2006 Volume 2006 Issue Supplement117 Pages 60-65
Endoscopic sinus surgery (ESS) achieves favorable results in the treatment of chronic sinusitis and has become the initial operative procedure. We examined surgical effects of ESS obtained from 90 patients who were treated in the department hospital. The patients were subdivided into four groups categorized by the existence of allergic rhinitis, asthma, and eosinophil infiltration. Preoperative and postoperative assessment was done and the severity of the disease was scored according to CT scanning and endoscopic nasal findings. Furthermore, we investigated whether the use of low dose macrolide, mucolytic agents, antihistamines, and antileukotrienes may improve postoperative nasal findings and prevent relapse of nasal polyps.
Patients with high eosinophil infiltration showed significant increase in preoperative CT scores and those with allergic rhinitis or asthma showed higher endoscopic nasal scores. After surgery,82% of the whole patients obtained satisfactory improvement of endoscopic nasal scores, whereas the proportion was reduced to 59% in the asthmatic group. Asthmatic patients generally showed reactive and unstable sinus mucosa with high eosinophil infiltration particularly in their ethmoid cells. The combination of antihistamines and antileukotrienes used as postoperative medical treatment significantly reduced endoscopic nasal scores both in allergic rhinitis and in eosinophil infiltration. These findings substantiate the fact that eosinophil infiltration with or without allergy plays a pivotal role in the persistent inflammation occurring in non-infectious chronic sinusitis. A new set of medical therapies including antihistamines, antileukotrienes, and corticosteroids as potent anti-inflammatory agents should be considered to obtain symptomatic and objective relief from the disease after sinus surgery.
