An audit of endoscopic sinus surgery

A prospective study was carried out to evaluate the results of endoscopic sinus surgery based on symptom score and endoscopic findings and to evaluate the prognostic factors using an audit form designed by IS Mackay of London.

Consecutive cases undergoing endoscopic sinus surgery were entered into the study. Pre-operative symptom, computer tomographic and endoscopic scores were recorded. Operations were also evaluated objectively; post-operative symptom and endoscopic scores were recorded at 3, 6 and 12 months. Cases lost to follow-up were interviewed over the telephone and offered free endoscopic assessments. Those who required revision surgery were considered failures and re-entered into the study.

The study comprised 113 cases (108 patients, 60 males and 48 females) with ages ranging from 14 to 80 years (mean 40.4). There were 52 with chronic rhinosinusitis, 46 with nasal polyps, 7 with tumours/inverted papillomata, 5 with acute complicated sinusitis and 3 with fungal sinusitis. Of these, 81.9% of patients with chronic rhinosinusitis or polyps showed an overall improvement of symptoms. Nasal obstruction showed the greatest improvement, followed by rhinorrhoea, loss of smell and headaches and facial pain. Endoscopic improvement was greatest in polyps (83.3%) and oedema (87.0%) but less for discharge (59.4%).

Our results compared well with international series. Computer tomography scoring and the number of revision operations emerged as potential prognostic indicators requiring further evaluation.