Embedded Files
collateral damage to surrounding sinus tissue and bone (83). Studies have also demonstrated the use of balloon catheter dilation under local anesthesia, which raises the possibility for use in the office setting (84, 85). However, limitations of the technique include the inability to address ethmoid sinus disease and to remove nasal polyps (86). The combination of careful surgical intervention (FESS) and postoperative medical therapy can have profound long-term benefits on both CRS and asthma, with significant long-term reductions in medical therapy. Khalid and coworkers (87) examined 150 postoperative patients and found that functional endoscopic sinus surgery was effective at maintaining a significant improvement (P , 0.05) in overall general health status of patients more than 3 years after surgical intervention. Furthermore, overall scores on the SF-36 quality-of-life questionnaire returned to a range of normative values for the general population. A prospective study by Gliklich and Metson (88) reviewed 108 patients undergoing ethmoidectomy and found that after 1 year, significant improvements were noted in 82% of patients. In these patients symptoms improved, and medication usage decreased. Others have shown that endoscopic sinus surgery improves postoperative olfactory function (89) and reduces bodily pain (90), asthma (91), and fatigue (92). Bradley and Kountakis (93) reported on 113 adult patients with 1 year of clinical follow-up after ESS. They found that a significant reduction in SNOT-20 symptom scores was achieved after endoscopic sinus surgery as early as 3 months after surgery, with an effect that remained significant after 1 year. Similar studies by Levine (94), Cohen and Kennedy (79), and Stammberger and Posawetz (80) revealed significant improvements after FESS as well, even as long as 10 years after surgery. CONCLUSION CRS remains a highly prevalent disease with a major impact on overall quality of life. Significant advances in medical and Figure 6. Intraoperative view with computed tomography (CT) image guidance of the left frontal sinus. *Indicates roof of left frontal sinus; #indicates tip of image guidance probe, which corresponds to cross-hairs on triplanar CT images. Figure 7. Postoperative endoscopic view in a different patient of the frontal sinuses after removal of the frontal intersinus septum creating a common frontal sinus cavity (Draf III or endoscopic modified Lothrop). FS 5 frontal sinus; S 5 nasal septum; *Indicates right orbital wall. 138 PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY VOL 8 2011 surgical therapy have not only reduced morbidity and improved the overall results of intervention but also provided long-term benefit when effectively combined. Current treatments aim to reduce inflammation with the goal of restoring normal sinus physiology. However, there remains significant work to be done to better understand the pathogenesis of the spectrum of disorders currently considered as CRS. Ongoing study in this common disorder will undoubtedly provide greater insight into the pathophysiology of this disease and improve outcomes. Author Disclosure: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. References 1. Benninger MS, Ferguson BJ, Hadley JA. Adult chronic rhinosinusitis: definitions, diagnosis, epidemoiology, and pathophysiology. Otolaryngol Head Neck Surg 2003;129:S1–S32. 2. Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, Gelzer A, Hamilos D, Haydon RC 3rd, Hudgins PA, et al. Clinical practice guidelines on adult sinusitis. Otolaryngol Head Neck Surg 2007;137:375–377. 3. Meltzer EO, Hamilos DL, Hadley JA. Rhinosinusitis:
Report abuse