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European Archives of Oto-Rhino-Laryngology

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30-05-2023 | Rhinosinusitis | Rhinology

Radiopathologic predictors of 1- and 2-year frontal sinusotomy outcomes in a southeast Asian chronic rhinosinusitis population

Authors: Jeremy Chee, Yew Kwang Ong, Ju Ee Seet, Xinni Xu

Published in: European Archives of Oto-Rhino-Laryngology | Issue 11/2023

Abstract

Background

The frontal sinus and its drainage pathway are difficult spaces to navigate surgically. The complexity of the frontal recess anatomy as well as inflammatory factors may influence outcomes of endoscopic frontal sinusotomy. It is not clear which factors are more important in determining post-operative frontal ostium patency.

Objective

The objective is to investigate whether the distribution of fronto-ethmoidal cells, frontal recess dimensions and sinonasal inflammation predict frontal ostium patency at 1- and 2-years after endoscopic frontal sinusotomy.

Methods

A retrospective review of 94 chronic rhinosinusitis patients (185 sides) who had undergone endoscopic frontal sinusotomies between 2015 and 2019 was conducted. Computed tomography was used to evaluate the type of fronto-ethmoidal cells present and determine the dimensions of the frontal recess. The International Classification of the Radiological Complexity of frontal recess and frontal sinus was used to grade the complexity of frontal recess anatomy. Mucosal inflammation was graded according to a structured histopathology report. Frontal ostium patency at 1- and 2-years post-operatively was recorded.

Results

The frontal ostium patency rates were 80.9% and 73.4% at 1- and 2-years respectively. Eosinophilic predominance (adjusted OR 3.5, 95% CI 1.6–8.0, p = 0.003) and mucosal ulceration on histology (adjusted OR 4.5, 95% CI 1.1–17.9, p = 0.033) predicted ostial stenosis at 1 year. Smoking (adjusted OR 7.6, 95% CI 2.4–24.7, p = 0.001), aspirin exacerbated respiratory disease (AERD) (adjusted OR 7.6, 95% CI 1.9–30.1, p = 0.004) and histological findings of severe inflammation (adjusted OR 8.9, 95% CI 1.9–41.2, p = 0.005) were independent predictors of ostial stenosis at 2 years. Frontal cell patterns, frontal recess dimensions and frontal recess complexity did not predict frontal ostium stenosis at both 1- and 2-years post-operatively.

Conclusion

Post-operative control of sinonasal inflammation is important in maintaining frontal ostium patency, regardless of frontal cell patterns or frontal recess dimensions.

Chandra RK, Palmer JN, Tangsujarittham T, Kennedy DW (2004) Factors associated with failure of frontal sinusotomy in the early follow-up period. Otolaryngol Head Neck Surg 131(4):514–518. https://doi.org/10.1016/j.otohns.2004.03.022CrossRefPubMed

Naidoo Y, Wen D, Bassiouni A, Keen M, Wormald PJ (2012) Long-term results after primary frontal sinus surgery. Int Forum Allergy Rhinol 2(3):185–190. https://doi.org/10.1002/alr.21015CrossRefPubMed

Hosemann W, Kuhnel T, Held P, Wagner W, Felderhoff A (1997) Endonasal frontal sinusotomy in surgical management of chronic sinusitis: a critical evaluation. Am J Rhinol 11(1):1–9. https://doi.org/10.2500/105065897781446793CrossRefPubMed

Wormald PJ, Hoseman W, Callejas C, Weber RK, Kennedy DW, Citardi MJ et al (2016) The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS). Int Forum Allergy Rhinol 6(7):677–696. https://doi.org/10.1002/alr.21738CrossRefPubMed

McHugh T, Snidvongs K, Xie M, Banglawala S, Sommer D (2018) High tissue eosinophilia as a marker to predict recurrence for eosinophilic chronic rhinosinusitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol 8(12):1421–1429. https://doi.org/10.1002/alr.22194CrossRef

Grayson JW, Li W, Ho J, Alvarado R, Rimmer J, Sewell WA et al (2020) Topography of polyp recurrence in eosinophilic chronic rhinosinusitis. Int Forum Allergy Rhinol 10(5):604–609. https://doi.org/10.1002/alr.22529CrossRefPubMed

Wormald PJ, Bassiouni A, Callejas CA, Kennedy DW, Citardi MJ, Smith TL et al (2017) The International Classification of the radiological Complexity (ICC) of frontal recess and frontal sinus. Int Forum Allergy Rhinol 7(4):332–337. https://doi.org/10.1002/alr.21893CrossRefPubMed

Snidvongs K, Lam M, Sacks R, Earls P, Kalish L, Phillips PS et al (2012) Structured histopathology profiling of chronic rhinosinusitis in routine practice. Int Forum Allergy Rhinol 2(5):376–385. https://doi.org/10.1002/alr.21032CrossRefPubMed

DeConde AS, Smith TL (2016) Outcomes after frontal sinus surgery: an evidence-based review. Otolaryngol Clin N Am 49(4):1019–1033. https://doi.org/10.1016/j.otc.2016.03.024CrossRef

10.

