Stilianos E. Kountakis

Objective: To evaluate the prevalence and severity of individual Rhinosinusitis Task Force (RSTF) symptoms in patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS).Methods: Retrospective analysis of prospectively collected data in 201 patients treated with FESS. The prevalence and severity of individual RSTF major and minor symptom scores graded on a visual analogue scale (VAS) were compared. Correlation between absolute improvement in individual symptom scores at 1‐year postoperative was performed.Results: One‐hundred fifty‐eight of 201 patients met inclusion criteria giving a response rate of 78%. The average age was 49.4 (range 18–80) with a male‐to‐female ratio of 1.1:1. The preoperative leading mean symptom scores were postnasal drip (5.8 ± 0.3), nasal obstruction (5.7 ± 0.3), and facial congestion (5.1 ± 0.3). These symptoms were also the most prevalent with 82%, 84%, and 79% of patients reporting these symptoms, respectively. Postoperative symptom improvements were significant (P < .0001) across all RSTF domains except fever. The highest percentage improvement was seen with facial congestion (93%), nasal obstruction (92%), and postnasal drip (85%). Multivariate analysis revealed significant (P < .0001) high correlation between improvements of facial pain/pressure with facial congestion (R = 0.72), facial congestion with nasal obstruction (R = 0.65), and facial pain/pressure with headache (R = 0.72).Conclusion: The top three RSTF symptoms were postnasal drip, nasal obstruction, and facial congestion in terms of prevalence and severity. Symptom scores improved after FESS. Of these symptoms, the degree of improvement of facial pain/pressure, facial congestion, nasal obstruction, and headache are highly correlated.

Objectives: To determine the role of interleukin (IL)-4, IL-4 receptor (R), IL-6, IL-8, IL-11, and transforming growth factor (TGF)-β in chronic rhinosinusitis (CRS) and chronic rhinosinusitis with n...

Objectives/Hypothesis: The aim of the study was to determine the correlation between preoperative computed tomography scores and the improvement of symptom scores in patients treated with functional ...

Purpose: To demonstrate the significance of nasal polyps on the symptoms of chronic rhinosinusitis (CRS) and their influence on surgical outcomes.Methods: Retrospective analysis of prospectively collected data comparing two groups of patients diagnosed with CRS with and without nasal polyps that underwent surgical management with a minimum 1‐year follow‐up period. Subjective scoring was performed using the Sino‐Nasal Outcome Test (SNOT‐20) questionnaire. Computed tomography (CT) scans were compared using the Lund‐Mackay scoring system. The two groups were analyzed for the need of revision surgery.Results: Two hundred one patients underwent surgical management of CRS over a 3‐year period. One hundred four were male, 97 were female, and the average age was 49 (range 18–80) years. Polyps were present in 78 patients with CRS, whereas 123 patients did not have polyps. The average CT score was 18 for the polyp group and 9.5 for the patients without polyps (P = .0000). Nonpolyp group SNOT‐20 scores were 26.5 preoperatively with improvement to 5.1 at 6 months and 5.0 at 12 months postoperatively (85% improvement). Polyp group SNOT‐20 preoperative scores averaged 32.2 with improvement to 9.2 at 6 months and 9.1 at 12 months postoperatively (81% improvement, P = .003). Nine patients required revision surgery (4.5%), eight (10%) who had polyps and one (0.8%) who did not (P = .002).Conclusion: The presence of nasal polyps has a significant negative impact on patients with CRS. Patients with nasal polyps have more severe symptoms with less improvement after operative intervention, higher CT scores at presentation, and a significantly higher need for revision surgery.

Purpose: Most anterior skull base defects causing cerebrospinal fluid (CSF) rhinorrhea can be readily approached using endoscopic techniques when surgical repair is necessary. We present our data from endoscopic repair of CSF rhinorrhea with long‐term follow‐up.Methods: Retrospective data analysis of patients that were diagnosed with anterior skull base CSF rhinorrhea and underwent endoscopic repair at a tertiary institution. Data were analyzed to determine the etiology and location of CSF leaks. Diagnostic techniques, surgical techniques, and surgical outcomes were reviewed.Results: Ninety‐two patients were diagnosed with CSF rhinorrhea and underwent endoscopic repair over a 12‐year period. Forty‐eight were males, and 44 were females. The average age was 49 (range 6–81) years. Average follow‐up was 25 months, with a range of 12 to 82 months. The etiology of CSF leak was prior endoscopic sinus surgery in 23 patients (25%), idiopathic in 19 (21%), neurosurgery in 17 (18%), trauma in 18 (20%), and the presence of meningocele/encephalocele in 11 patients (12%). The most common location of the defect was the sphenoid sinus (n = 36, 39%), followed by ethmoid roof (n‐27, 29%), and cribriform plate (n = 24, 26%). Endoscopic repair was initially successful in 78 (85%) patients. Seven additional patients underwent successful revision endoscopic repair for an overall success rate of 92% (n = 85). Five (6%) large skull base defects were eventually repaired by neurosurgery using open intracranial techniques. No major complications were encountered.Conclusion: The intranasal endoscopic approach is an effective and safe technique in the surgical management of anterior skull base CSF rhinorrhea. Long‐term success rate in our patient population was 92%.

Objective: Determine the diagnostic criteria and etiology of complete unilateral maxillary sinus opacification.Methods: A prospective analysis was performed on patients presenting to a tertiary care rhinology practice with complaints of chronic rhinosinusitis or acute exacerbation. Sixty‐four consecutive patients were identified with unilateral maxillary sinus opacification on computed tomography (CT) scan after at least a 3‐week medical therapy for rhinosinusitis. The study population comprised 30 men and 34 women with a mean age of 47.0 years. All patients completed a symptom score questionnaire, received nasal endoscopy, and CT imaging. Patient symptoms and endoscopic and radiographic findings were analyzed to determine patterns related to final diagnosis.Results: All 64 patients underwent functional endoscopic sinus surgery. Each surgical specimen was sent for pathologic confirmation of the diagnosis. Sixteen mucoceles, 12 cases of nasal polyposis, 27 cases of acute or chronic sinusitis, 7 cases of inverting papilloma, and 2 cases of mycetoma were identified. Endoscopic and radiographic appearances were correlated with each disease process.Conclusion: Unilateral maxillary sinus opacification is a relatively common finding. Early identification of inverting papillomas and mucoceles may avoid delay in surgical intervention, whereas acute/chronic rhinosinusitis and nasal polyposis can initially be managed medically. Careful history, endoscopic examination, and radiographic studies can often determine the responsible disease process.