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A formal FESS procedure usually done under local anaesthesia is considered as gold standard in the management of chronic rhinusinusitis. However, success is hampered by a significant recurrence rate of polyps requiring revision surgery, long waiting lists, reluctance of elderly patients, and due to anaesthesia problems. In this study, the authors operated ‘minimally’ on 30 patients. The procedure, done under local anaesthesia, involved debridement of polyps, reduction of middle turbinates and, if patients had FESS previously, ‘mucosal revision’ within the opened maxillary and ethmoid sinuses. The results were assessed in terms of the pre and postoperative SNOT-22 scores, modified Lund-Kennedy endoscopy scores in terms of inferior turbinate congestion, polyps and mucus and VAS scores for pain. The mean follow-up period was 7.3 months. The authors mention marked postoperative improvement in all these parameters. They are aware of the small patient number which comprised 11 previously-operated patients (FESS) and 19 primary cases. It is not unreasonable to do a mucosal revision in a previously-operated FESS patient, especially if one is elderly and has anaesthesia implications. However, to prove convincing, the application of this minimal procedure in de novo cases needs to be compared with FESS

Minimally invasive surgery under local anaesthesia for chronic rhinusinusitis with nasal polyps: our experience in older adults.
Casale M, Constantino A, Sabatino L, et al.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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