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Symptom Specific Outcomes of Endoscopic Sinus Surgery
Scientific Oral Presentations
Symptom Specific Outcomes of Endoscopic Sinus Surgery Jastin L Antisdel, MD (presenter); Raj Sindwani, MD, FRCS; Alexander C Chester, MD OBJECTIVE: 1) Learn the relative effectiveness of endoscopic sinus surgery (ESS) regarding improving individual major chronic rhinosinusitis (CRS) symptoms and headache. 2) Be able to more effectively counsel patients undergoing ESS. METHODS: A literature search of MEDLINE, EMBASE, Web of Science, Cochrane databases, and other Web-based sources from 1980-2008 was performed. Additional articles were identified by reviewing relevant bibliographies. Studies with more than 10 adult CRS patients that used symptom severity scores to analyze at least 4 major criteria (facial pressure, congestion, nasal obstruction, nasal discharge, and hyposmia/anosmia) or 3 major criteria as well as headache were included. 265 studies were identified and reviewed. 22 of these met inclusion criteria and their data were analyzed. After conversion of the symptom severity scores used in each study to a relative percent value, symptom categories were averaged, and compared in aggregate. RESULTS: This analysis included 1641 CRS patients (average of 74 pts/study). The patients were followed an average of 19.4 months (range, 1 week to 76 months) postoperatively. All
6 evaluated symptoms showed non-weighted, relative improvements in symptom scores. Overall, symptoms improved synchronously with a relative improvement over preoperative levels ranging from 27% to 36%. ESS provided the greatest relief from nasal obstruction (relative improvement of 36%), which was a significantly larger change than with facial pain (p⬍0.034) or nasal discharge (p⬍0.034). CONCLUSIONS: The relative improvement in major CRS symptoms and headache after surgery is similar. Nasal obstruction improves slightly more than facial pain and nasal discharge. The Role of Frontal Sinus Obliteration in the Era of FESS Nicolas BuSaba, MD (presenter); Stacey T. Gray, MD OBJECTIVE: To determine the current indications for osteoplastic frontal sinus obliteration (OFSO) for the treatment of inflammatory frontal sinus disease. METHODS: Retrospective case series from a single tertiary care facility. The medical records of 35 patients who underwent OFSO for chronic frontal sinusitis (n⫽26) and frontal sinus mucocele (n⫽9) between 1995 and 2007 were reviewed. Data regarding age, gender, date and nature of previous frontal sinus operation(s), pre-operative imaging, pre-operative diagnosis, and operative complications were culled. RESULTS: There were 19 males and 16 females with an age range of 19 to 76 years. All patients had pre-operative sinus CT, while 6 patients had additional MRI. Among the 9 patients diagnosed with frontal sinus mucocele, OFSO was first-line treatment in 8 and salvage for 2 failed endoscopic masupialization procedures in 1. Among the 26 patients with chronic frontal sinusitis, OFSO was first-line in 9 and salvage for failed frontal sinus surgery in 17. The failed surgeries were OFSO (n⫽7), Lynch procedure (n⫽2), and endoscopic frontal sinus surgery including drill-out (n⫽10). Five patients failed multiple previous operations. The failed operations dated from 1 to 33 years prior to the present illness in the case of OFSO, 1 to 4 years in the case of Lynch procedure, and 1 to 7 years in the case of endoscopic frontal sinus surgery. There was one reported complication (orbital hematoma). CONCLUSIONS: OFSO remains a key surgical treatment for frontal sinus mucocele, but is used more commonly as a salvage procedure for chronic frontal sinusitis.
Sleep Disorders Effectiveness of Pillar Implants in Snoring Management Joseph Clarke, Capt. (presenter); Marion B Gillespie, MD; Jacob E Smith, MD OBJECTIVE: Determine the effectiveness and complications
SCI. ORALS
eters are now available to dilate sinus ostia during endoscopic sinus surgery (ESS). Currently, balloon catheter position is confirmed under fluoroscopic visualization, which emits ionizing radiation. Radiation exposure has long been an area of concern. This study was initiated to determine radiation exposure to surgeons who used fluoroscopy with balloon catheters during ESS. METHODS: A multi-center, prospective evaluation of surgeon radiation exposure was conducted. For 3 months, each sinus surgeon (9 surgeons) wore 2 dosimeters to record radiation exposure when using C-arm fluoroscopy during surgery utilizing balloon catheter instruments. One dosimeter was placed at collar level (chest badge), outside the lead surgical apron and another dosimeter was placed on a finger (extremity badge). These dosimeters were sent for readings. Deep, eye, and shallow radiation dose for each surgeon was calculated. RESULTS: 9 chest badges recorded annualized averages of 104, 100, and 104 millirems for deep, eye, and shallow exposure respectively. 8 ring badges recorded 312 millirems. CONCLUSIONS: A recent publication has reported low levels of surgeon radiation exposure during a clinical study. This study further validates that radiation exposure among experienced surgeons is well below the annual occupational radiation exposure limit (Shallow Dose Equivalent) of 50,000 millirem. With vigilant technique and education, reliance on fluoroscopy can be minimized.