Chan Y, Melroy CT, Kuhn CA, Kuhn FL, Daniel WT, Kuhn FA (2009) Long-term frontal sinus patency after endoscopic frontal sinusotomy. Laryngoscope 119(6):1229–1232. https://doi.org/10.1002/lary.20168CrossRefPubMed

11.

Askar MH, Gamea A, Tomoum MO, Elsherif HS, Ebert C, Senior BA (2015) Endoscopic management of chronic frontal sinusitis: prospective quality of life analysis. Ann Otol Rhinol Laryngol 124(8):638–648. https://doi.org/10.1177/0003489415573959CrossRefPubMed

12.

Kubota K, Takeno S, Hirakawa K (2015) Frontal recess anatomy in Japanese subjects and its effect on the development of frontal sinusitis: computed tomography analysis. J Otolaryngol Head Neck Surg 44:21. https://doi.org/10.1186/s40463-015-0074-6CrossRefPubMedPubMedCentral

13.

Johari HH, Mohamad I, Sachlin IS, Aziz ME, Mey TY, Ramli RR (2018) A computed tomographic analysis of frontal recess cells in association with the development of frontal sinusitis. Auris Nasus Larynx 45(6):1183–1190. https://doi.org/10.1016/j.anl.2018.04.010CrossRefPubMed

14.

Okushi T, Mori E, Nakayama T, Asaka D, Matsuwaki Y, Ota K et al (2012) Impact of residual ethmoid cells on postoperative course after endoscopic sinus surgery for chronic rhinosinusitis. Auris Nasus Larynx 39(5):484–489. https://doi.org/10.1016/j.anl.2011.09.001CrossRefPubMed

15.

Khafagy Y, Ghonim M, Elgendy A, Elzayat S (2021) The preoperative radiological findings associated with failure of frontal sinusotomy: a prospective study. Clin Otolaryngol 46(4):834–840. https://doi.org/10.1111/coa.13750CrossRefPubMed

16.

Chiu AG (2006) Frontal sinus surgery: its evolution, present standard of care, and recommendations for current use. Ann Otol Rhinol Laryngol Suppl 196:13–19. https://doi.org/10.1177/00034894061150s903CrossRefPubMed

17.

Khalmuratova R, Shin HW (2021) Crosstalk between mucosal inflammation and bone metabolism in chronic rhinosinusitis. Clin Exp Otorhinolaryngol 14(1):43–49. https://doi.org/10.21053/ceo.2020.00416CrossRefPubMed

18.

Hong SN, Kim YS, Cha H, Park JA, Kim JK, Oh H et al (2022) Endotype-related recurrence pattern of chronic rhinosinusitis in revision functional endoscopic sinus surgery. Auris Nasus Larynx 49(2):215–221. https://doi.org/10.1016/j.anl.2021.07.010CrossRefPubMed

19.

Goshtasbi K, Abouzari M, Abiri A, Yasaka T, Sahyouni R, Bitner B et al (2019) Efficacy of steroid-eluting stents in management of chronic rhinosinusitis after endoscopic sinus surgery: updated meta-analysis. Int Forum Allergy Rhinol 9(12):1443–1450. https://doi.org/10.1002/alr.22443CrossRefPubMedPubMedCentral

20.

ARS Position Statement (2023) Criteria for drug-eluting implants [press release]. Am Rhinol Soc 28:2023

21.

Statement P (2023) Drug-eluting sinus implants [press release]. Am Acad Otolaryngol Head Neck Surg 17:2023

22.

Forwith KD, Han JK, Stolovitzky JP, Yen DM, Chandra RK, Karanfilov B et al (2016) RESOLVE: bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis after sinus surgery: 6-month outcomes from a randomized, controlled, blinded study. Int Forum Allergy Rhinol 6(6):573–581. https://doi.org/10.1002/alr.21741CrossRefPubMed

23.

Bassiouni A, Wormald PJ (2013) Role of frontal sinus surgery in nasal polyp recurrence. Laryngoscope 123(1):36–41. https://doi.org/10.1002/lary.23610CrossRefPubMed

Title: Radiopathologic predictors of 1- and 2-year frontal sinusotomy outcomes in a southeast Asian chronic rhinosinusitis population
Authors: Jeremy Chee
Yew Kwang Ong
Ju Ee Seet
Xinni Xu
Publication date: 30-05-2023
Publisher: Springer Berlin Heidelberg
Keyword: Rhinosinusitis
Published in: European Archives of Oto-Rhino-Laryngology / Issue 11/2023
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08048-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiopathologic predictors of 1- and 2-year frontal sinusotomy outcomes in a southeast Asian chronic rhinosinusitis population

Abstract

Background

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

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