Vol.95 No.7 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 95 No. 7 July 2002
Clinical Efficacy of Endoscopic Sinus Surgery
for Chronic Sinusitis
Naoki Otsuki and Kazuo Kumoi
(Himeji National Hospital)
Yasuji Teramoto
(Takatsuki Hospital)
Functional endoscopic sinus surgery (FESS) is the surgical treatment of choice in chronic sinusitis for many physicians.
We evaluated subjective and objective improvement in patients undergoing first-time FESS over a 5-year period. Eighty-seven patients were followed for mean of 11 months (range 3 months to 45 months). A retrospective analysis was performed using the patient's medical records. Outcomes analyzed included pre- and postoperative clinical symptoms (nasal obstruction, nasal discharge, postnasal discharge, headache, olfactory disturbance), preoperative computed tomographic (CT) findings and postoperative endoscopic findings of maxillary and ethmoid sinuses.
The most common presenting complaint was nasal obstruction, followed by nasal discharge and olfactory disturbance. Clinical symptoms improved in 94％ of the patients subjectively. However, the cure rate of olfactory disturbance and postnasal discharge was below 70％. In the objective endoscopic findings, 87％ of patients obtained a good outcome. Residual or recurrent polyposis was noted in 12 (13％) of the 87 patients. Four patients with persistent symptoms underwent revision FESS. The extent of disease on CT was classified into four groups according to Kennedy's staging system. Patients with severe disease (stage III-IV) had a worse outcome than patients with mild/moderate disease (stage I-II) but this difference was not significant. Seventeen patients with allergic rhinitis and/or asthma had a worse objective outcome than patients without allergic rhinitis and asthma but this difference was not significant. There was no significant difference in subjective outcome between patients with and without allergic rhinitis and/or asthma. The finding in this study suggest that factors affecting outcome after FESS included the CT stage of disease, allergic rhinitis and asthma, but that FESS improved in terms of subjective symptoms in patients with severe disease and with allergic rhinitis and asthma.
Key words : chronic sinusitis, functional endoscopic sinus surgery (FESS), postoperative evaluation