Surgical management of chronic rhinosinusitis and nasal polyposis: a review of the evidence

Abstract

Functional endoscopic sinus surgery is a common adjunct to medical therapy in the management of chronic rhinosinusitis and nasal polyposis. As with most surgical procedures, there is a paucity of randomized, controlled clinical trials examining the use of functional endoscopic sinus surgery in the management of chronic rhinosinusitis and nasal polyposis. This is primarily a result of the physical and ethical conundrums faced in performing a study that involves comparing a surgical procedure with a placebo. However, there is documentation of the marked impact that chronic rhinosinusitis can have on the overall quality of life and evidence that this improves following combined surgical and medical intervention. There are many case series with large patient populations that have shown significant improvement in short- and long-term patient symptoms following surgery. These outcomes are expected to improve with even greater refinement of technology, experience, and instrumentation, and the quality of future studies may be improved by determining and using objective measures of success and, possibly, by the use of control groups.

Genetics and phenotyping in chronic sinusitis

“…53 The increased ventilation of the sinuses is likely able to contribute to the therapeutic benefit observed after surgery because of a secondary reduction of HIF-1a and hypoxically induced inflammation and fibrosis. Furthermore, the increased ostial size allows for enhanced penetration of sinonasal irrigants.…”

Actual Concepts in Rhinosinusitis: A Review of Clinical Presentations, Inflammatory Pathways, Cytokine Profiles, Remodeling, and Management

“…The concept is to restore the aeration and drainage of the paranasal cavities while preserving healthy mucosa on the ethmoid roof and lamina papyracea. Postoperatively, most patients experience significant reductions in headache, nasal obstruction, and postnasal drip, and have improved quality-of-life scores [76][77][78]. In patients with asthma, functional endoscopic sinus surgery improves peak expiratory flow and reduces the use of inhaled and systemic glucocorticosteroids [79][80][81][82][83].…”

Effects of topical phenytoin on nasal wound healing after mechanical trauma: An experimental study

“…ESS is a common procedure, accounting for more than 50% of all ear, nose, and throat operations performed . The delayed mucosal healing of nasal cavity is one of the most frequent problems after ESS . These complications may block the normal mucociliary drainage pathways of the sinuses, causing the recurrence of chronic sinusitis.…”