS and 32 with periocular inflammation, including periocular cellulitis and dacryocystitis.…”

Endoscopic Dacryocystorhinostomy as Treatment for Lower Lacrimal Pathway Obstructions in Adults: Review Article

“…1 The presence of a postoperative infection is also known to threaten the normal healing process and surgical outcome of EN-DCR. 79 , 80 …”

A prospective outcome study of membranous and solid distal common canalicular obstructions

“…This was part of the larger prospective study to investigate a variety of factors influencing functional and anatomical outcomes following EnDCR surgery, which have been published. [10][11][12][13][14][15] As part of this study, patients with distal CCOs were analyzed separately. Demographics were recorded and symptoms were evaluated pre-operatively using a tearing symptoms score questionnaire graded using the Munk score.…”