Medical and surgical considerations in patients with Samter's triad.
BACKGROUND
The aim of this study was to report on objective and subjective outcomes of patients with Samter's triad (ST) treated with functional endoscopic sinus surgery (FESS), and correlate these results with aspirin desensitization (DS) in patients.


METHODS
We performed a retrospective analysis of prospectively collected data in 15 patients requiring revision FESS after failing maximum medical therapy and prior sinus surgery for chronic rhinosinusitis in the context of ST. Five patients underwent aspirin DS and 10 patients did not (non-DS). These patients represent a subset of patients previously reported who were treated in a tertiary rhinology setting over a 3-year period (1999-2001). CT scans were graded according to the Lund-Mackay grading scale and symptom scores were assessed using the Sino-Nasal Outcome Test (SNOT-20). Endoscopy was scored according to the Rhinosinusitis Task Force methodology. All patients had a minimum 2-year follow-up.


RESULTS
Preoperative CT scores were 20.1+/-1.9 for non-DS patients and 20.4+/-2.0 for DS patients (p = NS). Preoperative and postoperative SNOT-20 scores for non-DS patients were 31.8+/-3.9 and 8.8+/-1.7, respectively, as compared with 32.0 z 3.6 and 7.3 +/-1.7 for DS patients (p = NS). Preoperative and postoperative endoscopy scores for non-DS patients were 7.6+/-1.2 and 2.0+/-0.4, respectively, as compared with 7.6 +/-1.3 and 1.1+/-0.4 for DS patients (p = NS). Of DS patients, none required additional surgery whereas 8 of 10 non-DS patients required additional revision during the follow-up period (p = 0.003).


CONCLUSIONS
Revision FESS benefits patients with ST; however, the addition of aspirin DS decreases the likelihood that patients with ST will require additional surgical intervention over a 2-year period.
McMains
K Christopher
KC
Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia 30912, USA.
Kountakis
Stilianos E
SE
D000328:Adult; D000368:Aged; D001241:Aspirin / Q000009:adverse effects*; D001249:Asthma / Q000150:complications*; D003888:Desensitization, Immunologic / Q000379:methods; D004342:Drug Hypersensitivity / Q000150:complications* / Q000188:drug therapy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005938:Glucocorticoids; D001241:Aspirin