Increased expression of the TNF superfamily member LIGHT/TNFSF14 and its receptors (HVEM and LTßR) in patients with systemic sclerosis.

OBJECTIVES: This study aimed to assess the potential role of the TNF superfamily member lymphocyte T-related inducible ligand that competes for glycoprotein D binding to herpesvirus entry mediator on T cells (LIGHT) in SSc through evaluation of: skin expression of LIGHT and its receptors, herpesvirus entry mediator and lymphotoxin ß-related receptor, and serum concentration of LIGHT in SSc patients. METHODS: Expression of LIGHT and its receptors was investigated by immunohistochemistry and evaluated semi-quantitatively in skin biopsies from 19 SSc patients and 9 healthy controls. Serum levels of LIGHT were measured using ELISA in 329 patients with SSc and 50 control subjects. RESULTS: Expression of LIGHT and both receptors was higher in SSc patients compared with controls (P < 0.05 for all comparisons). Patients with early SSc (⩽ 3 years from the first non-Raynaud's phenomenon symptom) showed higher expression of LIGHT and herpesvirus entry mediator compared with patients with longer disease duration (P < 0.05 for both comparisons). The mean serum concentration of LIGHT was significantly higher in SSc patients compared with the controls (P < 0.05). High serum concentration of LIGHT was associated with male sex, presence of digital ulcers, muscle involvement (defined by elevated serum creatine kinase levels), steroid treatment and lack of ACA. However, in multivariate regression analysis only presence of digital ulcers and creatine kinase elevation were independently associated with serum concentration of LIGHT. CONCLUSION: These data provide the first evidence of overexpression of LIGHT and its receptors in SSc and suggest that the LIGHT axis might contribute to the pathogenesis of SSc. Increased serum concentrations of LIGHT seem to reflect vascular injury in SSc.

Minimally invasive medial maxillectomy and the position of nasolacrimal duct: the CT study.

Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.

Haemangiopericytoma-like tumor of the nasal cavity treated by endoscopy - a case report.

Haemangiopericytoma (HPC) is an uncommon, vascular tumor derived from Zimmerman pericytes surrounding blood vessels. HPC constitute around 1% of all tumors of vascular origin and may appear anywhere, 5% of them can be situated in nasal cavity. Tumor location within the head and neck predispose to its benign character and improves prognosis. This case report presents the case of 33-year-old patient with haemangiopericytoma-like tumor of the nasal cavity, presented symptoms of impaired nasal breathing and recurrent epistaxis. Tumor was excised with 0 degree endoscope. The follow-up recurrence-free period was 2 year 6 months and shows this is effective way of treatment. Described in the literature late recurrences and metastases reminds that regular, life-long observation is mandatory.

The transmaxillary endoscopic approach to the inferior part of the orbit: how I do it.

BACKGROUND: Transmaxillary endoscopic approach to the inferior part of the orbit was demonstrated on cadaveric preparations; however, its clinical application has not been reported. We describe a clinically useful technique of the transmaxillary approach to the lower orbit. METHODS: A four-hand technique is essential for extensive preparation within the orbit; therefore, the tools have to be introduced into the maxillary sinus through two ports: either through the canine fossa and antrostomy or through antrostomy using the bi-nostril transseptal approach. CONCLUSION: Intraorbital pathologies located in the inferior retrobulbar space can be successfully operated on using the transmaxillary endoscopic approach.

Endoscopic lateral orbitotomy.

BACKGROUND: Lateral orbitotomy can be minimalized using contemporary endoscopy. METHODS: Anatomy of the temporal fossa/orbital wall junction is described. The attachment of the temporal fascia is cut off from the orbital rim through a 1.5 cm skin incision in the lateral orbital wrinkle. The temporal muscle is detached from the bone to create a space for the telescope. An appropriate bone opening in the lateral orbital wall is created with the aid of neuronavigation to handle intraorbital pathology. CONCLUSION: Endoscopic lateral orbitotomy is an original alternative to the microsurgical Krönlein approach and yields good functional and cosmetic results.

Endoscopic drainage of orbital abscesses aided with intraoperative sonography.

