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Endoscopic sinus surgery in previously irradiated patients
P 138
Otolaryngology Head and Neck Surgery August 1997
Research Forum -- Tuesday
egy. From this study, we hypothesize that disease of the middle turbinate and nasal cavity precedes the invasion of deeper tissues in the majority of cases: Therefore a thorough evaluation and biopsy of the nasal cavity in high-risk patients is important in the overall treatment strategy even in the absence of clinical or radiographic sinusitis. Poster 38
Endoscopic Sinus Surgery in Previously Irradiated Patients FRANCISCO J. CIVANTOS, Jr., MD, FACS (presenter), and ADY YOSCOVITCH, MD, Miami, Fla., and Montreal, Quebec, Canada
The treatment of a variety of malignancies can require radiation therapy without surgery to the paranasal sinuses. Our literature review has revealed no information regarding the safety and efficacy of endoscopic sinus surgery in previously irradiated patients. Our purpose was to evaluate the safety and efficacy of endoscopic sinus surgery in irradiated patients with absolute indications for sinus surgery. Seven patients presented at a tertiary center with significant sinus infections in the absence of tumor recurrence. Surgical interventions included ethmoidectomy, multiple osteotomies, debridement of scarred or devitalized tissue, and dacryocystorhinostomy. Outcome measures included intraoperative findings and complications, length of hospital stays, endoscopic assessments of healing over 6 months postoperatively, and improvement of persistence of symptoms over 2 to 3 years of follow-up. Results indicated that surgery was more technically difficult due to derangements of normal anatomy. No major complications occurred. Bleeding problems, prolonged admission, and delayed healing were noted in certain cases. We conclude that previous irradiation is not a contraindication to endoscopic sinus procedures in appropriate patients, but greater caution is advisable in these cases. Poster 39
Symptomatic Exacerbations of Chronic Sinus Disease Following Functional Endoscopic Sinus Surgery: Role of Viral Infections KAREN A. HAUNSS, MD (presenter), CHARLES W. GROSS, MD, JACK M. GWALTNEY, Jr., MD, J. OWEN HENDLEY, MD, and BIRGITWINTHER, MD, Charlottesville, Va.
A small proportion of patients with chronic sinus disease who have undergone functional endoscopic sinus surgery (FESS) continue to experience symptomatic exacerbations, the cause of which is unknown. The possibility that common respiratory viral infections may be responsible for some of these exacerbations has not been explored. A cohort of 20 adult post-FESS patients were contacted weekly by telephone throughout the winter season (December 1995 to March 1996) to monitor for upper respiratory tract symptoms. Symptomatic patients had two samples for viral cultures collected from the sinuses and nasopharynx.
Secretions from the maxillary sinus were obtained endoscopically by aspiration with a curved suction through a patent postsurgical antrostomy site. Nasopharyngeal secretions were obtained by way of the mouth using a culture swab with a bent shaft. Each sample was eluted into viral collection broth and stored at -70 ~ C prior to viral identification. Human rhinovirus was identified by examining for cytopathic effect in the human embryonic lung cell fibroblast cell lines (WI-38) and adenovirus and parainflnenza virus in human lung carcinoma cells (549). In addition, all samples were tested by in vitro enzyme immunoassay membrane test for rapid detection of influenza A (Flu A) viral antigen (Directigen Flu A, Becton Dickinson) and respiratory syncytial virus antigen (Testpack RSV, Abbot Laboratories). Twenty-two episodes of symptomatic illness were experienced by 14 patients. Five samples from three patients were positive for viruses. Respiratory syncytial virus and Flu A were detected in both the sinus and nasopharynx samples, whereas human rhinovirus was detected only in the nasopharynx sample. No adenovirus or parainfluenza virus infections were detected. This study showed that 14% of symptomatic exacerbations in patients with chronic sinus disease after FESS were associated with respiratory viral infections. Poster 40
The Role of Nitric Oxide in an Animal Model of Nasal Allergy WILLIAM DURLAND, MSIV (presenter), JIRI PRAZMA, MD, PhD, KENNETH JOHNSON, MSIV, TIMOTHYSMITH, MD, ANDREW LANE, MD, and HAROLD C. PILLSBURYt11,MD, Chapel Hill, N.C., and Nashville, Tenn.
Objective: Previous research in our laboratory has demonstrated that nitric oxide (NO) is a mediator of vascular exudation in the contralateral response to a histamine challenge (i.e., the "naso-nasal" reflex). We propose to investigate the role of NO in a true model of allergy by stimulating the entire mucosal surface of the nose with allergen in "allergic" rats that have been actively sensitized to the protein ovalbumin. Methods: We developed a rat model of allergic rhinitis to investigate the role of NO in the nasal allergic response. Brown Norway rats were sensitized to ovalbumin and then challenged with a solution of ovalbumin by continuous perfusion of the nose. L-NAME, a competitive inlaibitor of nitric oxide synthase (the enzyme that catalyzes the formation of NO) was then perfused along with the allergen. In each experiment, nasal lavage samples were collected after each test solution had been administered. Albumin (an indicator of vascular exudation) and mucin (an indicator of glandular secretion) were measured by enzyme-linked immunosorbent assay (ELISA). Results: Preliminary data shows that L-NAME, when added to a challenge solution of ovalbumin, inhibits both vascular exudation and mucin secretion in Brown Norway rats sensitized to ovalbumin. Conclusion: These data indicate that NO is a mediator of both vascular exudation and glandular secretion in an animal model of nasal allergy.
