Anni Koskinen

Endoscopic sinus surgery might reduce exacerbations and symptoms more than balloon sinuplasty.

Background Endoscopic sinus surgery (ESS) is considered after medical therapy failure of chronic rhinosinusitis (CRS). The balloon sinuplasty dilates the natural ostium without moving mucosa or bone. It still lacks evidence from randomized controlled trials. The aim of this retrospective controlled study was to compare the symptom outcomes after maxillary sinus surgery with either the ESS or the balloon sinuplasty technique. No previous or additional sinonasal operations were accepted. Methods Two hundred eight patients with CRS without nasal polyps underwent either balloon sinuplasty or ESS. The patients who met with the inclusion criteria (n = 45 in ESS group and n = 40 in balloon group) replied to a questionnaire of history factors, exacerbations, and a visual analog scale (VAS) scoring of the change in symptoms, on average 28 ± 6 (mean ± SD) months postoperatively. Results The groups were identical in the response rate (64%), patient characteristics, and the improvement in all of the asked symptoms. Patients with CRS-related comorbidity and/or present occupational exposure had a statistically significantly better symptom reduction after ESS than after balloon sinusotomy. Moreover, the balloon sinusotomy group reported a statistically significant higher number of maxillary sinus punctures and antibiotic courses during the last 12 months. Conclusion ESS might be superior to balloon sinuplasty, especially in patients with risk factors. There is a need to perform more controlled studies on the treatment choices of CRS.

Comparison of intra-operative characteristics and early post-operative outcomes between endoscopic sinus surgery and balloon sinuplasty

Abstract Conclusion: In terms of operation time, anesthesia method, and low complication rate, ESS and balloon sinuplasty seemed comparable. The advantages of balloon sinuplasty were shown to be shortness of sick leave, possibility to be performed as an in-office procedure, and lower adhesion formation. Background: Endoscopic sinus surgery (ESS) has been considered as a treatment of choice for persistent chronic rhinosinusitis (CRS). During the last decade balloon sinuplasty has been introduced as an alternative technique to dilate the ostium. Although balloon sinuplasty is considered relatively safe and efficient, comparative evidence of its putative intra-operative and post-operative advantages remain limited. Objectives: The aim of this retrospective controlled study was to evaluate intra-operative factors and early post-operative outcomes among CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique. Materials and methods: Data were collected from 208 patients with CRS treated either with ESS or balloon sinuplasty during the years 2008–2010. Intra- and peri-operative factors were collected from patient records of the patients who met the inclusion criteria (n = 39 in ESS group and n = 36 in balloon sinuplasty group). Results: There was no significant difference in operation time and anesthesia method between the two groups. No complications occurred with either technique. All ESS procedures and 67% of the balloon sinuplasty procedures were done in the hospital setting, whereas 33% of the balloon sinuplasty procedures were done in the office setting. The duration of sick leave and the number of patients with adhesions were significantly higher in the ESS group compared to the balloon sinuplasty group.

Long-term follow-up after ESS and balloon sinuplasty: Comparison of symptom reduction and patient satisfaction.

Abstract Conclusion This is the first controlled study of balloon sinuplasty’s long-term efficacy with the follow-up time over 5 years. The results are in accordance with a previous 2-year-follow-up study. Both techniques retained the efficacy and patient satisfaction on average 6 years after the surgery. Background Endoscopic sinus surgery (ESS) and balloon sinuplasty are considered as a treatment for chronic rhinosinusitis (CRS) after a failure of conservative therapy. High cost and lack of long-term follow-up studies restrain the use of balloon sinuplasty. Objective The aim of this study was to compare long-term efficacy and satisfaction in CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique. Previous or additional sinonasal operations were exclusion criteria. Materials and methods Study patients were recruited from 208 CRS-patients who underwent either ESS or balloon sinuplasty. Patients with nasal polyposis (gradus ≥ 2), previous sinonasal surgery, unilateral disease, or immune deficiency were excluded. Altogether 45 patients in the ESS group and 40 patients in the balloon group were included. Of these, 30 and 28, respectively, answered to a phone interview held on average 6 years after primary surgery. Symptom reduction and long-term satisfaction were evaluated by using symptom scores of 19 parameters altogether. Results Both groups experienced improvement in symptoms and were equally satisfied with the operation. The number of patient-reported acute exacerbations was higher among the balloon dilated patients. Also, the reduction of thick nasal discharge was less evident in the balloon sinuplasty group. Four patients in the balloon sinuplasty group underwent revision surgery. There were no revisions in the ESS group.