BACKGROUND AND PURPOSE: Accurate localization and adequate visualization of the superiorly or inferiorly located subperiosteal orbital abscesses or intraorbital abscess is difficult with transnasal endoscopic approach. Sonography is a well-known and effective tool for evaluation of orbital pathologies but no paper documenting intraoperative application of this method in orbital abscess surgery has been published to date. MATERIAL AND METHODS: We present a series of 12 patients in whom orbital abscesses were drained endoscopically with an aid of neuronavigation and intraoperative ultrasonography. The abscesses were localized subperiosteally in the medial (n=6), superior (n=2) or inferior (n=1) part of the orbit whereas in 3 patients the abscess was localized in the intraconal space. RESULTS: According to intraoperative sonographic imaging complete drainage of the abscess was achieved in 11 out of 12 patients and no complications occurred. Intraoperative sonography helped to limit opening of the orbital wall in the medial subperiosteal abscesses, enabled check-up for completeness of drainage of the far extending pouches in the superior and inferior subperiosteal abscesses and enabled visualization of the tip of surgical instrument when reaching deeply located intraorbital abscesses. CONCLUSIONS: Intraoperative ultrasonography facilitates the endoscopic management of orbital abscesses, especially those which are difficult to reach due to subperiosteal location in the superior and inferior parts of the orbit, or abscesses localized intraorbitally.

Endoscopic transconjunctival surgical approach to intraconal space of the orbit: first clinical experience.

BACKGROUND AND PURPOSE: Recently, a transconjunctival, endoscope-assisted (TEA) approach to the medial intra-orbital space was developed based on cadaver preparations, with an ultimate goal of minimizing disturbances of the anatomic structures of the orbit. However, no report on clinical validation of this promising technique was published thus far. We present our experiences with the TEA approach in two patients. MATERIAL AND METHODS: In emergency conditions, we approached the lateral retrobulbar space of a 42-year-old male through a 180° incision close to the corneal limbus; a scrap of metal, which had perforated the globe and resided at its posterior wall, was removed endoscopically. Moreover, we used the TEA approach to remove a tumor from the upper intraconal space in a 63-year-old woman. RESULTS: In both patients the surgical goal was achieved with no muscle transection and without additional morbidity and complications. CONCLUSIONS: Our experiences with TEA approach suggest that the procedure is clinically feasible, produces no co-morbidity and yields good functional and cosmetic results. As a result, the whole circumference of the retrobulbar space can be conveniently explored.

Blood flow velocity in the middle cerebral artery during transnasal endoscopic skull base surgery performed in controlled hypotension.

BACKGROUND AND PURPOSE: To assess blood flow velocity in the middle cerebral artery (MCA) during transnasal endoscopic procedures performed with decreased hemodynamic parameters. MATERIALS AND METHODS: In 40 patients who underwent endoscopic skull base surgery in controlled hypotension (studied group) and in 13 patients operated without reduction of hemodynamic parameters (control group), blood flow velocity in MCA was assessed with transcranial color Doppler sonography. RESULTS: Blood flow velocity in MCA remained within the range of age-specific reference values in all patients before operation. It decreased significantly in both groups after induction of anesthesia and then dropped even further in studied group of patients when hemodynamic parameters were reduced; the systolic velocity fell below the normal reference values in 25% of patients, the mean velocity in 50% and the diastolic velocity in 57% of patients. The diastolic velocity was much more heavily influenced by diminished hemodynamic parameters than systolic velocity in the studied group as opposed to the control group where reduction of blood flow velocity pertained equally systolic and diastolic velocity. CONCLUSION: During transnasal endoscopic procedures performed in moderate hypotension, in addition to significant drop of blood flow velocity to values well below the normal reference range, a divergent reduction of systolic and diastolic velocity was detected. Since divergent systolic and diastolic velocity may indicate an early phase of cerebral autoregulation compromise, and the decrease of mean blood flow velocity in MCA corresponds with a decrease of cerebral blood flow, further investigations in this field seem warranted.

Hearing impairment in systemic sclerosis patients-what do we really know?

