Our Summary

This research looked at the factors that might influence the recurrence of chronic rhinosinusitis (CRS), a long-term sinus inflammation, after functional endoscopic sinus surgery (FESS), a minimally invasive surgical procedure used to treat sinusitis. The researchers studied two types of CRS based on their molecular characteristics: eosinophilic CRS (ECRS) and non-eosinophilic CRS (NECRS).

They used computed tomography (CT), a type of X-ray that provides detailed images of the body, to examine the sinuses of patients who underwent a second FESS due to the recurrence of CRS. They found that the recurrence patterns in the sinuses differed based on the type of CRS.

Despite complete surgical procedures, ECRS patients had higher recurrence rates in the frontal and ethmoidal sinuses (located in the forehead and between the eyes, respectively). Interestingly, incomplete surgeries were more common in NECRS patients.

So, the main takeaway is that the type of CRS influences how and where it might recur after surgery, and this could help in planning treatment strategies for CRS patients.

FAQs

  1. What is chronic rhinosinusitis (CRS) and how is it treated?
  2. How does the type of CRS influence its recurrence after functional endoscopic sinus surgery (FESS)?
  3. What did the researchers find about the recurrence of CRS in patients who underwent a second FESS?

Doctor’s Tip

A doctor might tell a patient that the type of chronic rhinosinusitis (CRS) they have can influence the recurrence of symptoms after sinus surgery. Patients with eosinophilic CRS (ECRS) may experience higher recurrence rates in specific sinuses compared to patients with non-eosinophilic CRS (NECRS). Understanding the type of CRS you have can help in planning effective treatment strategies to prevent recurrence after surgery.

Suitable For

Patients who are typically recommended sinus surgery are those who have chronic rhinosinusitis (CRS) that does not respond to other treatments such as medications or nasal sprays. Factors that may indicate the need for sinus surgery include:

  • Recurrent sinus infections: Patients who experience frequent sinus infections that do not improve with antibiotics may benefit from surgery to improve sinus drainage.
  • Nasal polyps: Patients with nasal polyps that obstruct the nasal passages and cause symptoms such as difficulty breathing, loss of smell, or facial pain may require surgery to remove the polyps.
  • Structural abnormalities: Patients with structural issues in the sinuses, such as a deviated septum or narrow sinus openings, may benefit from surgery to correct these issues and improve sinus drainage.
  • Sinus tumors: Patients with benign or malignant tumors in the sinuses may require surgery to remove the tumor and prevent further complications.
  • Severe symptoms: Patients with severe symptoms of CRS, such as facial pain, pressure, or headaches that significantly affect their quality of life, may benefit from surgery to alleviate these symptoms.

Overall, sinus surgery is typically recommended for patients with chronic sinusitis who have not responded to other treatments and continue to experience symptoms that significantly impact their quality of life.

Timeline

Before sinus surgery, a patient may experience symptoms of chronic rhinosinusitis such as nasal congestion, facial pain or pressure, postnasal drip, and reduced sense of smell. They may also have undergone various treatments such as antibiotics, nasal corticosteroids, and sinus rinses to manage their symptoms.

After sinus surgery, the patient may experience some post-operative symptoms such as nasal congestion, mild pain or discomfort, and nasal drainage. They will need to follow post-operative care instructions provided by their surgeon, including using saline rinses, avoiding strenuous activities, and attending follow-up appointments.

Over time, the patient should experience a reduction in their symptoms and improved quality of life as the sinus surgery helps to open up the sinuses and improve drainage. However, there is a risk of recurrence of chronic rhinosinusitis, especially in patients with eosinophilic CRS. In such cases, a second sinus surgery may be necessary to address the recurrent symptoms and improve outcomes for the patient.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sinus surgery include:

  1. What type of CRS do I have (ECRS or NECRS) and how does this influence my likelihood of recurrence after surgery?
  2. What specific areas of my sinuses are more prone to recurrence based on my CRS type?
  3. What factors might contribute to incomplete surgeries in NECRS patients and how can we ensure a complete surgical procedure for me?
  4. What are the potential risks and complications associated with a second FESS procedure for recurrent CRS?
  5. What alternative treatment options are available if my CRS recurs after surgery?
  6. How can I best manage my symptoms and prevent recurrence following sinus surgery?
  7. What is the expected recovery time and what follow-up care will be needed after the surgery?
  8. Are there any lifestyle changes or medications that can help prevent or reduce the recurrence of CRS after surgery?
  9. How will you monitor my progress and recurrence risk after the surgery?
  10. Are there any specific precautions I should take to avoid complications or recurrence after sinus surgery?

Reference

Authors: Hong SN, Kim YS, Cha H, Park JA, Kim JK, Oh H, Kim M, Ryu HT, Hong SD, Kim DW. Journal: Auris Nasus Larynx. 2022 Apr;49(2):215-221. doi: 10.1016/j.anl.2021.07.010. Epub 2021 Jul 24. PMID: 34312018