title: Outcomes of modified endoscopic Lothrop in aspirin-exacerbated respiratory disease with nasal polyposis.
abstract: Patients with aspirin-exacerbated respiratory disease (AERD) and chronic rhinosinusitis with nasal polyps (CRSwNP) are often reported to be recalcitrant to standard medical and surgical intervention. Failure rates of standard endoscopic sinus surgery in these patients are reported to be as high as 90%. We review the outcomes for our cohort of AERD patients undergoing endoscopic sinus surgery and endoscopic modified Lothrop procedure (EMLP).
  
  
  
  Data was collected prospectively between January 2001 and December 2013. Information including demographics, asthma status, aspirin sensitivity, 22-item Sino-Nasal Outcome Test (SNOT-22), Lund-Mackay scores, and endoscopic ostium assessment were collected for up to 5 years. Minimum follow-up was 6 months.
  
  
  
  A total of 31 AERD patients underwent complete sphenoethmoidectomy, maxillary antrostomy and EMLP during the study period with an average follow-up of 36 months. Polyp recurrence was seen in a total of 18 patients (58%). Seven patients required revision EMLP following initial surgery demonstrating a failure rate of 22.5%. AERD patients had a statistically significant increased risk of both nasal polyps recurrence and need for revision surgery. Revision EMLP was needed due to recurrence of nasal polyps in 6 cases and frontal ostium stenosis in a single case. Time to revision EMLP was similar between the groups.
  
  
  
  Complete sphenoethmoidectomy, maxillary antrostomy, and EMLP is successful in a significant majority of patients with AERD and CRSwNP. It is well tolerated with a low complication rate and facilitates successful ongoing medical management of the condition in patients with AERD.
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Australia.|Department of Otolaryngology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
authors.forename: David K
authors.initials: DK
authors.lastname: Morrissey
authors.affiliation: Department of Surgery-Otorhinolaryngology, Head and Neck Surgery University of Adelaide, Adelaide, Australia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bassiouni
authors.affiliation: Department of Surgery-Otorhinolaryngology, Head and Neck Surgery University of Adelaide, Adelaide, Australia.|Department of Otolaryngology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
authors.forename: Alkis J
authors.initials: AJ
authors.lastname: Psaltis
authors.affiliation: Department of Surgery-Otorhinolaryngology, Head and Neck Surgery University of Adelaide, Adelaide, Australia.
authors.forename: Yuresh
authors.initials: Y
authors.lastname: Naidoo
authors.affiliation: Department of Surgery-Otorhinolaryngology, Head and Neck Surgery University of Adelaide, Adelaide, Australia.|Department of Otolaryngology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
mesh_terms: D055963:Asthma, Aspirin-Induced / Q000601:surgery*; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012220:Rhinitis / Q000601:surgery; D012852:Sinusitis / Q000601:surgery; D016896:Treatment Outcome
keywords: asthma; chronic rhinosinusitis; endoscopic sinus surgery; extended frontal sinusotomy; frontal sinusotomy; sinus surgery