Background: Systemic sclerosis (SSc) is a disease of a very heterogeneous clinical picture and immunological profile with progression rate that varies between individuals. Although hearing deterioration is not a complaint that comes to the fore in SSc patients, as it is not life-threatening compared to many other more severe symptoms of this disease, it can significantly impair the quality of life. Medical literature concerning this problem is rather scarce. Materials and methods: In this article we systematically reviewed the medical publications concerning hearing impairment in patients with systemic sclerosis to evaluate current understanding of this complex problem. Following PRISMA guidelines a total of 19 papers were found and analysed including 11 original studies and 8 case reports. Results: Although it seems that hearing impairment in SSc patients is relatively more common than in the general population, based on the analysis of available literature, no firm conclusions regarding its frequency and pathomechanism can be drawn yet. Microangiopathy leading to damage to the sensory cells of the inner ear is suspected to be the main mechanism of hearing loss, although damage to the higher levels of the auditory pathway appears to be underestimated due to incomplete audiological diagnosis. Conclusion: Undoubtedly, the reason for the difficulty in such an evaluation are the complex and still not fully elucidated pathomechanism of SSc, the individually variable dynamics of the disease and the unique heterogeneity of symptoms. Nevertheless, further studies in larger and appropriately selected groups of patients, focused more on the dynamics of microangiopathy and not solely on clinical symptoms could provide answers to many key questions in this regard.

Operative field temperature during transnasal endoscopic cranial base procedures.

BACKGROUND: Data regarding the safety of endoscopic skull base exploration are very scarce. With this method, fragile vital structures (cranial nerves, the optic complex, brainstem, hypothalamus or cerebral ventricles) are exposed to direct illumination within a closed space. Also, high-speed drills, cauterization and ultrasonic aspiration deliver a significant load of thermal energy. The aim of this study was to record the temperature close to the structures of the skull base and in the intradural space during the procedures performed using extended endoscopic transnasal approaches. METHODS: The temperature of the skull base was continuously recorded during six transnasal endoscopic procedures. Implantable copper-constantan thermocouples were inserted: one into the esophagus and another through the nostril to reach the operative field at the skull base. RESULTS: At the beginning of the procedure, the temperature of the operative field was on average 36.8 °C ± 0.80 °C, i.e. only 1 °C higher than the esophageal temperature. Then it grew continuously during the whole procedure, to eventually reach a level of 42-43 °C at the final stage, whereas the esophageal temperature remained stable. Occasionally, the temperature increased up to 45 °C during cauterization and ultrasonic aspiration, and even up to 62 °C during high-speed drilling. CONCLUSION: Endoscopic skull base surgery is associated with an incessant increase of the temperature of the intraoperative field. The temperature can peak suddenly to levels which can potentially harm neural structures and influence the rate of postoperative complications.

[Transnasal endoscopic approaches to the cranial base]. / Przeznosowe dostepy chirurgiczne w endoskopowych operacjach podstawy czaszki.

Recent advances in surgical endoscopy have made it possible to reach nearly the whole cranial base through a transnasal approach. These 'expanded approaches' lead to the frontal sinuses, the cribriform plate and planum sphenoidale, the suprasellar space, the clivus, odontoid and atlas. By pointing the endoscope laterally, the surgeon can explore structures in the coronal plane such as the cavernous sinuses, the pyramid and Meckel cave, the sphenopalatine and subtemporal fossae, and even the middle fossa and the orbit. The authors of this contribution use most of these approaches in their endoscopic skull base surgery. The purpose of this contribution is to review the hitherto established endoscopic approaches to the skull base and to illustrate them with photographs obtained during self-performed procedures and/or cadaver studies.

Endoscopic treatment of adversely located osteomas of the frontal sinus.

OBJECTIVES: We assess the utility and limitations of an endoscopic technique in the treatment of osteomas that are considered difficult to manage endoscopically, ie, those located superiorly or laterally in the frontal sinus, extending beyond a virtual plane through the lamina papyracea, and we describe the principles of a surgical technique that facilitates removal of such tumors. METHODS: We performed a retrospective study on 8 patients with symptomatic frontal sinus osteomas, including tumors extending past the commonly recognized limits of endoscopic resection because of their size or site of attachment. RESULTS: All tumors were removed by a purely transnasal endoscopic approach. No major complications were observed during or after the operation. All patients experienced improvement or total regression of their symptoms. CONCLUSIONS: With appropriate instruments and specific endoscopic techniques, it is possible to resect osteomas that not long ago were deemed inaccessible to endoscopic surgeons. The commonly recognized limits of endoscopic treatment of such tumors may be exceeded in some cases; however, favorable anatomic conditions are decisive for a successful operation.

