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Medical management in functional endoscopic sinus surgery failures
James N Palmer1, David W Kennedy
1Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, 5 Ravdin, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. james.palmer@uphs.upenn.edu
Current Opinion in Otolaryngology & Head and Neck Surgery
|September 30, 2003
Summary
Functional endoscopic sinus surgery offers significant symptom relief for chronic rhinosinusitis. However, persistent symptoms in some patients necessitate accurate diagnosis and ongoing medical management to prevent recurrence.
Area of Science:
- Otolaryngology
- Rhinology
Background:
- Functional endoscopic sinus surgery (FESS) achieves 75-95% symptom improvement in chronic rhinosinusitis (CRS).
- Symptom improvement post-FESS does not always equate to disease resolution, with 5-25% of patients experiencing persistent symptoms.
- Long-term medical management and surveillance are crucial for asymptomatic patients to prevent late recurrence.
Purpose of the Study:
- To emphasize the importance of accurate diagnosis in managing patients with refractory or recurrent chronic rhinosinusitis.
- To highlight the multifaceted approach required for challenging cases, including medical and surgical interventions.
- To advocate for viewing CRS as a medical condition where surgery is a therapeutic adjunct.
Main Methods:
- Review of diagnostic strategies for persistent CRS.
- Emphasis on comprehensive patient evaluation including history, nasal endoscopy, and computed tomography (CT) scans.
- Discussion of management options including medical therapy and surgical interventions.
Main Results:
- Accurate diagnosis through detailed history, nasal endoscopy, and CT is critical for successful treatment of recidivistic CRS.
- Revisiting preoperative diagnoses, especially for headache or facial pain, is essential before considering revision surgery.
- Management is multifaceted, incorporating topical/systemic medications and improving sinus drainage.
Conclusions:
- Chronic rhinosinusitis should be considered a medical disease with surgery playing a therapeutic role.
- Persistent inflammation in CRS often resolves over time with appropriate medical management.
- Accurate diagnosis and a comprehensive, individualized treatment plan are key to managing challenging CRS cases.