Abstract
Eosinophilic chronic rhinosinusitis (ECRS) is a refractory and recurrent disease and its prevalence has been increasing. ECRS recurrence is known to be associated with the early development of frontal recess polyps after endoscopic sinus surgery (ESS). We found it challenging to address recurrent frontal sinus opacification early after surgery at our department. Consequently, in August 2018, we modified our technique for opening the frontal sinus drainage pathway (FSDP), introduced the building block concept, and changed the surgical instruments used for opening the FSDP. Our present study included 32 patients with ECRS who underwent type IV ESS at our department between March 2016 and October 2020; the patients were divided into two groups: group A and group B, comprising patients who underwent ESS before and after August 2018, respectively. To evaluate the effects of the changes, we retrospectively compared the operative time, degree of patency of the frontal recess, computed tomography (CT) score improvement rate (IR), and peripheral blood eosinophil percentage between the two groups.
Group A showed no significant difference in the degree of patency in the frontal recess or peripheral blood eosinophil percentage before and after the surgery, whereas group B showed significant improvement of both. Furthermore, group B showed a significantly higher IR of all the sinuses, including the posterior ethmoid and sphenoid sinuses than group A, although the IRs of the frontal, anterior ethmoid, and maxillary sinuses did not differ statistically significantly between the two groups.
Despite the significantly improved frontal recess patency in group B, no significant differences in the IR of the anterior ethmoid and frontal sinuses were observed between the two groups. This could be attributable to persistent sinus opacification due to inadequate removal of the lamina in the ethmoid sinus. Improvement of total sinus opacification in patients with ECRS may reduce postoperative peripheral eosinophilia. Future studies with long-term follow-ups are warranted to further explore this possibility.