Possible role of α-mannosidase and ß-galactosidase in larynx cancer.

BACKGROUND: Lysosomal exoglycosidases, such as α-mannosidases (MAN) and ß-galactosidases (GAL), are found in different glycoside hydrolase sequence-based families. Considerable research has proved plays the role of MAN, which play a key role in the modification and diversification of hybrid N-glycans, processes with strong cellular links to cancer. Therefore the study aim was to investigate the activities of MAN and GAL in larynx cancer compared to controls. MATERIAL AND METHODS: Larynx cancer (n = 21) and normal healthy tissue (n = 21) were collected from patients during total laryngectomy. A biopsy of macroscopically healthy tissue in the area of the lower 1/3 of omohyoid muscle was taken for frozen sections in each case and these served as controls. The release of p-nitrophenol from p-nitrophenol derivatives of MAN and GAL was used. RESULTS: In all specimens we observed significantly higher activity of investigated enzymes in larynx cancer compared with controls. The mean release of MAN from activated cells was 3.702 ±1.3245 nkat/g wet tissue compared to controls (1.614 ±0.8220 nkat/g wet tissue). The mean release of GAL from the activated cells was 3.383 ±2.1980 nkat/g wet tissue compared to controls (2.137 ±1.3685 nkat/g wet tissue). Differences in observed activity were statistically significant. CONCLUSION: The present data indicate that MAN and GAL are significantly and consistently elevated in larynx cancer growth. It also means that catabolic reactions involving glycoproteins, glycolipids and proteoglycans may play a role in larynx cancer. Further research should also evaluate the relative importance of these particular exoglycosidases in indicating the progress of the disease in considering the spectrum of identified marker mediators.

Isolated sphenoid sinus pathologies--the problem of delayed diagnosis.

BACKGROUND: Isolated sphenoid sinus pathologies are relatively rare. In the majority of cases, symptoms do not arise in the early stages of the disease or are non-specific, therefore making diagnosis difficult. The aim of this study was to investigate the diagnostic process and the reasons for development of complications in patients with isolated sphenoid sinus pathology. MATERIAL/METHODS: The clinical data and observation charts of 32 patients were investigated to determine how long the main symptoms of sphenoid pathology had been present before the patients were referred for medical treatment, and the time that elapsed from the first ambulatory medical assessment to the initial diagnosis. RESULTS: Complaints and symptoms of sphenoid sinus pathology had been present for 10.2 months before the diagnosis was established. Although the duration of complaints in "ORL" (diagnosed by otorhinolaryngologist) and "non-ORL" (diagnosed by other specialists) group of patients was similar (10.8 and 9.5 months on average, respectively), unexpectedly, in the "non-ORL" group of patients, the time necessary for making the initial diagnosis was actually shorter than in the "ORL" group (1.8 vs 4.1 months). At the time of hospital admission, endoscopic examination revealed no abnormalities in 31.2% of patients. In 28.1% of patients the pathological process in the sphenoid sinus was diagnosed only after the onset of complications. CONCLUSIONS: The occult character of the disease and the lack of severe and specific symptoms, rather than the delay in getting extensive diagnostic tests, are responsible for the delayed diagnosis and treatment.

[Reduction of intraoperative bleeding during functional endoscopic sinus surgery]. / Wspólczesne poglady na temat ograniczania krwawienia w polu operacyjnym w endoskopowej chirurgii zatok przynosowych.

Functional endoscopic sinus surgery (FESS) is a surgical procedure, during which all necessary manipulations are performed while using a fibreoptic camera. The endoscope is inserted together with the surgical instruments, through the nasal cavity. During the surgery, bleeding has to be minimized, since even a small amount of blood may completely obstruct vision via the endoscope. Various approaches have been used to secure a dry operating field; among them are: topical vasoconstrictors, Fowler's position, alpha-and beta-adrenergic blockade, and preoperative steroids. All these methods are far from being effective and are associated with significant side effects. The recently approved approach to this problem is to combine total intravenous anaesthesia using propofol and remifentanil, together with esmolol. With the heart rate reduced to 60 bpm, excellent operative conditions can be achieved with moderate hypotension (MAP 65 mm Hg-8.7 kPa). Altered microcirculation and a low cardiac output are the principal underlying mechanisms in these cases.

