Improvement after endoscopic sinus surgery in patients with chronic rhinosinusitis varies considerably. If elaborate preoperative and intraoperative data could be used to predict the postoperative course, management and length of the follow-up could be adjusted to provide optimal care. Two hundred and ten patients with ‘eosinophilic chronic rhinosinusitis’ (a diagnosis based on bilateral polyposis, ethmoid involvement and high eosinophil count) were compared with 81 non-eosinophillic chronic rhinosinusitis. Outcome measures included operative findings, (the status of the mucosa and secretions in the olfactory clefts and inside the sinuses), postoperative endoscopic findings, depending on the degree of polyposis affecting patency of sinus openings, computed tomography based on Lund and Mackay scores and, lastly, olfactometry. The focus seems to be on the operative scores which were site-specific and elaborated the degree of involvement. These helped in predicting postoperative recovery.

The operative ‘scores’ were worse in patients with eosinophilic sinusitis than in those with non-eosinophilic sinusitis. Improvement after endoscopic sinus surgery, judged in terms of olfaction and endoscopic appearance, were less in patients with eosinophilic rhinosinusitis, suggesting that these patients require a longer and modified follow-up.

Postoperative course prediction during endoscopic sinus surgery in patients with chronic rhinosinusitis.
Tsuzuki K, Hashimoto K, Okazaki K, Sagakami M.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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