Older Age Is Associated With Better Compliance With Follow-up in Taiwan After Functional Endoscopic Sinus Surgery.

BACKGROUND/AIM: Functional endoscopic sinus surgery (FESS) is frequently conducted for restoring sinus ventilation and function. Postoperative care is critical for success. However, loss to follow-up is disturbing. The specific aim of this study was to identify critical factors contributing to loss of patients to follow-up and how to improve it. PATIENTS AND METHODS: A total of 221 patients with chronic rhinosinusitis undergoing FESS were enrolled. Patients were divided into three groups according to their follow-up after surgery: Less than 1 month (short-term), 1-3 months (medium-term) and more than 3 months (long-term). The gender, age, smoking status, comorbidities, laterality, Lund-Mackay score, 22-question Sinonasal Outcome Test, nasal obstruction Visual Analogue Scale and mucociliary clearance were evaluated for their contribution to better compliance in follow-up. RESULTS: The results revealed that older patients had better compliance in follow-up compared with younger ones (p=0.0093). Other factors were not contributory (p>0.05). CONCLUSION: In contrast to the US, older patients in Taiwan have better compliance in postoperative follow-up, while younger ones require more education on the importance of follow-up.

Does chronic rhinosinusitis increase the risk of lung cancer? A population cohort study.

BACKGROUND AND AIMS: Chronic rhinosinusitis is one of the most common chronic inflammatory diseases of the upper airway. A previous study of chronic rhinosinusitis and the risks of lung cancer was based on a self-reported questionnaire concerning rhinosinusitis. Population-based cohort studies of the correlation between chronic rhinosinusitis and the adenocarcinoma subtype of lung cancer have been limited. OBJECTIVES: In the present study, we used a population-based database to investigate the risks related to the adenocarcinoma subtype of lung cancer among patients with chronic rhinosinusitis. METHODS: We identified 13 072 patients who were diagnosed with chronic rhinosinusitis in 1998-2010 as the exposure group. There were 52 288 randomly selected patients as the comparison cohort. We used data from the Taiwan National Health Insurance Research Database; the Taiwan National Health Insurance programme offers health-care services to 99% of the 23 million people residing in Taiwan. We compared the incidence of the adenocarcinoma subtype of lung cancer between the two cohorts. The cumulative incidence and hazard ratios of developing the adenocarcinoma subtype of lung cancer were calculated. RESULTS: This study included 13 072 participants with chronic rhinosinusitis and 52 288 participants with non-chronic rhinosinusitis. The risk of the adenocarcinoma subtype of lung cancer was higher in the chronic rhinosinusitis cohort than in the non-chronic rhinosinusitis cohort, with an adjusted hazard ratio of 3.52 after controlling for age and gender. CONCLUSION: This large population-based cohort study demonstrated that patients in Taiwan with previous chronic rhinosinusitis are at greater risk of developing the adenocarcinoma subtype of lung cancer.

Hyperdense findings in sinus computed tomography of chronic rhinosinusitis.

BACKGROUND: Our study investigated the diagnostic value of the mineralization findings and high-density secretion features of sinus computed tomography (CT) images in cases of chronic rhinosinusitis (CRS) compared to histopathology and operative findings. METHODS: This was a prospective cohort study of 193 patients consecutively enrolled for endoscopic sinus surgery (ESS). Group 1 had mineralization in the sinus; group 2 had high-density secretions in the sinus but no mineralization; group 3 lacked both high-density secretions and evidence of mineralization. Intergroup comparisons were performed for histopathology (especially presence of fungus ball), CT scores, and gross operative appearance. RESULTS: Histopathologic evidence of fungus ball (FB) compared to presence of CT findings was significantly different between the groups, with the following percentages of patients demonstrating FB presence: 33% of group 1 (CT mineralization) (n = 48); 4% of group 2 (CT hyperdensity) patients (n = 25); and 2% of group 3 (no mineralization, no hyperdensity) patients (n = 120) (p < 0.05). Operative findings did not necessarily correlate with CT findings and all groups demonstrated varying amounts of dry cheesy (DCM) or wet clay-like (WCLM) material, though this was slightly higher in groups 1 and 2. CONCLUSION: A preoperative survey of sinus mineralization and high-density secretion features observed with CT was predictive of operative findings and histopathological results indicating a sinus FB.