Endoscopic transconjunctival optic nerve sheath fenestration for progressive idiopathic visual field deficit: a case report.

Intra-orbital optic nerve sheath fenestration (ONSF) is an effective option in patients with progressive vision loss due to idiopathic intracranial hypertension. Most proposed techniques involve surgical trauma and require disinsertion of the medial rectus muscle; thus, less invasive surgical procedures are needed. Here, a feasible and effective technique of endoscopic intra-orbital ONSF through a conjunctival incision is presented, in a patient with a progressively compromised visual field, papilloedema, and distended subarachnoid space around the optic nerves. The retrobulbar segment of the optic nerve was exposed for incision, avoiding manipulation of the lateral orbital rim bones and irritation of the ciliary microvessels and nerves. The patient regained the entire visual field. ONSF was safely and effectively performed endoscopically through a narrow corridor gained by brushing away the orbital fat with minimal traction on the medial rectus muscle. The small postoperative wound was associated with faster and easier convalescence, and less tissue trauma versus conventional open approaches.

Assessment of Lacrimal Duct Patency in Patients Undergoing Endoscopic Medial Maxillectomy.

PURPOSE: The risk of epiphora after medial maxillectomy with lacrimal duct transection is difficult to assess. The data available in the literature are inconclusive due to various operating techniques used by the authors of medical publications, different additional procedures aimed at improving tear drainage after maxillectomy, and a variety of lacrimal duct patency assessment techniques. The aim of our work was to assess the anatomical and functional patency of lacrimal ducts after medial maxillectomy without performing additional procedures to improve tear drainage as well as comparison of the results obtained with different assessment tests. MATERIALS AND METHODS: 21 patients who underwent medial maxillectomy in the years 2016-2019 were assessed for discomfort and epiphora based on patients' own reports and basic clinical examination, lacrimal duct rinse test, the Munk score, and a modified endoscopic Jones I test. RESULTS: Gradually increasing the sensitivity of the assessment method resulted in an increase in the number of patients with potential tear drainage disorders, starting from 0% in the rinsing test, 4.8% self-reported tearing complaints, 14.3% Munk score, and 19% modified endoscopic Jones I test. CONCLUSIONS: The study results revealed that a small fraction of patients tend to report epiphora as a consequence of medial maxillectomy themselves. Subtle functional disorders, which are not particularly bothersome to patients, are more common. More sensitive lacrimal duct patency tests reveal more cases of tear drainage disorders. The results of studies assessing the incidence of epiphora after medial maxillectomy appear to depend on the type of test used.

Expression of LIGHT/TNFSF14 and Its Receptors, HVEM and LTßR, Correlates with the Severity of Fibrosis in Lacrimal Sacs from Patients with Lacrimal Duct Obstruction.

INTRODUCTION: Fibrosis is one of the factors contributing to the development of primary acquired lacrimal duct obstruction (LDO). LIGHT (homologous to lymphotoxins, exhibiting inducible expression and competing with herpes simplex virus glycoprotein D for herpes virus entry mediator [HVEM]), a receptor expressed by T lymphocytes, has recently emerged as a new regulator of connective tissue remodeling and fibrotic response. The purpose of this study was to evaluate the role of LIGHT in the pathogenesis of LDO through: (1) assessment of expression of LIGHT and its two receptors, HVEM and LTßR (lymphotoxin ß receptor), and (2) investigation of potential relationships between expression of LIGHT and its receptors and clinical and histopathologic features. METHODS: Lacrimal sacs of 30 patients undergoing endoscopic dacryocystorhinostomy because of LDO were assessed intraoperatively and histopathologically with respect to inflammation and fibrosis. Expression of LIGHT, HVEM and LTßR was assessed by immunohistochemistry using specific antibodies and evaluated semiquantitatively using a four-grade scoring system. RESULTS: All investigated molecules, LIGHT/TNFSF14, HVEM and LTßR, were expressed in biopsies from all patients. The most prominent expression was seen within inflammatory infiltrates. Expression of LIGH, HVEM and LTßR correlated significantly with the intensity of fibrosis and duration of the disease. In multivariate analysis only LIGHT showed a significant relationship with fibrosis (ß coefficient = 0.759, p = 0.02). There was no significant correlation between expression of any molecule and other demographic or clinical features. CONCLUSION: We assume that LIGHT along with its receptors may be a factor contributing to fibrosis and synechiae formation in the lacrimal sac. This assumption needs to be proven in a future study in a group of patients who fail to improve after the first operation.

