Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps: Clinical Outcome and Predictive Factors of Recurrence

Veloso-Teles, Rafaela; Cerejeira, Rui

doi:10.2500/ajra.2017.31.4402

Cited by 83 publications

(72 citation statements)

References 34 publications

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“…Endoscopic sinus surgery (ESS) is the mainstay treatment for CRS that is refractory to medical therapy. Nevertheless, there is still a 31% to 55% recurrence rate after ESS . Furthermore, it is challenging for physicians to predict surgery outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, there is still a 31% to 55% recurrence rate after ESS. [5][6][7] Furthermore, it is challenging for physicians to predict surgery outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…5,[13][14][15] CRS in Japan has more pronounced eosinophilic inflammation than in China. 15 Moreover, comorbid asthma and computed tomography (CT) scores are considered as risk factors in some studies, 7,13,16 but not in others. 9,17 In addition, researchers have demonstrated that age, 11 gender, 9 previous CRS surgery, 6,9 preoperative endoscopic score, 6 and allergy 11 are also related to poor ESS outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Prediction models for postoperative uncontrolled chronic rhinosinusitis in daily practice

et al. 2018

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Objectives/Hypothesis The European Position Paper on Rhinosinusitis and Nasal Polyps proposes an assessment of clinical control of chronic rhinosinusitis (CRS). However, there are limited data about the percentage of postoperative control, and no prediction models for uncontrolled CRS have been reported. The aim of the study was to develop prediction models for postoperative uncontrolled CRS. Study Design Retrospective case series. Methods Patients (n = 136) who had undergone endoscopic sinus surgery at least 1 year prior to the study were recruited to assess the clinical control. Risk factors were determined by logistic models and presented as odds ratio (OR) with a 95% confidence interval. Receiver operating characteristics curves were constructed to set the cutoff points and create predictive models. Results Approximately 47.8% of patients had controlled, 22.1% partially controlled, and 30.1% uncontrolled CRS. Univariate regression models revealed the risk factors for uncontrolled CRS: tissue eosinophilia, blood eosinophilia, high computed tomography (CT) score, bilateral disease, asthma, and allergic rhinitis. Multiple regression models found tissue eosinophil ratio >0.206 (OR: 12.96, P = .001) or blood eosinophil ratio >0.025 (OR: 4.56, P = .003), Lund‐Mackay (LM) score ≥ 15 (OR: 15.50, P < .001) and CT ethmoid (E) score ≥ maxillary (M) score (OR: 3.51, P = .037) were independent risk factors. We generated a pathological model (tissue eosinophil ratio and LM score) and a clinical model (blood eosinophil ratio, LM score and E ≥ M score) to categorize CRS into mild, moderate, and severe. Conclusions This research provides simplified and efficient prediction models for uncontrolled CRS. It may help otolaryngologists to predict the prognosis before surgery in daily practice. Level of Evidence 2b Laryngoscope, 128:2673–2680, 2018

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Section: Introductionmentioning

confidence: 99%

“…Nevertheless, there is still a 31% to 55% recurrence rate after ESS. [5][6][7] Furthermore, it is challenging for physicians to predict surgery outcomes.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction models for postoperative uncontrolled chronic rhinosinusitis in daily practice

et al. 2018

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“…Lou and colleagues suggested that a tissue eosinophil proportion of >27% of total cells or a tissue eosinophil absolute count of >55 eosinophils per high‐power field may be reliable as markers for nasal polyp recurrence within 2 years after sinus surgery, whereas Younis and colleagues suggested that the presence of eosinophilic mucin was a strong predictor of CRS recurrence . Similarly, other studies suggested CRSwNP recurrence to be associated with occupational dust exposure, serum periostin, and polypoid change of anterior free border of middle turbinate . However, use of these markers is limited because they are either invasive or impossible to obtain before surgery.…”

mentioning

confidence: 99%

Predictive value of computed tomography in the recurrence of chronic rhinosinusitis with nasal polyps

Meng

Zhang

Lou

2019

Int Forum Allergy Rhinol

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Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a nasal disease with a high tendency for recurrence. The aim of this study was to compare the use of computed tomography (CT) scan with other clinical parameters in predicting the recurrence of CRSwNP. Methods A total of 272 consecutive CRSwNP patients undergoing endoscopic functional sinus surgery were recruited. The demographic characteristics and clinical parameters, including CT scores, level of exhaled nitric oxide, and peripheral eosinophilia, were recorded. The degree of infiltration of inflammatory cells in the sinus mucosa was evaluated. Results Two hundred thirty of the 272 patients completed the study (118 patients with recurrence and 112 patients with no recurrence). The average follow‐up time was 24 months after the first surgery. The 2 groups were not significantly different with respect to age, gender distribution, comorbid allergy, exhaled oral fractional exhaled nitric oxide levels, nasal obstruction/runny nose/headache/facial pain scores, Lund‐Mackay score, peripheral eosinophil percentage, and peripheral eosinophil absolute count. The onset of surgical history and asthma, visual analog scores of CRS, anosmia score, ratio of total ethmoid sinus scores for both sides and maxillary sinus score for both sides (E/M ratio), Lund‐Kennedy score, tissue eosinophil percentage, and tissue eosinophil absolute count were significantly higher in the recurrence group. The E/M ratio showed high accuracy as a predictor for CRSwNP recurrence. The cut‐off point of 2.55 for E/M ratio indicated the highest predictive value of CRSwNP recurrence. Conclusion The E/M ratio is a useful predictor for the recurrence of CRSwNP in the Chinese population.

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“…Disease recurrence occurred in 31% of the patient, but only 7% required surgical reintervention. Their analysis identified occupational dust 41 exposure and non-immunoglobulin E mediated asthma as independent predictive variables in CRSwNP recurrence (57).…”

Section: Efficacy Of Muv/vis In the Prevention Of Recurrence Of Nasalmentioning

confidence: 99%

Intranasal ultraviolet phototherapy in the treatment of allergic rhinitis and chronic rhinosinusitis with nasal polyposis

Kiricsi

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Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps: Clinical Outcome and Predictive Factors of Recurrence

Abstract: ESS proved to be an effective treatment in CRSwNP but with a considerable rate of recurrence. These results indicated an important correlation of occupational dust exposure and non-IgE-mediated asthma with disease recurrence.

Cited by 83 publications

References 34 publications

Prediction models for postoperative uncontrolled chronic rhinosinusitis in daily practice

Prediction models for postoperative uncontrolled chronic rhinosinusitis in daily practice

Predictive value of computed tomography in the recurrence of chronic rhinosinusitis with nasal polyps

Intranasal ultraviolet phototherapy in the treatment of allergic rhinitis and chronic rhinosinusitis with nasal polyposis

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