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Symptom Specific Outcomes of Endoscopic Sinus Surgery Jastin L Antisdel, MD (presenter); Raj Sindwani, MD, FRCS; Alexander C Chester, MD OBJECTIVE: 1) Learn the relative effectiveness of endoscopic sinus surgery (ESS) regarding improving individual major chronic rhinosinusitis (CRS) symptoms and headache. 2) Be able to more effectively counsel patients undergoing ESS. METHODS: A literature search of MEDLINE, EMBASE, Web of Science, Cochrane databases, and other Web-based sources from 1980-2008 was performed. Additional articles were identified by reviewing relevant bibliographies. Studies with more than 10 adult CRS patients that used symptom severity scores to analyze at least 4 major criteria (facial pressure, congestion, nasal obstruction, nasal discharge, and hyposmia/anosmia) or 3 major criteria as well as headache were included. 265 studies were identified and reviewed. 22 of these met inclusion criteria and their data were analyzed. After conversion of the symptom severity scores used in each study to a relative percent value, symptom categories were averaged, and compared in aggregate. RESULTS: This analysis included 1641 CRS patients (average of 74 pts/study). The patients were followed an average of 19.4 months (range, 1 week to 76 months) postoperatively. All
6 evaluated symptoms showed non-weighted, relative improvements in symptom scores. Overall, symptoms improved synchronously with a relative improvement over preoperative levels ranging from 27% to 36%. ESS provided the greatest relief from nasal obstruction (relative improvement of 36%), which was a significantly larger change than with facial pain (p⬍0.034) or nasal discharge (p⬍0.034). CONCLUSIONS: The relative improvement in major CRS symptoms and headache after surgery is similar. Nasal obstruction improves slightly more than facial pain and nasal discharge. The Role of Frontal Sinus Obliteration in the Era of FESS Nicolas BuSaba, MD (presenter); Stacey T. Gray, MD OBJECTIVE: To determine the current indications for osteoplastic frontal sinus obliteration (OFSO) for the treatment of inflammatory frontal sinus disease. METHODS: Retrospective case series from a single tertiary care facility. The medical records of 35 patients who underwent OFSO for chronic frontal sinusitis (n⫽26) and frontal sinus mucocele (n⫽9) between 1995 and 2007 were reviewed. Data regarding age, gender, date and nature of previous frontal sinus operation(s), pre-operative imaging, pre-operative diagnosis, and operative complications were culled. RESULTS: There were 19 males and 16 females with an age range of 19 to 76 years. All patients had pre-operative sinus CT, while 6 patients had additional MRI. Among the 9 patients diagnosed with frontal sinus mucocele, OFSO was first-line treatment in 8 and salvage for 2 failed endoscopic masupialization procedures in 1. Among the 26 patients with chronic frontal sinusitis, OFSO was first-line in 9 and salvage for failed frontal sinus surgery in 17. The failed surgeries were OFSO (n⫽7), Lynch procedure (n⫽2), and endoscopic frontal sinus surgery including drill-out (n⫽10). Five patients failed multiple previous operations. The failed operations dated from 1 to 33 years prior to the present illness in the case of OFSO, 1 to 4 years in the case of Lynch procedure, and 1 to 7 years in the case of endoscopic frontal sinus surgery. There was one reported complication (orbital hematoma). CONCLUSIONS: OFSO remains a key surgical treatment for frontal sinus mucocele, but is used more commonly as a salvage procedure for chronic frontal sinusitis.
Sleep Disorders Effectiveness of Pillar Implants in Snoring Management Joseph Clarke, Capt. (presenter); Marion B Gillespie, MD; Jacob E Smith, MD OBJECTIVE: Determine the effectiveness and complications
SCI. ORALS
eters are now available to dilate sinus ostia during endoscopic sinus surgery (ESS). Currently, balloon catheter position is confirmed under fluoroscopic visualization, which emits ionizing radiation. Radiation exposure has long been an area of concern. This study was initiated to determine radiation exposure to surgeons who used fluoroscopy with balloon catheters during ESS. METHODS: A multi-center, prospective evaluation of surgeon radiation exposure was conducted. For 3 months, each sinus surgeon (9 surgeons) wore 2 dosimeters to record radiation exposure when using C-arm fluoroscopy during surgery utilizing balloon catheter instruments. One dosimeter was placed at collar level (chest badge), outside the lead surgical apron and another dosimeter was placed on a finger (extremity badge). These dosimeters were sent for readings. Deep, eye, and shallow radiation dose for each surgeon was calculated. RESULTS: 9 chest badges recorded annualized averages of 104, 100, and 104 millirems for deep, eye, and shallow exposure respectively. 8 ring badges recorded 312 millirems. CONCLUSIONS: A recent publication has reported low levels of surgeon radiation exposure during a clinical study. This study further validates that radiation exposure among experienced surgeons is well below the annual occupational radiation exposure limit (Shallow Dose Equivalent) of 50,000 millirem. With vigilant technique and education, reliance on fluoroscopy can be minimized.
P81