Advances in the Surgical Management of Chronic Sinusitis and Nasal Polyps

Abstract

Current research has only reinforced the belief that chronic rhinosinusitis is a multifactorial and idiosyncratic disease process. Most basic science research on the topic focuses on delineating the many proposed contributing factors and attempting to establish therapeutic targets. In patients whose symptoms do not respond to medical therapy, endoscopic sinus surgery may be offered. Several surgical techniques have been proposed, and it would appear that certain techniques are ideal for certain situations. Recent clinical research has focused on the introduction of new technology and new techniques. Additionally, investigators have looked for ways to optimize current techniques and to determine which patient populations may expect to benefit from which types of interventions.

The Development of Keratopathy after Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study

“…Topical corticosteroid therapy, oral corticosteroid administration, and antibiotic treatment with macrolide have been applied to treat CRS with acceptable outcomes [3,7]. Functional endoscopic sinus surgery (FESS) is a well-established intervention for CRS that is severe and refractory to medical management [8,9,10]. Nevertheless, the recovery of nasal sinus mucosa in patients with CRS is incomplete one year after FESS management [3].…”

SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases

“…Despite recent clinical and basic research efforts, the pathophysiology of the disease is only beginning to be understood. Current research has reinforced the belief that CRS is a multifactorial disease process involving genetic, environmental, occupational, anatomic, iatrogenic and immunological factors (7) . Based on the concept of "united airways", new diagnostic and therapeutic approaches are required to delineate whether intermittent and persistent inflammatory disorders of the upper airways represent a common disease with strong relationships with asthma and other diseases, or are distinct entities that interact with each other or are simply being confused because of common symptoms ( Figure 1).…”

The Development of Dry Eye Disease after Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study

“…The local corticosteroid therapy, systemic corticosteroid usage and antibiotic treatment have been used to treat CRS with favorable outcomes [3,6]. In addition, functional endoscopic sinus surgery (FESS) is a well-established procedure for severe CRS that shows poor response to medical management and can yield high anatomical success rate after the surgery [7][8][9]. Still, the recovery of maxillary sinus mucosa in patient with CRS is incomplete one year after the FESS performance [3].…”

“…Still, the recovery of maxillary sinus mucosa in patient with CRS is incomplete one year after the FESS performance [3]. Moreover, patients with certain risk factors, like higher Lund-Mackay CT scores and those with fungal-induced CRS, may still experience a poor quality of life or persistent nasal polyp formation even after successful FESS intervention [7,8]. The above lines of evidence suggest that the local effect of severe CRS would endure despite the FESS management.…”