Transnasal endoscopic skull base surgery in the COVID-19 era: Recommendations for increasing the safety of the method.

Transnasal endoscopic skull base surgery (eSBS) has been adopted in recent years, in great part to replace the extended procedures required by external approaches. Though sometimes perceived as "minimally invasive", eSBS still necessitates extensive manipulations within the nose/paranasal sinuses. Furthermore, exposure of susceptible cerebral structures to light and heat emanated by the telescope should be considered to comprehensively evaluate the safety of the method. While the number of studies specifically targeting eSBS safety still remains scarce, the problem has recently expanded with the SARS-CoV-2 pandemic, which also has implications for the safety of the surgical personnel. It must be stressed that eSBS may directly expose the surgeon to potentially high volumes of virus-contaminated aerosol. Thus, the anxiety of both the patient and the surgeon must be taken into account. Consequently, safety requirements must follow the highest standards. This paper summarizes current knowledge on SARS-CoV-2 biology and the peculiarities of human immunology in respect of the host-virus relationship, taking into account the latest information concerning the SARS-CoV-2 worrisome affinity for the nervous system. Based on this information, a workflow proposal is offered for consideration. This could be useful not only for the duration of the pandemic, but also during the unpredictable timeline involving our coexistence with the virus. Recommendations include technical modifications to the operating theatre, personal protective equipment, standards of testing for SARS-CoV-2 infection, prophylactic pretreatment with interferon, anti-IL6 treatment and, last but not least, psychological support for the patient.

[Assessment of olfactory disturbances in the patients with rhinosinusitis and polypi nasi treated by endoscopic sinus surgery]. / Ocena zaburzen wechu u pacjentów operowanych metoda endoskopowa z powodu przewleklego, zapalenia blony sluzowej nosa i zatok z polipami.

UNLABELLED: One of the most common symptoms of chronic rhinosinusitis with polyps is smell deterioration. Polypectomy and mechanical restoration of patency of the nose not always and not to the same degree leads to the sense of smell improvement. THE AIM OF STUDY was to assess the sense of smell and nasal patency in patients with chronic rhinosinusitis with polyps treated endoscopically during the healing period and the process of functional normalization of the nasal mucosa. MATERIAL AND METHODS: 30 patients suffering from chronic rhinosinusitis with polyps treated endoscopically were included in the study. Nasal resistance (anterior rhinomanometry), smell (smell threshold and identification tests) and rhinoscopic findings were assessed and analyzed 1, 3, 6 and 12 months postoperatively. RESULTS: The most conspicuous decrease of mean nasal resistance was observed in the first control examination (1 month postoperatively) and then further slight improvement continued until sixth postoperative month. Restoration of the patency of the nose yielded only inconsiderable improvement of smell in first postoperative month. Significant improvement of smell could be detected as late as in third and sixth month after the operation. In the twelfth postoperative month slight deterioration of the mean results of smell and nasal patency tests was noted. At the same time control endoscopic examination revealed recurrent polyposis in 26.6% of patients whereas the improvement in mean smell test result in comparison to preoperative results was observed in over 66.6% of patients. CONCLUSIONS: The smell improvement in patients with rhinosinusitis with polyps after endoscopic surgery occurs later than the nasal patency improvement what may be attributed to the process of healing and functional normalization of the nasal mucosa. On average after a year in some patients first clinical symptoms of recurrent disease emerges. Taking in to the consideration chronic and complex nature of the disease it seems reasonable to assess nasal resistance and smell during longer follow up period.