Outcomes of chronic frontal sinusitis treated with ethmoidectomy

a prospective study

Waleed M. Abuzeid, Jess C. Mace, Milena L. Costa, Luke Rudmik, Zachary M. Soler, Grace S. Kim, Timothy Smith, Peter H. Hwang

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: In medically refractory chronic frontal sinusitis, ethmoidectomy without instrumentation of the frontal ostium may resolve frontal disease. Our aim was to determine the efficacy of ethmoidectomy alone for the treatment of chronic frontal sinusitis. Methods: Adults with chronic rhinosinusitis prospectively enrolled in a multicenter study who demonstrated frontal sinusitis on computed tomography were divided into 2 groups: (1) endoscopic sinus surgery (ESS) incorporating ethmoidectomy, but excluding frontal sinusotomy; and (2) ESS incorporating frontal sinusotomy. The primary outcome was improvement in 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Secondary outcomes included endoscopic scores and use of corticosteroids and antibiotics. Results: A total of 196 cases undergoing frontal sinusotomy and 30 cases treated with ethmoidectomy without frontal sinusotomy were analyzed and were comparable demographically. The prevalence of nasal polyps, previous ESS, asthma, and aspirin intolerance was more common in the frontal sinusotomy group (p <0.050). Preoperative endoscopy and computed tomography scores were higher in the frontal sinusotomy group (p ≤ 0.001). Postoperatively, both groups showed comparable SNOT-22 scores with worse endoscopy scores in the frontal sinusotomy group (p = 0.038). Postoperative improvement in SNOT-22 total and subdomain scores was comparable between groups. Nasal endoscopy scores improved to a greater degree in the frontal sinusotomy group (p = 0.023). Duration of postoperative topical steroid use was higher in the frontal sinusotomy group (p = 0.007). Revision surgery was needed in 2.6% of frontal sinusotomy patients and 0% of patients without frontal sinusotomy. Conclusion: The treatment of chronic frontal sinusitis through ethmoidectomy is a potential alternative to frontal sinusotomy achieving similar quality of life (QOL) improvements in patients manifesting less severe sinus disease.

Original languageEnglish (US)
Pages (from-to)597-604
Number of pages8
JournalInternational Forum of Allergy and Rhinology
Volume6
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Frontal Sinusitis
Prospective Studies
Endoscopy
Nose
Tomography
Nasal Polyps
Quality Improvement
Reoperation
Aspirin
Multicenter Studies
Adrenal Cortex Hormones
Asthma
Steroids
Quality of Life
Anti-Bacterial Agents
Therapeutics

Keywords

  • endoscopy
  • frontal sinusitis
  • minimally invasive surgical procedures
  • outcome assessment (health care)
  • patient selection
  • quality of life
  • sinusitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Abuzeid, W. M., Mace, J. C., Costa, M. L., Rudmik, L., Soler, Z. M., Kim, G. S., ... Hwang, P. H. (2016). Outcomes of chronic frontal sinusitis treated with ethmoidectomy: a prospective study. International Forum of Allergy and Rhinology, 6(6), 597-604. https://doi.org/10.1002/alr.21726

Outcomes of chronic frontal sinusitis treated with ethmoidectomy : a prospective study. / Abuzeid, Waleed M.; Mace, Jess C.; Costa, Milena L.; Rudmik, Luke; Soler, Zachary M.; Kim, Grace S.; Smith, Timothy; Hwang, Peter H.

In: International Forum of Allergy and Rhinology, Vol. 6, No. 6, 01.06.2016, p. 597-604.

Research output: Contribution to journalArticle

Abuzeid, WM, Mace, JC, Costa, ML, Rudmik, L, Soler, ZM, Kim, GS, Smith, T & Hwang, PH 2016, 'Outcomes of chronic frontal sinusitis treated with ethmoidectomy: a prospective study', International Forum of Allergy and Rhinology, vol. 6, no. 6, pp. 597-604. https://doi.org/10.1002/alr.21726
Abuzeid, Waleed M. ; Mace, Jess C. ; Costa, Milena L. ; Rudmik, Luke ; Soler, Zachary M. ; Kim, Grace S. ; Smith, Timothy ; Hwang, Peter H. / Outcomes of chronic frontal sinusitis treated with ethmoidectomy : a prospective study. In: International Forum of Allergy and Rhinology. 2016 ; Vol. 6, No. 6. pp. 597-604.
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abstract = "Background: In medically refractory chronic frontal sinusitis, ethmoidectomy without instrumentation of the frontal ostium may resolve frontal disease. Our aim was to determine the efficacy of ethmoidectomy alone for the treatment of chronic frontal sinusitis. Methods: Adults with chronic rhinosinusitis prospectively enrolled in a multicenter study who demonstrated frontal sinusitis on computed tomography were divided into 2 groups: (1) endoscopic sinus surgery (ESS) incorporating ethmoidectomy, but excluding frontal sinusotomy; and (2) ESS incorporating frontal sinusotomy. The primary outcome was improvement in 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Secondary outcomes included endoscopic scores and use of corticosteroids and antibiotics. Results: A total of 196 cases undergoing frontal sinusotomy and 30 cases treated with ethmoidectomy without frontal sinusotomy were analyzed and were comparable demographically. The prevalence of nasal polyps, previous ESS, asthma, and aspirin intolerance was more common in the frontal sinusotomy group (p <0.050). Preoperative endoscopy and computed tomography scores were higher in the frontal sinusotomy group (p ≤ 0.001). Postoperatively, both groups showed comparable SNOT-22 scores with worse endoscopy scores in the frontal sinusotomy group (p = 0.038). Postoperative improvement in SNOT-22 total and subdomain scores was comparable between groups. Nasal endoscopy scores improved to a greater degree in the frontal sinusotomy group (p = 0.023). Duration of postoperative topical steroid use was higher in the frontal sinusotomy group (p = 0.007). Revision surgery was needed in 2.6{\%} of frontal sinusotomy patients and 0{\%} of patients without frontal sinusotomy. Conclusion: The treatment of chronic frontal sinusitis through ethmoidectomy is a potential alternative to frontal sinusotomy achieving similar quality of life (QOL) improvements in patients manifesting less severe sinus disease.",
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