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Quality of life improvement in patients with chronic sinusitis after functional endoscopic sinus surgery
Otolaryngology Head and Neck Surgery P 148
August 1996
Scientific Sessions-- Wednesday
the authors discuss their experience with the use of this "hybrid" technique in 100 patients. 8:08 AM
Sinusitis in Intensive Care Patients: What is the Role of Antral Puncture? HASSAN H. RAMADAN, MD, ROBERT M. OWENS, MD (presenter), CHRISTOPHER TIU, and MARK K. WAX, MD, Morgantown, W.V.
Objective: To determine when a maxillary sinus puncture is indicated and whether it has an impact on outcome in patients in the intensive care unit (ICU). Study Design: Retrospective review of all ICU patients who underwent maxillary sinus puncture between January 1991 and December 1994. Data: Forty-four patients were identified. The majority were trauma patients (41%). All patients had findings on plain sinus films or CT scans of the sinuses. Forty of 44 patients were febrile, and 48% of them had associated wound infections. Fifty-eight percent had nasogastric tubes. Twenty-four punctures (54.5%) recovered pus, of which 83.3% grew organisms. Fourteen patients (32%) had a negative lavage, of which 21% grew organisms (p < 0.0001). Sixty-eight percent of the cultures identified a single organism compared with 32% with multiple organisms. Gram negative organisms were most commonly found, followed by anaerobes. In only 50% of the cases, antibiotic therapy was changed. In 73% of the cases the change was directed by the culture result, and in 27% it was changed despite a negative culture (p < 0.05). Resolution of symptoms occurred with a mean of 12.3 days, and no notable differences were demonstrated when the culture was positive or whether the antibiotics were changed. Conclusion: A sinus puncture seems to be helpful in patients with fever and air fluid levels on sinus films. If pus is obtained by maxillary puncture, a positive culture resulted in 84% of the cases. However, changes in antibiotic regimens based on culture results did not seem to affect outcome. 8:16 AM
Transsphenoidal Hypophysectomy Using the Acustar I BRIAN B. BURKEY,MD, MATTHEW SPEYER,MD (presenter), ROBERT J. MAClUNAS, MD, and GEORGE ALLEN, MD, Nashville, Tenn.
Objective: Advances in imaging resolution have resulted in superior visualization of intracranial lesions. Because of the inherent complexity of these lesions, intraoperative localization techniques are required. Currently, C-arm fluorography provides only two-dimensional localization for these lesions. The recently described ACUSTAR I system is an interactive, image-guided device that allows three-dimensional localization with a degree of accuracy previously unattainable. We assessed the clinical utility of the ACUSTAR I for intraoperative spatial confirmation during transsphenoidal approaches to pituitary lesions.
Methods: Six patients underwent transsphenoidal approaches to pituitary lesions in conjunction with the ACUSTAR I. The spatial relationships were clinicallyjudged intraoperatively by the surgeon and compared with the ACUSTAR I results. Results: In all six patients the ACUSTAR I correctly displayed the surgical orientation and provided localization to within less than 1 mm. In one patient this facilitated the redirection of a deviated approach. There were no complications associated with the use of this image-guided device. Conclusions: The ACUSTAR I system is useful in displaying accurate, three-dimensional anatomic relationships during transsphenoidal approaches to pituitary lesions. This system provides critical information intraoperatively to redirect deviated approaches and prevent significant morbidity. 8:24 AM
Discussion 8:30 AM
Quality of Life Improvement In Patients With Chronic Sinusitis After Functional Endoscopic Sinus Surgery STEFAN M. ZECHOWY and JOHN F. BIEDLINGMAIER, MD, Baltimore, Md.
Objective: Many otolaryngologists consider functional endoscopic sinus surgery (FESS) to be the treatment of choice for patients with severe chronic sinusitis who do not respond to medical therapy. This study evaluates the improvement of quality of life after FESS using a reliable, validated questionnaire. Methods: Forty-one preoperative FESS candidates from two centers were given the SF-36 questionnaire to measure quality of life in eight categories: physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, and mental health. These scores of the surgical candidates in each category were then compared with 41 patients who had FESS between the last 6 months and 4 years and who did not have another confounding illness. Results: Each of the eight categories listed above has a numerical score computed from each questionnaire, ranging from 0 to 100, with 0 representing the lowest quality of life and 100 representing the highest. The average preoperative scores were 75.09, 45.16, 52.32, 56.28, 42.31, 68.14, 61.29, and 66.58, respectively. The average postoperative scores were 87.78, 76.25, 67.64, 65.95, 57.92, 79.06, 83.33, and 73.27, respectively. The average score increase of the postoperative patients was 15.5, or 27%, over the preoperative patients. Conclusions: Chronic sinusitis affects many aspects of a patient's life, including physical, mental, and emotional. Relief from chronic sinusitis can greatly improve the quality of life of suffering patients. Functional endoscopic sinus surgery provides the relief that can enable a patient to experience better overall quality of life.
