Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.
Laryngoscope. 2023 Oct;133(10):2511-2516. doi: 10.1002/lary.30586. Epub 2023 Jan 24.
Eosinophilic chronic rhinosinusitis (ECRS) is known to recur after surgery. The treatment choice for recurrent ECRS, such as oral steroids or biological agents, must be chosen carefully, and identifying the lesion location may be useful. This study aimed to evaluate the postoperative course of ECRS patients and assess the relationship between endoscopic lesion location and postoperative oral steroid use.
Patients with chronic rhinosinusitis who underwent bilateral endoscopic sinus surgery from April 2018 to March 2020 were divided into two groups based on the presence or absence of oral steroid use after surgery. The primary endpoint was the lesion location on endoscopic findings during surgery: middle turbinate, middle meatus, superior turbinate, superior meatus, nasal septum, and sphenoethmoidal recess. Subjective symptoms, blood tests, and computerized tomography (CT) findings (Lund-Mackay score) were evaluated as secondary endpoints.
Among 264 patients, 88 were diagnosed histologically with ECRS (mean 48.98 ± 1.40 years, 67 males/21 females). Twenty-three patients were steroid-using, 65 were steroid-free, and six stopped attending their appointments. Patients with sphenoethmoidal recess lesions were significantly more likely to require steroids (p = 0.019). There was a significant association between steroid use and younger age (p = 0.041), olfactory dysfunction (p = 0.021), and all sinuses (Frontal sinus: p < 0.001, Anterior ethmoid sinus: p = 0.002, Posterior ethmoid sinus: p = 0.011, Maxillary sinus: p = 0.018, Sphenoid sinus: p = 0.034, Total score: p < 0.001).
A sphenoethmoidal recess lesion was a risk factor for requiring postoperative steroids. Young age, olfactory dysfunction, and preoperative severe CT findings were also significant risk factors.
3 Laryngoscope, 133:2511-2516, 2023.
嗜酸性慢性鼻-鼻窦炎（ECRS）已知在手术后会复发。对于复发性 ECRS 的治疗选择，例如口服类固醇或生物制剂，必须谨慎选择，并且确定病变位置可能会有所帮助。本研究旨在评估 ECRS 患者的术后病程，并评估内镜下病变位置与术后口服类固醇使用之间的关系。
2018 年 4 月至 2020 年 3 月期间接受双侧内镜鼻窦手术的慢性鼻-鼻窦炎患者根据手术后是否使用口服类固醇分为两组。主要终点是手术中内镜检查发现的病变位置：中鼻甲、中鼻道、上鼻甲、上鼻道、鼻中隔和蝶筛隐窝。评估主观症状、血液检查和计算机断层扫描（CT）发现（Lund-Mackay 评分）作为次要终点。
在 264 名患者中，88 名患者组织学诊断为 ECRS（平均年龄 48.98±1.40 岁，男性 67 例/女性 21 例）。23 名患者使用类固醇，65 名患者未使用类固醇，6 名患者停止就诊。蝶筛隐窝病变的患者更有可能需要类固醇（p=0.019）。类固醇使用与年龄较小（p=0.041）、嗅觉功能障碍（p=0.021）和所有鼻窦（额窦：p<0.001，前筛窦：p=0.002，后筛窦：p=0.011，上颌窦：p=0.018，蝶窦：p=0.034，总评分：p<0.001）之间存在显著关联。
蝶筛隐窝病变是需要术后类固醇的危险因素。年龄较小、嗅觉功能障碍和术前严重 CT 发现也是显著的危险因素。
3 Laryngoscope, 133:2511-2516, 2023.
