Efficacy of Functional Endoscopic Sinus Surgery and Impact of Chronic Lung Disease on its Outcome in Patients of Chronic Rhinosinusitis

Abstract

Introduction

Chronic rhinosinusitis (CRS) is a common health condition affecting a significant proportion of population which results in considerable morbidity and deterioration in quality of life. Functional Endoscopic Sinus Surgery (FESS) has gained acceptance throughout the world as a procedure believed to improve the symptoms of chronic rhinosinusitis and consequently the general wellbeing of patients suffering from the condition. Patients with CRS are also known to have comorbidities. Chronic lung disease(CLD) i.e. bronchial asthma, COPD and chronic bronchitis are commonly associated with CRS. In view of the above, this study was carried out to determine the prevalence and severity of various symptom manifestations of chronic rhinosinusitis as well as to compare the symptomatic relief of the patients following surgery by regular follow ups and by using grading systems. This study also evaluated the impact of Chronic Lung Disease (CLD) on the outcome and complications of FESS.

Material & Method

This prospective longitudinal cohort study was carried out for 18 months’ duration with 50 patients amongst the patients attending the OPD of Otorhinolaryngology with chronic Rhinosinusitis following inclusion and exclusion criteria. A detailed history including associated CLD and other co-morbidities were documented. All the patients underwent pre-operative clinical, radiological and endoscopic evaluation followed by FESS. Post-operative follow up was done at 1week, 2 weeks, 4 weeks, 8 weeks, 3 months, 6 months, 9 months and 1year intervals for one year and assessment was done in respect to improvement of symptoms using grading scale where success is meant by complete resolution of symptoms or improvement of symptoms (score +1) and cases with no change of symptoms (score 0) or deterioration of symptoms (score -1) are said to be failures within 1 year of follow-up. Rates of complications were also assessed.

Results were analyzed using SPSS software.

Result

The mean age of this study population was 35.60 years with M: F ratio 1.27:1. Majority presented with symptoms of nasal obstruction with nasal discharge. FESS was found to be highly effective in reliving all symptoms- 88.89% for Nasal obstruction, 79.07% for Rhinorrhoea, 80.65% for Headache, 80% for Epistaxis, 75% for Facial pain/ pressure, except for smell dysfunction where it was found to be 53.57%. Among those 21 cases of OM unit patterns 13(61.9%) were successful after FESS. In case of sporadic form 9(69.2%), diffuse polyp form 6(60%), infundibular form 1(33.3%) and spheno-ethmoidal form 2(66.7%) were successful. The success rate among CLD patients was 66.6% and those who had no co-morbidities was 65.6 %. Similarly, the complication rate in CLD patients was 33.34% whereas in patients with no co-morbidities it was 31.25%.

Conclusion

The leading complaints within the symptom profile of patients with CRS are nasal obstruction with nasal discharge. FESS is highly effective treatment to relieve all major symptoms of CRS except smell dysfunction. This study also concludes that chronic lung disease has got no influence in the outcome and complications of FESS.