Revision functional endoscopic sinus surgery: objective and subjective surgical outcomes

Area of Science:

• Otolaryngology
• Rhinology
• Surgical Outcomes Research

Background:

• Chronic rhinosinusitis (CRS) poses challenges, often necessitating revision surgery after failed medical and surgical interventions.
• Evaluating outcomes of revision sinus surgery (RESS) is crucial for optimizing patient care in refractory CRS cases.

Purpose of the Study:

• To assess objective and subjective outcomes following revision functional endoscopic sinus surgery (RESS) for chronic rhinosinusitis (CRS).
• To determine the efficacy of RESS in patients with persistent CRS symptoms despite maximal medical therapy and previous surgeries.

Main Methods:

• Retrospective analysis of prospectively collected data from 125 patients undergoing RESS for CRS.
• Utilized Lund-MacKay CT grading and Sinonasal Outcome Test 20 (SNOT-20) for objective and subjective outcome assessment.
• Minimum 2-year follow-up with pre- and post-operative symptom evaluation using visual analog scales.

Main Results:

• Significant improvements observed in SNOT-20 scores (30.7 to 7.7) and endoscopy scores (7.3 to 2.1) at 2-year follow-up (p < 2.8 x 10(-10)).
• All individual rhinosinusitis symptom scores decreased significantly by 12 months post-surgery.
• A low overall failure rate of 8.0% (10 patients) requiring further intervention, with all failures associated with nasal polyposis.

Conclusions:

• Revision functional endoscopic sinus surgery (RESS) is an effective treatment for chronic rhinosinusitis (CRS) patients refractory to medical therapy and prior surgeries.
• RESS yields significant improvements in both objective (CT scans, endoscopy) and subjective (symptom scores) measures.
• Nasal polyposis may be a factor in RESS failure, warranting consideration in surgical planning.