Endoscopic surgical management of sphenoid sinus disease

To assess the outcome of functional endoscopic sphenoid sinus surgery, and to determine the predictors of outcome.

Retrospective chart review of 651 consecutive endoscopic sinus procedures performed between 1992 and 1997.

USC University Hospital, University of Southern California, Los Angeles.

Seventy-four patients (11.4% of all endoscopic procedures) with sphenoid sinus disease were selected. All 74 patients were mailed a sinusitis-specific questionnaire, and 46 of them (62.2%) responded. Outcome measures derived from clinician ratings were applied to all 74 patients, and those derived from self-report were applied to 46. Outcome measures were determined from patient questionnaires at a minimum of 6-month postoperative follow-up, operative complications, and clinician perceptual ratings. Patient questionnaires addressed general patient satisfaction, symptom score, and medication usage. A statistical analysis was performed using chi2 test, linear regression, and one-way nonparametric ANOVA.

Favorable surgical outcomes based on general patient satisfaction (84.8%, n = 39) and clinician perceptual rating (78.4%, n = 58) were noted. Minor postoperative complications were noted in 10 patients (13.5%) and 8 patients (10.8%) needed revision endoscopic procedures during follow-up. Of the complications, eight (80%) occurred in revision endoscopic procedures. The use of an expanded, sinus-specific symptom score revealed far fewer favorable outcomes (56.5%, n = 26). Seven outcome predictors were established, although none of the predictors held for more than one of the six outcome measures used.

Endoscopic sphenoid sinus surgery is safe and effective. An expanded symptom score is recommended to assess the outcome of this procedure.