Migha K P, Vasu Rajan Kezhaeplackal, Reynolds Anjana Mary
Department of ENT, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala India.
Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):3326-3331. doi: 10.1007/s12070-023-03953-5. Epub 2023 Jun 21.
Chronic Rhinosinusitis (CRS) is a common condition causing significant symptoms to those affected, cause burden to the healthcare consumption and productivity loss (Fokkens et al. in Rhinol J 58:82-111, 2020). Chronic Rhinosinusitis is diagnosed clinically on the basis of characteristic symptoms with inflammation of the mucosa of the nose and paranasal sinuses of at least 12 consecutive weeks duration (Fokkens et al. in A summary for otorhinolaryngologists Rhinology 50:1-12, 2012). Functional Endoscopic Sinus Surgery is a minimally invasive procedure recommended for chronic Rhinosinusitis. Patients are not routinely assessed specifically for functional and symptomatic improvement after surgery. Previous studies assessed either subjective or objective outcome of surgery (Elwany et al. in Eur Arch Otorhinolaryngol 255:511-514, 1998; Sino-nasal Outcome Test (SNOT-22): A predictor of post-surgical improvement in patients with chronic sinusitis - PMC, 2022. The present study assessed pre and post operative comparison of nasal mucociliary clearance, nasal patency and Sino-nasal outcome score and evaluated both subjective and objective outcomes of functional endoscopic sinus surgery simultaneously. To assess the effect of functional and symptomatic outcomes after Functional Endoscopic Sinus Surgery in patients with Chronic Rhinosinusitis visiting a tertiary care centre in South India. The present study was a hospital based cross-sectional study conducted in the Department of Otorhinolaryngology, in a tertiary care centre in South India, between February 2021 and May 2022. After obtaining informed consent all the patients fulfilling inclusion and exclusion criteria in the given time period were selected as the study population via consecutive sampling method. Detailed history, clinical examination and Diagnostic nasal endoscopy, Computed Tomography (CT) paranasal sinuses were done in all cases. Pre operative Saccharine transit time (STT), Peak nasal inspiratory flow rate (PNIFR) and Sino nasal outcome test (SNOT) 22 score were measured. All cases underwent Functional Endoscopic Sinus Surgery (FESS). Patients were followed up at 1st, 3rd and 6th month for functional and symptomatic outcomes. Data were analysed statistically using Friedman's ANOVA test. A total of 40 patients between the age of 20 and 60 with Chronic Rhinosinusitis with /without nasal polyposis were analysed. Incidence was found to be more common in middle aged group (37.5%). Among the study group 52.5% were females and 47.5% were males 55% was diagnosed as Chronic Rhinosinusitis with nasal polyp (CRSwNP) type and 45% as without nasal polyp (CRSsNP) type. On comparing the variation of Saccharine transit time, Peak nasal inspiratory flow rate and SNOT 22 score with post operative results done at, 1st, 3rd and 6th months using Friedman's ANOVA test showed statistically significant results ( value < 0.05). According to our study there is significant improvement in functional and symptomatic outcomes after Functional Endoscopic sinus surgery and restoration of mucociliary function in Chronic Rhinosinusitis patients. Thus, FESS is an excellent choice for treatment of CRS.
慢性鼻窦炎（CRS）是一种常见疾病，给患者带来严重症状，给医疗保健消费造成负担并导致生产力损失（福肯斯等人，《鼻科学杂志》58:82 - 111，2020年）。慢性鼻窦炎根据特征性症状进行临床诊断，鼻和鼻窦黏膜炎症持续至少连续12周（福肯斯等人，《耳鼻咽喉科医生总结：鼻科学》50:1 - 12，2012年）。功能性鼻内镜鼻窦手术是推荐用于慢性鼻窦炎的微创手术。患者术后通常不会专门针对功能和症状改善情况进行评估。以往研究评估的是手术的主观或客观结果（埃尔瓦尼等人，《欧洲耳鼻咽喉头颈外科学档案》255:511 - 514，1998年；鼻窦结局测试（SNOT - 22）：慢性鼻窦炎患者术后改善情况的预测指标 - PMC，2022年）。本研究评估了鼻黏液纤毛清除功能、鼻通畅度和鼻窦结局评分的术前与术后比较，同时评估了功能性鼻内镜鼻窦手术的主观和客观结果。为评估在印度南部一家三级医疗中心就诊的慢性鼻窦炎患者接受功能性鼻内镜鼻窦手术后功能和症状结局的效果。本研究是在印度南部一家三级医疗中心的耳鼻咽喉科进行的一项基于医院的横断面研究，时间为2021年2月至2022年5月。在获得知情同意后，通过连续抽样法选择在给定时间段内符合纳入和排除标准的所有患者作为研究人群。所有病例均进行了详细病史采集、临床检查以及诊断性鼻内镜检查、鼻窦计算机断层扫描（CT）。测量了术前糖精转运时间（STT）、最大鼻吸气流量率（PNIFR）和鼻窦结局测试（SNOT）22评分。所有病例均接受了功能性鼻内镜鼻窦手术（FESS）。在第1、3和6个月对患者进行功能和症状结局随访。使用弗里德曼方差分析检验对数据进行统计学分析。共分析了40例年龄在20至60岁之间患有/不患有鼻息肉的慢性鼻窦炎患者。发现发病率在中年组更为常见（37.5%）。在研究组中，52.5%为女性，47.5%为男性，55%被诊断为伴有鼻息肉的慢性鼻窦炎（CRSwNP）型，45%为不伴有鼻息肉的慢性鼻窦炎（CRSsNP）型。使用弗里德曼方差分析检验比较第1、3和6个月术后糖精转运时间、最大鼻吸气流量率和SNOT 22评分的变化，结果显示具有统计学意义（P值<0.05）（此处原文有误，应为P值）。根据我们的研究，慢性鼻窦炎患者接受功能性鼻内镜鼻窦手术后功能和症状结局有显著改善，黏液纤毛功能得以恢复。因此，FESS是治疗CRS的极佳选择。
