Repetitive endoscopic sinus surgery failure: a role for radical surgery?
OBJECTIVE
Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the inflammatory burden and optimization of drainage of the sinuses has been suggested as a last resort for these patients.


METHODS
A prospective, questionnaire-based study was conducted in a group of 23 patients who underwent Denker's procedure for refractory chronic rhinosinusitis. Symptoms were evaluated before Denker's procedure and 12 months and 2 years after surgery.


RESULTS
Patients reported improvement of feelings of congestion in 74%, rhinorrhea in 70%, and nasal obstruction in 60% of the cases. The following postoperative improvements were statistically significant: rhinorrhea (P = 0.001), feelings of congestion (P = 0.02), and nasal obstruction (P = 0.03). Reduced olfactory perception and asthma did not improve.


CONCLUSIONS
Radical surgery may be a viable treatment option in case of recurrent ESS failure.


METHODS
C-4.
Department of Otorhinolaryngology-Head and Neck Surgery, Academic Medical Center, Amsterdam, The Netherlands. W.J.Videler@amc.uva.nl
Ward J M
WJ
Videler
Volkert B
VB
Wreesmann
Freerk W
FW
van der Meulen
Paul P
PP
Knegt
Wytske J
WJ
Fokkens
D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D012086:Reoperation; D012220:Rhinitis / Q000150:complications / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000601:surgery*; D011795:Surveys and Questionnaires; D017211:Treatment Failure