Al-Hail Noora, Shaikh Ahmad, Al Saey Hamad
Medical Education, Otorhinolaryngology - Head and Neck Surgery (ENT), Hamad Medical Corporation, Doha, QAT.
Otorhinolaryngology - Head and Neck Surgery (ENT), Hamad Medical Corporation, Doha, QAT.
Cureus. 2025 Aug 15;17(8):e90160. doi: 10.7759/cureus.90160. eCollection 2025 Aug.
Functional endoscopy sinus surgery (FESS) is a frequently employed surgical technique to treat patients with sinus diseases. However, limited studies are available that discuss the impact of sinus surgery on the non-diseased contralateral side. The present review was conducted to examine existing literature regarding the role of sinus surgery on the non-diseased contralateral side in patients with unilateral sinus disease (USD). We conducted a comprehensive systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant literature was searched from different electronic databases, including PubMed, Scopus, Cochrane Library, ScienceDirect, and Google Scholar, until February 2025. Studies' screening, selection, quality assessment, grading for certainty of evidence, and data extraction were done by two independent reviewers, and any disagreement was resolved by discussion. Results were integrated into tables and synthesized through a narrative summary. A total of 10 studies (N = 1,233 patients), aged 27.5-64.4 years, with a higher ratio of female participants, were included in the present review. Different pathological conditions were reported in selected studies, including chronic rhinosinusitis (CRS) alone, CRS with nasal polyposis (NP), antrochoanal polyp (ACP), fungus ball, benign tumor, malignant neoplasia, NP alone, acute or chronic unilateral sinusitis, and unilateral allergic fungal rhinosinusitis (AFRS). Most studies observed significant patient improvement, with a high success rate in improving symptoms such as nasal obstruction and postnasal drainage. However, studies also reported disease recurrence on the non-diseased contralateral side. Multiple medical interventions typically involve β-lactam antibiotics, decongestants, mucolytics, and nasal steroids to reduce inflammation and control the recurrence of diseases. Most studies showed a low risk of bias. In addition, no publication bias was observed. No serious concern was found in the reporting of these observational studies and found low risk of bias among the studies. A high level of certainty of evidence was observed. The present findings highlight that unilateral FESS improves one side of sinusitis; however, it gradually affects the non-diseased contralateral side, suggesting the importance of patient counseling and resulting in disease events on the contralateral side. Further, multicentre studies with large sample sizes are needed to validate these findings. Our study explores the potential benefits of operating on the contralateral side in cases of USD to prevent future recurrence on the previously uninvolved side.
功能性鼻内镜鼻窦手术（FESS）是治疗鼻窦疾病患者常用的外科技术。然而，关于鼻窦手术对未患病对侧影响的研究有限。本综述旨在探讨现有文献中鼻窦手术对单侧鼻窦疾病（USD）患者未患病对侧的作用。我们使用系统评价和Meta分析的首选报告项目（PRISMA）指南进行了全面的系统评价。从不同的电子数据库中检索相关文献，包括PubMed、Scopus、Cochrane图书馆、ScienceDirect和谷歌学术，检索截至2025年2月。研究的筛选、选择、质量评估、证据确定性分级和数据提取由两名独立的评审员完成，如有分歧通过讨论解决。结果整合到表格中，并通过叙述性总结进行综合。本综述共纳入10项研究（N = 1233例患者），年龄在27.5至64.4岁之间，女性参与者比例较高。所选研究报告了不同的病理状况，包括单纯慢性鼻-鼻窦炎（CRS）、伴鼻息肉（NP）的CRS、上颌窦后鼻孔息肉（ACP）、真菌球、良性肿瘤、恶性肿瘤、单纯NP、急性或慢性单侧鼻窦炎以及单侧变应性真菌性鼻-鼻窦炎（AFRS）。大多数研究观察到患者有显著改善，在改善鼻塞和鼻后滴漏等症状方面成功率较高。然而，研究也报告了未患病对侧的疾病复发情况。多种医学干预通常包括β-内酰胺类抗生素、减充血剂、黏液溶解剂和鼻用类固醇，以减轻炎症并控制疾病复发。大多数研究显示偏倚风险较低。此外，未观察到发表偏倚。在这些观察性研究的报告中未发现严重问题，且研究中发现偏倚风险较低。观察到证据确定性水平较高。目前的研究结果表明，单侧FESS可改善一侧鼻窦炎；然而，它会逐渐影响未患病的对侧，提示患者咨询的重要性，并导致对侧出现疾病事件。此外，需要开展大样本量的多中心研究来验证这些发现。我们的研究探讨了在USD病例中对侧手术预防先前未受累侧未来复发的潜在益处。
