Efficacy of Functional Endoscopic Sinus Surgery in the treatment of Ethmoidal polyps

摘要

The efficacy of sinus surgery for treatment of ethmoidal polyps continues to be an issue of debate among otolaryngologists. A study was undertaken to assess the efficacy of Functional Endoscopic Sinus Surgery (FESS) in treatment of ethmoidal polyps. Thirty patients of either sex above 16 years of age, suffering from ethmoidal polyps were included in the study. The patients were discharged a day after surgery and were called for endoscopic examination during subsequent follow up. Final results were recorded 3 months after the operative procedure. The results suggest that FESS is highly effective for treatment of ethmoidal polyps with the recurrence rate being as low as 10% and with no major complication. Introduction Nasal polyps remain a significant challenge to the treating physician. The treatment modalities of nasal polyps encompass both medical and surgical modalities following the assessment of the patient. Surgical treatment comprises of polypectomy which has a high recurrence rate, intranasal ethmoidectomy – a blind procedure and external ethmoidectomy with its inherent complication of external scar. All these shortcomings are overcome by FESS, which is fast becoming the surgical treatment of choice for nasal polyp disease. The first attempt at nasal and sinus endoscopy was performed by Hirschmann in 1901 using modified cystoscope. Since then, many advances have been made in the field of endoscopic sinus surgery.1 In the early 1970s, Messerklinger theory that the anatomical variations of the lateral nasal wall could cause obstruction of both drainage and ventilation of the sinuses, initiated the development of a functionally oriented surgical approach. 2,3 The functional endoscopic sinus surgery technique provides a tool by which the clinician can accurately diagnose, meticulously and atraumatically perform surgery and precisely provide post-operative care and follow up for nasal polyp diseases. The present study was undertaken to evaluate the efficacy of functional endoscopic sinus surgery in the treatment of ethmoidal polyps. Materials And Methods The present study was conducted in the Department of Otorhinolaryngology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak. Thirty patients of either sex above 16 years of age, suffering from ethmoidal polyps were included in the study. Patients having antrochoanal polyp, marked deviated nasal septum, and nasal or antral growth were excluded from the study.Initial patient work-up included detailed history taking about the symptoms and their duration. Thereafter, detailed examination including anterior rhinoscopy, posterior rhinoscopy, throat and ear examination was done. All patients were given medical treatment for two weeks in the form of broad-spectrum antibiotics, antihistaminics and local or systemic decongestants. The patients were then subjected to computed tomography scan of paranasal sinuses- both axial and coronal views. Patients were taken up for the surgery under local anaesthesia after the routine investigations like complete haemogram, urine albumin and sugar and other relevant investigations.The extent of surgery was decided based on the findings in pre-operative CT scan of paranasal sinuses. Anterior ethmoidectomy, posterior ethmoidectomy, middle meatus antrostomy and clearance of frontal recess were performed in all the patients. Sphenoid sinus ostium was widened only if CT scan showed evidence of its involvement. Along with this any significant anatomical abnormality was also noted and taken care of during surgery. At the time of discharge from the hospital, the patients were given systemic antibiotic for 10 days along with decongestant drops. Steroid nasal spray was advised in all cases. Alkaline nasal douching was also advised. Patients were advised follow-up after one week, six weeks and three months. Subjective assessment for symptomatic improvement was done and objective results were assessed by check endoscopy. The results were the