Evaluation of Pulmonary Function Tests and Nasal Symptoms Pre and Post Endoscopic Sinus Surgery in Patients with Ethmoidal Polyposis

Abstract

Ethmoidal polyposis (EP) is a frequent form of chronic rhinosinusitis. Medical therapy is the main modality of treatment. Non responders to medical treatment require surgical removal of polyps by Endoscopic Sinus Surgery (ESS). Many studies showed worsening of the lung function following ESS whereas few studies showed improvement in the symptoms and better quality of life. Hence this study is an attempt to assess the effect of ethmoidal polyps on the pulmonary function and also the change in the lung function in the patients with ethmoidal polyps post ESS. Methods: A prospective observational study was conducted in a tertiary care hospital on 50 subjects with ethmoidal polyposis who were unresponsive to medical treatment and hence underwent ESS. Pulmonary function tests were assessed using spirometry and nasal symptoms were scored as per TNSS system prior to surgery and 3 months post surgery and compared with the pre op values and analysed. Results: There were 30 males and 20 females with majority of them in the age group of 41-50 yrs. The mean pre op FVC, FEV1, MEFR were 2.94liters, 2.41 liters and 2.51 liters respectively whereas the mean post operative values were 2.95 liters, 2.39 liters and 2.49 liters respectively.. The ratio of FEV1 and FVC was more than 0.7 in 98 % patients pre operatively and 94% post operatively. There was no statistically significant change in lung function tests following ESS. Pre operatively majority (35) had TNSS value between 6-9 where as post operatively the score was reduced to 2-3 in many patients (38). The mean TNSS was 7.24 before surgery which declined to 2.82 after surgery with a p value <0.0001indicating a statistically significant improvement in the nasal symptoms post ESS. Conclusion: Our study shows that ESS benefits patients with nasal polyps by improving the symptoms and there by the quality of life without any adverse effects on the lower airways.