Richard E Glicklich

Outcomes in Sinus Surgery—Management Parameters

David W. Kennedy and Erin D. Wright

CHAPTER 16

Since the mid-1980s, there has been an enormous improvement both in our understanding of rhinosinusitis and in our ability to manage patients with this disorder. According to the emerging theories, there is general agreement that chronic rhi-nosinusitis is a disorder in which there is a tendency toward hyperreactivity, whether associated with chronic infection, atopy, ASA (Salycilate) intolerance, or idiopathic. More recent hypotheses also propose a role for underlying osteitis in the perpetuation of the chronic inflammatory process. The management of these patients is multifaceted and includes medication, specific allergy treatment, and endoscopic sinus surgery. Thus, chronic rhinosinusitis can be said to be a medical disease in which surgery plays a therapeutic role. Consequently, close postoperative follow-up is an integral part of the management of this disorder. What has been repeatedly demonstrated in recent years is that there is often a discrepancy between the subjective symptoms experienced by patients and their objective endoscopic findings.1'2 The controversy that remains is to evaluate whether the subjective or objective outcomes are more important and/or relevant from a prognostic perspective. Obviously, from the patient's point of view, and from the standpoint of third-party carriers, what may be most important is the short-to medium-term symptomatic relief. However, we have demonstrated that this does not correspond to long-term disease resolution or freedom from the potential for recurrent surgery. In a 7.8-year follow-up of surgical patients, we demonstrated that endoscopic resolution of disease by 1.5 years postoperatively correlated with subsequent avoidance of further surgical intervention.1 Indeed, no patients whose cavity was normal or almost normal endoscopically at 1.5 years required further surgical intervention during the subsequent period.

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