Factors affecting revision rate of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a variable multifactorial disease. It can be divided into forms with nasal polyps (CRSwNP) and without (CRSsNP). Sinus and/or nasal polypectomy surgery are considered if maximal conservative treatment is insufficient. The predictive factors of the need of revision surgery comprise mostly the CRSwNP phenotype and are not fully understood.

A detection dog for obstructive sleep apnea

PurposeWe sought to assess whether a dog can be trained to distinguish obstructive sleep apnea patients from healthy controls based on the olfactory detection of urine.MethodsUrine samples were collected from 23 adult male obstructive sleep apnea patients and from 20 voluntary adult male volunteers. Three dogs were trained through reinforced operant conditioning.ResultsTwo of the three dogs correctly detected two thirds of obstructive sleep apnea patients (p < 0.000194 and p < 0.000003, respectively).ConclusionsWe found that dogs can be trained to distinguish obstructive sleep apnea patients from healthy controls based on the smell of urine. Potentially, dogs could be utilized to identify novel biomarkers or possibly screen for obstructive sleep apnea.

Diagnostic Accuracy of Symptoms, Endoscopy, and Imaging Signs of Chronic Rhinosinusitis Without Nasal Polyps Compared to Allergic Rhinitis:

Objectives The diagnosis of chronic rhinosinusitis without nasal polyps (CRSsNP) and distinguishing it from allergic rhinitis is difficult. Yet, early detection of CRSsNP is important to prevent progressive and severe chronic rhinosinusitis. Our aim was to compare diagnostic accuracy of symptoms, endoscopy, and imaging signs of CRSsNP and allergic rhinitis -only phenotypes. Setting Prospective controlled follow-up study. Participants Forty-two nonsmoking patients visiting tertiary care due to CRSsNP and 19 nonsmoking volunteer controls with allergic rhinitis filled a symptoms questionnaire and underwent nasal endoscopy off-seasonally. All CRSsNP patients underwent computed tomography scans of paranasal sinuses. All the allergic rhinitis control subjects and 14 of the CRSsNP patients underwent sinus magnetic resonance imaging. Results Radiologic Lund–Mackay score, duration of symptoms, visual analogue scale scores of symptoms, and Sinonasal Outcome Test 22 were significantly higher in the CRSsNP group compared to allergic rhinitis control group. These factors also correlated in part with each other. Endoscopic score did not correlate with other factors, nor did it differ between CRSsNP and allergic rhinitis groups. The highest area under curve value was demonstrated for visual analogue scale score of facial pain/pressure (0.93) and score ≥4/10 showed 60% sensitivity and 95% specificity for detecting CRSsNP group (P < .001). Radiologic sign of obstructed osteomeatal complex showed 100% specificity and 38% sensitivity for detecting CRSsNP group (P < .001). Conclusions CRSsNP phenotype could be primarily distinguished from allergic rhinitis by higher facial pain/pressure score and secondarily by radiologic sings of obstructed ostiomeatal complex and higher Lund–Mackay score. Endoscopic score has limited value in distinguishing CRSsNP from allergic rhinitis.

Antibody responses to tetanus and diphtheria vaccine in chronic and recurrent rhinosinusitis.

OBJECTIVES Chronic rhinosinusitis may be accompanied by impaired immunity despite normal levels of serum immunoglobulins. Immune responses in sinusitis patients have previously been evaluated using polysaccharide vaccines. Our AIM was to assess the immune status by evaluating responses to diphtheria and tetanus vaccine. METHODS Specific antibodies were measured before and 2 weeks after vaccination in 25 patients with chronic or recurrent sinusitis and in 30 healthy individuals. The mean age of the patients was 46 years and that of healthy controls 43 years. RESULTS After vaccination the patients had on average 4.08-fold lower responses to diphtheria toxoid and 2.20-fold lower responses to tetanus than the controls. Fourteen out of 25 patients had antibody levels that did not reach the 95% normal distribution range of healthy controls after either diphtheria or tetanus vaccination. All the patients had normal levels of serum immunoglobulins. CONCLUSIONS A significant proportion of patients with persisting symptoms of rhinosinisitis may have impaired responses to protein vaccines. Responses to protein vaccines may be used to evaluate immune function of sinusitis patients.