Otolaryngology Head and Neck Surgery August 1997
Research Forum -- Tuesday
egy. From this study, we hypothesize that disease of the middle turbinate and nasal cavity precedes the invasion of deeper tissues in the majority of cases: Therefore a thorough evaluation and biopsy of the nasal cavity in high-risk patients is important in the overall treatment strategy even in the absence of clinical or radiographic sinusitis. Poster 38
Endoscopic Sinus Surgery in Previously Irradiated Patients FRANCISCO J. CIVANTOS, Jr., MD, FACS (presenter), and ADY YOSCOVITCH, MD, Miami, Fla., and Montreal, Quebec, Canada
The treatment of a variety of malignancies can require radiation therapy without surgery to the paranasal sinuses. Our literature review has revealed no information regarding the safety and efficacy of endoscopic sinus surgery in previously irradiated patients. Our purpose was to evaluate the safety and efficacy of endoscopic sinus surgery in irradiated patients with absolute indications for sinus surgery. Seven patients presented at a tertiary center with significant sinus infections in the absence of tumor recurrence. Surgical interventions included ethmoidectomy, multiple osteotomies, debridement of scarred or devitalized tissue, and dacryocystorhinostomy. Outcome measures included intraoperative findings and complications, length of hospital stays, endoscopic assessments of healing over 6 months postoperatively, and improvement of persistence of symptoms over 2 to 3 years of follow-up. Results indicated that surgery was more technically difficult due to derangements of normal anatomy. No major complications occurred. Bleeding problems, prolonged admission, and delayed healing were noted in certain cases. We conclude that previous irradiation is not a contraindication to endoscopic sinus procedures in appropriate patients, but greater caution is advisable in these cases. Poster 39
Symptomatic Exacerbations of Chronic Sinus Disease Following Functional Endoscopic Sinus Surgery: Role of Viral Infections KAREN A. HAUNSS, MD (presenter), CHARLES W. GROSS, MD, JACK M. GWALTNEY, Jr., MD, J. OWEN HENDLEY, MD, and BIRGITWINTHER, MD, Charlottesville, Va.
A small proportion of patients with chronic sinus disease who have undergone functional endoscopic sinus surgery (FESS) continue to experience symptomatic exacerbations, the cause of which is unknown. The possibility that common respiratory viral infections may be responsible for some of these exacerbations has not been explored. A cohort of 20 adult post-FESS patients were contacted weekly by telephone throughout the winter season (December 1995 to March 1996) to monitor for upper respiratory tract symptoms. Symptomatic patients had two samples for viral cultures collected from the sinuses and nasopharynx.
Secretions from the maxillary sinus were obtained endoscopically by aspiration with a curved suction through a patent postsurgical antrostomy site. Nasopharyngeal secretions were obtained by way of the mouth using a culture swab with a bent shaft. Each sample was eluted into viral collection broth and stored at -70 ~ C prior to viral identification. Human rhinovirus was identified by examining for cytopathic effect in the human embryonic lung cell fibroblast cell lines (WI-38) and adenovirus and parainflnenza virus in human lung carcinoma cells (549). In addition, all samples were tested by in vitro enzyme immunoassay membrane test for rapid detection of influenza A (Flu A) viral antigen (Directigen Flu A, Becton Dickinson) and respiratory syncytial virus antigen (Testpack RSV, Abbot Laboratories). Twenty-two episodes of symptomatic illness were experienced by 14 patients. Five samples from three patients were positive for viruses. Respiratory syncytial virus and Flu A were detected in both the sinus and nasopharynx samples, whereas human rhinovirus was detected only in the nasopharynx sample. No adenovirus or parainfluenza virus infections were detected. This study showed that 14% of symptomatic exacerbations in patients with chronic sinus disease after FESS were associated with respiratory viral infections. Poster 40
The Role of Nitric Oxide in an Animal Model of Nasal Allergy WILLIAM DURLAND, MSIV (presenter), JIRI PRAZMA, MD, PhD, KENNETH JOHNSON, MSIV, TIMOTHYSMITH, MD, ANDREW LANE, MD, and HAROLD C. PILLSBURYt11,MD, Chapel Hill, N.C., and Nashville, Tenn.
Objective: Previous research in our laboratory has demonstrated that nitric oxide (NO) is a mediator of vascular exudation in the contralateral response to a histamine challenge (i.e., the "naso-nasal" reflex). We propose to investigate the role of NO in a true model of allergy by stimulating the entire mucosal surface of the nose with allergen in "allergic" rats that have been actively sensitized to the protein ovalbumin. Methods: We developed a rat model of allergic rhinitis to investigate the role of NO in the nasal allergic response. Brown Norway rats were sensitized to ovalbumin and then challenged with a solution of ovalbumin by continuous perfusion of the nose. L-NAME, a competitive inlaibitor of nitric oxide synthase (the enzyme that catalyzes the formation of NO) was then perfused along with the allergen. In each experiment, nasal lavage samples were collected after each test solution had been administered. Albumin (an indicator of vascular exudation) and mucin (an indicator of glandular secretion) were measured by enzyme-linked immunosorbent assay (ELISA). Results: Preliminary data shows that L-NAME, when added to a challenge solution of ovalbumin, inhibits both vascular exudation and mucin secretion in Brown Norway rats sensitized to ovalbumin. Conclusion: These data indicate that NO is a mediator of both vascular exudation and glandular secretion in an animal model of nasal allergy.