Can FESS combined with submucosal resection (SMR)/septoplasty reduce revision rate?

OBJECTIVES: Our study was designed to ascertain the outcomes of functional endoscopic sinus surgery (FESS) combined with submucosal resection (SMR)/septoplasty in reducing FESS revision rates. STUDY DESIGN: Retrospective population-based study. SETTING: Academic tertiary medical center. SUBJECTS AND METHODS: By using the Taiwan Longitudinal Health Insurance Database, we obtained the patients who underwent FESS for chronic rhinosinusitis. These patients were divided into 2 groups: the control group (FESS alone) and the study group (FESS combined with SMR). The primary outcome was the revision operative rate. RESULTS: In total, 4484 patients who had undergone FESS were recruited into this study. The number of patients who underwent revision FESS was 528 (11.78%). In our sample, 80.45% of patients received FESS alone, whereas 19.54% of the patients underwent concurrent SMR/septoplasty during FESS. There are more female patients and older patients in the control group than in the study group. The revision rates of these 2 groups were significantly different (12.36% vs 9.36%, respectively; P = .016). Moreover, logistic regression analysis came out that patients in the control group had a higher revision rates than those in the study group. Male patients and younger patients were found to have higher revision rates. In addition, patients with asthma or allergic rhinitis had higher revision rates compared with those patients without these 2 comorbidities. CONCLUSIONS: This study showed an association between FESS combined with concurrent SMR/septoplasty and less incidence of revision rate of FESS. Patients with asthma or allergic rhinitis have an increased risk of requiring more revision surgeries after FESS.

Objective measurements differ for perception of left and right nasal obstruction.

OBJECTIVE: Nasal obstruction is one of the most common sensation complaints of nasal disease in clinical practice. It is a subjective sensation of nasal airflow. Objective assessment of nasal patency and nasal physiology includes the use of rhinomanometry and acoustic rhinometry. The perception of nasal obstruction changes as the alternating of nasal airway resistance and nasal airflow. However, there were limited studies reported whether the perceptions of the left and right nostrils are similar. We examined the relationship between subjective and objective parameters of the nasal airway in the left and right nostrils. METHODS: A prospective study of 101 patients with a deviated nasal septum and chronic hypertrophic rhinitis was conducted for subjective and objective nasal airway evaluation. Patients were then divided into three groups based on the visual analog scale. Associations between measures were evaluated with analysis of variance, f tests and simple regression. RESULTS: Among three patient groups with different subjective sensations of nasal obstruction, there were significant differences among three patient groups according to the objective measurements of airflow resistance on the right side (p=0.0002 for inspiration right mean resistance; p=0.0049 for expiration right mean resistance), and for the minimal cross-sectional area (p=0.030) and nasal cavity volume (p=0.028 for 0-3.3cm left nostril; p=0.047 for 2-4cm left nostril) on the left side. This indicates that nasal flow resistance is an important determinant for right side nasal obstruction. Nasal minimal cross-sectional area and nasal cavity volume are an important determinant for left side nasal obstruction. CONCLUSION: Our study indicates the important role of rhinomanometry in objective measurement of right side nasal obstruction and acoustic rhinometry in objective measurement of left side nasal obstruction. Thus, human perception of right and left nostrils may be different and requires further study.

Resolution of hydronephrosis due to massive mesenteric fibromatosis using cyclo-oxygenase 2 inhibitors.

Mesenteric fibromatosis is currently a diagnostic and therapeutic challenge. We report a case of mesenteric fibromatosis in a 29-year-old man with a 2-month history of periumbilical fullness who was discovered to have an abdominal mass with hydronephrosis. To the best of our knowledge, we report the first case of hydronephrosis in a mesenteric fibromatosis with Gardner's syndrome, which was successfully treated with a cyclo-oxygenase 2 inhibitor without surgical removal of the mesenteric fibromatosis. The hydronephrosis and mesenteric fibromatosis improved modestly with long-term celecoxib (200 mg twice daily). Our case also highlights the importance of performing a detailed examination in patients with hydronephrosis.