Endoscopic Surgery Effectively Relieves Sinusitis Symptoms

Functional endoscopic sinus surgery (FESS) can significantly relieve symptoms of chronic rhinosinusitis (inflammation of the sinus cavities), according to a new study.

Researchers at Georgetown University Medical Center (GUMC, Washington, DC, USA) and St. Louis University School of Medicine (MI, USA) conducted a meta-analysis of symptom relief following sinus surgery, examining 21 different published studies which included a total of 2,070 patients, and analyzed improvement for each symptom usually associated with chronic sinusitis, including nasal obstruction, facial pain, postnasal discharge, headaches, and impaired smell. The researchers assessed symptom relief using two different measures; a measurement called "effect size", where any effect greater than 0.8 is considered a large effect; and a second measurement, which is less accurate but more commonly used, that compares the percent of improvement in symptoms after surgery compared to the situation before surgery.

The researchers found that with a 1.73 effect size, nasal obstruction improved the most, followed by postnasal discharge (1.19), facial pain (1.13), headache relief (.98) and improvement in smell (.97). Percentage improvements pre- and post-surgery were 61% in facial pain, 59% in nasal obstruction, 53% in headache, 49% in smell, and 47% in postnasal discharge. The researchers also found that improvements do not decrease over time, as some smaller studies had suggested. The study was published in the In the May 2009 issue of Otolaryngology Head Neck Surgery.

"Reports of relative symptom relief vary across studies, so it was important to pool the study results. We wanted to know not only if symptoms improve overall, but if they improve to a similar degree, and if these benefits last,” said lead author Alexander Chester, M.D., a physician and clinical professor at GUMC. "Our findings offer reassurance that, with minor exceptions, individual symptoms usually improve substantially and similarly following surgery.”

FESS is the mainstay in the surgical treatment of sinusitis and nasal polyposis, including fungal sinusitis. The procedure uses nasal endoscopes (with Hopkins rod lens telescopes) to minimize cutting and trauma to the skin. The endoscopes have diameters of 4 mm and 2.7 mm and come in varying angles of vision, providing good illumination of the inside of the head. There are four sinuses dealt with by means of this surgery: The frontal sinus with frontal recess dissection, the maxillary by uncinectomy and antrostomy, the anterior and posterior ethmoids, which require careful dissection to the skullbase and orbital lamina, and finally the sphenoid sinus which is managed via a sphenoidotomy. Extreme care is required due to the paranasal sinus' proximity to the orbits, brain, internal carotid arteries, and optic nerves.

Related Links:
Georgetown University Medical Center
St. Louis University School of Medicine