Prospective analysis of sinus symptoms and correlation with CT scan

OtolaryngologyHead and Neck Surgery Scientific Sessions--Monday

Volume 121 Number 2

ferred surgical technique for sinus disease. This technique has been improved by adding constant warm sinus irrigation and a contact YAG laser. Using both subjective and objective criteria, this study evaluates the effects of saline sinus irrigation, no local anesthesia, no vasoconstrictors, and the contact laser. Methods: For 2 years, 118 patients had preoperative and postoperative evaluations. The results of these patients were collected, evaluated, and compared with results of regular endoscopic sinus surgery. Results: The improved visual surgical field, control of bleeding, and vasoconstriction without medication produced a greatly improved procedure. The recurrence rate was less than 5% after 2 years. Conclusion: Constant sinus irrigation with the use of a contact YAG laser is an effective technique to perform sinus surgery. The vasoconstriction and improved visual surgical field using the warm irrigation enable the surgeon to perform total sinus surgery with added safety. Because of less postoperative pain, minimal bleeding, and no nasal packing, the patients were more pleased than regular endoscopic sinus surgery patients. 8:16 AM

Prospective Analysis of Sinus Symptoms and Correlation with CT Scan THOMAS KENNY MD (presenter); ALTAN YILDIRIM MD; JAMES A DUNCAVAGE MD; JAMES BRACIKOWSKI MD; JOHN J MURRAY MD; S BOBO TANNER MD; Antioch TN; Nashville TN; Nashville TN; Nashville TN; Nashville TN; Nashville TN

Objectives: The symptoms of sinusitis and the findings of CT scan evidence of sinusitis have been reported to have no' correlation. The Vanderbilt Asthma and Allergy Program (ASAP) uses symptom severity score protocols to evaluate and treat sinusitis. Using the ASAP system, a prospective study was designed to search for any dependency between sinus Symptoms and CT evidence of sinusitis. Methods: Patients with recurrent acute and chronic sinusitis rated their symptoms from 0 to 6 on a Likert severity scale and had a CT scan of the sinuses taken the same day. All CT scans were read using a standardized CT reading system. Result: On CT scan 122 patients were found to have sinusitis and 169 patients did not have sinusitis. When these severity scores were compared with the CT scan, no correlation of severity of symptoms and CT scan evidence was found. Conclusion: Otolaryngologists nmst be aware that severity of sinus symptoms does not correlate with CT scan findings of sinusitis. The use of a CT scan may be necessary to identify the presence and degree of sinusitis. 8:30 AM

Infections Following Endoscopic Polypectomy Using Nasal Steroids DANIEL BROSS-SORIANO MD (presenter); JOSE R ARRIETAGOMEZ MD; Mexico City Mexico

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Objectives: Beclomethasone dipropionate and fluticasone propionate are topical nasal nonabsorbable steroids that have been used in the treatment of such pathologies as rhinitis and polyposis. Mostapha reported the increase of infection with the use of fluticasone in the postoperative treatment of polypectomy. This study was designed to determine the incidence of nose and sinus infections after endoscopic polypectomy with the use of nasal steroids. Methods: Forty-five patients with the indication of polypectomy were randomly divided in 3 groups of 15 patients each. The patients from the first group were treated with saline lavages only, patients from the second group also received fluticasone propionate 400 gg a day in nasal spray, and the patients of the third group received beclomethasone dipropionate 600 Ixg a day after lavages. The prevalence of infections and recurrence of polyposis in the 3 groups were compared. Results': None of the patients from the 3 groups developed infections during the first 3 months of the postoperative period. The recurrence of polyps in the group without steroids was 46% as compared with 7% in the patients treated with fluticasone and 13% in the patients with beclomethasone with a minimum follow-up of 18 months. Conclusion: The use of nasal nonabsorbable steroids does not appear to increase the prevalence of infections after endoscopic polypectomy, contrary to what was reported by Mostapha in 1996. 8:38 AM

Middle furbinate Medialization and Preservation in ESS MICHAEL FRIEDMAN MD (presenter); HASAN M TANYERI MD; ROY LANDSBERG MD; DAVID D CALDARELLI MD; Chicago IL

Objective~Hypothesis: The fate of the middle turbinate in endoscopic sinus surgery (ESS) remains controversial. In spite of obvious theoretical benefits of turbinate preservation, surgeons often resect part of the middle turbinate to avoid the most common complication of ESS, lateral synechia formation. In an attempt to prevent lateral synechia of the middle turbinate, we have developed a simple technique to preserve and medialize the middle turbinate. Methods: Five hundred consecutive patients underwent endoscopic sinus surgery (ESS) with middle turbinate medialization and preservation. The caudal end of the middle turbinate and the opposing septal mucosa was abraded with a microdebrider for controlled synechia formation in an attempt to avoid lateralization of the middle turbinate. Results: All patients were assessed for medial or lateral synechia formation, complications, and failure to control infections; 95% of the patients had successful middle turbinate medialization with a well-defined synechia between the septum and the middle turbinate at 4 weeks after surgery. Follow-up ranged from 2 to 9 months (mean 3.5 months). We achieved an 88% success rate in preventing lateral synechia;