Immunotherapy in patients undergoing functional endoscopic sinus surgery

Abstract

A total of 283 consecutive patients with chronic sinusitis underwent functional endoscopic sinus surgery. There were 72 allergic patients and 211 nonallergic patients. Data were collected on the effect of immunotherapy on middle meatotomy patency, synechiae formation, and recurrent polyps in allergic patients. Data supported the following conclusions: (1) Immunotherapy given either before or after surgery does not statistically influence middle meatotomy patency, synechiae formation, or recurrence of polyps after functional endoscopic sinus surgery. However, the data do suggest, for all three outcome parameters, that allergic patients who undergo immunotherapy do better than those who do not undergo immunotherapy and, with the exception of recurrent polyps, do as well as nonallergic patients. (2) The prevalence of preoperative polyps is the same for allergic and nonallergic patients in this study, but polyp recurrence is higher in allergic patients. (3) Approximately 40% of allergic patients who began preoperative immunotherapy stopped immunotherapy after surgery because their allergic symptoms resolved or were minimal. A comment regarding this observation is provided.

Influence of allergy on the symptoms and treatment of nasal polyposis

“…Drake-Lee [18] and Settipane [19] found that the presence of a positive allergy skin test did not correlate with the number of polypectomies [15]. Nishioka et al [20] published a study carried out on 283 consecutive patients who had undergone functional endoscopic sinus surgery, but only 140 had nasal polyps (49%). There was a greater recurrence of polyps in those having positive skin tests (36%) than those who had not (17%), but no statistical analysis was given.…”

The microbiology and management of acute and chronic rhinosinusitis

“…Nishioka et al [51] showed that allergic patients who received immunotherapy had a better long-term outcome after surgery. Newman et al [10] reported an association between extensive sinus disease on CT and upper respiratory tract allergy in 78% of patients.…”

Surgical Causes of Failure in Endoscopic Sinus Surgery

“…Failures can be due to numerous causes including an allergic diathesis, 10 nasal polyposis, cystic fibrosis, 21 immotile ciliary dysfunction, and other systemic causes 22 . However, some failures may be strictly related to anatomical abnormalities that are evident on nasal endoscopy and/or computed tomography scan of the sinuses.…”