August 1996
Scientific Sessions-- Wednesday
the authors discuss their experience with the use of this "hybrid" technique in 100 patients. 8:08 AM
Sinusitis in Intensive Care Patients: What is the Role of Antral Puncture? HASSAN H. RAMADAN, MD, ROBERT M. OWENS, MD (presenter), CHRISTOPHER TIU, and MARK K. WAX, MD, Morgantown, W.V.
Objective: To determine when a maxillary sinus puncture is indicated and whether it has an impact on outcome in patients in the intensive care unit (ICU). Study Design: Retrospective review of all ICU patients who underwent maxillary sinus puncture between January 1991 and December 1994. Data: Forty-four patients were identified. The majority were trauma patients (41%). All patients had findings on plain sinus films or CT scans of the sinuses. Forty of 44 patients were febrile, and 48% of them had associated wound infections. Fifty-eight percent had nasogastric tubes. Twenty-four punctures (54.5%) recovered pus, of which 83.3% grew organisms. Fourteen patients (32%) had a negative lavage, of which 21% grew organisms (p < 0.0001). Sixty-eight percent of the cultures identified a single organism compared with 32% with multiple organisms. Gram negative organisms were most commonly found, followed by anaerobes. In only 50% of the cases, antibiotic therapy was changed. In 73% of the cases the change was directed by the culture result, and in 27% it was changed despite a negative culture (p < 0.05). Resolution of symptoms occurred with a mean of 12.3 days, and no notable differences were demonstrated when the culture was positive or whether the antibiotics were changed. Conclusion: A sinus puncture seems to be helpful in patients with fever and air fluid levels on sinus films. If pus is obtained by maxillary puncture, a positive culture resulted in 84% of the cases. However, changes in antibiotic regimens based on culture results did not seem to affect outcome. 8:16 AM
Transsphenoidal Hypophysectomy Using the Acustar I BRIAN B. BURKEY,MD, MATTHEW SPEYER,MD (presenter), ROBERT J. MAClUNAS, MD, and GEORGE ALLEN, MD, Nashville, Tenn.
Objective: Advances in imaging resolution have resulted in superior visualization of intracranial lesions. Because of the inherent complexity of these lesions, intraoperative localization techniques are required. Currently, C-arm fluorography provides only two-dimensional localization for these lesions. The recently described ACUSTAR I system is an interactive, image-guided device that allows three-dimensional localization with a degree of accuracy previously unattainable. We assessed the clinical utility of the ACUSTAR I for intraoperative spatial confirmation during transsphenoidal approaches to pituitary lesions.
Methods: Six patients underwent transsphenoidal approaches to pituitary lesions in conjunction with the ACUSTAR I. The spatial relationships were clinicallyjudged intraoperatively by the surgeon and compared with the ACUSTAR I results. Results: In all six patients the ACUSTAR I correctly displayed the surgical orientation and provided localization to within less than 1 mm. In one patient this facilitated the redirection of a deviated approach. There were no complications associated with the use of this image-guided device. Conclusions: The ACUSTAR I system is useful in displaying accurate, three-dimensional anatomic relationships during transsphenoidal approaches to pituitary lesions. This system provides critical information intraoperatively to redirect deviated approaches and prevent significant morbidity. 8:24 AM
Discussion 8:30 AM
Quality of Life Improvement In Patients With Chronic Sinusitis After Functional Endoscopic Sinus Surgery STEFAN M. ZECHOWY and JOHN F. BIEDLINGMAIER, MD, Baltimore, Md.
Objective: Many otolaryngologists consider functional endoscopic sinus surgery (FESS) to be the treatment of choice for patients with severe chronic sinusitis who do not respond to medical therapy. This study evaluates the improvement of quality of life after FESS using a reliable, validated questionnaire. Methods: Forty-one preoperative FESS candidates from two centers were given the SF-36 questionnaire to measure quality of life in eight categories: physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, and mental health. These scores of the surgical candidates in each category were then compared with 41 patients who had FESS between the last 6 months and 4 years and who did not have another confounding illness. Results: Each of the eight categories listed above has a numerical score computed from each questionnaire, ranging from 0 to 100, with 0 representing the lowest quality of life and 100 representing the highest. The average preoperative scores were 75.09, 45.16, 52.32, 56.28, 42.31, 68.14, 61.29, and 66.58, respectively. The average postoperative scores were 87.78, 76.25, 67.64, 65.95, 57.92, 79.06, 83.33, and 73.27, respectively. The average score increase of the postoperative patients was 15.5, or 27%, over the preoperative patients. Conclusions: Chronic sinusitis affects many aspects of a patient's life, including physical, mental, and emotional. Relief from chronic sinusitis can greatly improve the quality of life of suffering patients. Functional endoscopic sinus surgery provides the relief that can enable a patient to experience better overall quality of life.