2.1

Study design

A prospective study was carried out between January of 2011 and April of 2013 at a university hospital, tertiary referral center, after approval of the ethics committee.

2.2

Patient sample

A total of 58 patients who underwent FESS from January 2011 to April 2013 were evaluated and followed for 1 year.

Inclusion criteria were:

• –
  

  Chronic rhinosinusitis (CRS) patients with bilateral nasal polyps (NP) who had not improved after at least 6 months of drug therapy;

  
  
• –
  

  Patients undergoing functional endoscopic sinus surgery (FESS);

  
  
• –
  

  Age above 18 years.

Exclusion criteria were:

• –
  

  Other subgroups of CRS;

  
  
• –
  

  Secondary CRS;

  
  
• –
  

  No preoperative CT scan;

  
  
• –
  

  Age under 18 years;

  
  
• –
  

  Pregnancy;

  
  
• –
  

  Immunodeficiency;

  
  
• –
  

  Patients who underwent revision endoscopic sinus surgery during the study for other complications.

2.3

Diagnosis of CRS with nasal polyposis

The diagnosis of nasal polyposis was based on the definition of the European academy of allergology and clinical immunology (EAACI) .

Preoperative CT scans of the sinuses were classified using the Lund–Mackay scoring system .

2.4

Treatment and follow-up

Medical treatment was the first therapy introduced at least for 6 months. It was based on topical nasal steroid (budenoside spray) on each nostril every 12 hours and short cures of oral steroid (prednisolone) for 7 days (maximum 3 cures per year).

FESS was performed under general anesthesia, the surgical technique was as described by Messerklinger and the extent of surgery was at least a bilateral unciformectomy with functional anterior ethmoidectomy . Septoplasty and/or inferior turbinoplasty were performed when indicated ( Table 1 ).

Postoperative care was as follows: the nasal packing was removed 2 days post operatively; all patients received amoxicillin and clavulanic acid (1 g/125 mg) twice a day for 10 days and topical nasal steroid on each nostril every 12 hours for 1 year; saline irrigation and endoscopic dressing were performed for 6 weeks.

2.5

Quality of life assessment and endoscopy scores

The rhinosinustis disability index (RSDI), a validated disease-specific instrument, was used to quantify the patient’s symptoms before and 12 months after surgery . Thirty questions were asked and each was scored on 0 to 4 scale (0 = never, 1 = almost never, 2 = sometimes, 3 = almost always, 4 = always). The RSDI was calculated for a total score and for functional, emotional and physical fields ( Table 2 ).

The endoscopic examination was scored by the physician using the Lund–Kennedy scoring system before and 12 months after surgery . It includes three parameters: nasal polyps (0 = absent, 1 = polyps within the middle meatus, 2 = beyond the middle meatus, 3 = reaching to or below the lower border of the inferior turbinate or medial to the middle turbinate); edema and crusting (0 = absent, 1 = mild, 2 = severe) and discharge (0 = absent, 1 = clear and thin discharge, 2 = thick and purulent discharge).

2.6

Statistical analysis

The data sets were analyzed using SPSS 20.0. The normal distribution was assessed by using Shapiro–Wilk test and skewness kurtosis z-values.

Clinically significant improvement was defined as a change of ≥½ standard deviation (SD) of the baseline RSDI score . So the improvement was defined as a decrease of ≥ 8.0515 points.

The Wilcoxon signed-rank test was used to compare RSDI scores before and after FESS. Correlation and multiple regression analysis were used to assess the relationship between preoperative characteristics and significant improvement after surgery. Multiple regression models were chosen using forced entry method and stepwise method selection. A p value under 0.05 (5%) was considered statistically significant for all analyses.

2.1

Study design

A prospective study was carried out between January of 2011 and April of 2013 at a university hospital, tertiary referral center, after approval of the ethics committee.

2.2

Patient sample

A total of 58 patients who underwent FESS from January 2011 to April 2013 were evaluated and followed for 1 year.

Inclusion criteria were:

• –
  

  Chronic rhinosinusitis (CRS) patients with bilateral nasal polyps (NP) who had not improved after at least 6 months of drug therapy;

  
  
• –
  

  Patients undergoing functional endoscopic sinus surgery (FESS);

  
  
• –
  

  Age above 18 years.

Exclusion criteria were:

• –
  

  Other subgroups of CRS;

  
  
• –
  

  Secondary CRS;

  
  
• –
  

  No preoperative CT scan;

  
  
• –
  

  Age under 18 years;

  
  
• –
  

  Pregnancy;

  
  
• –
  

  Immunodeficiency;

  
  
• –
  

  Patients who underwent revision endoscopic sinus surgery during the study for other complications.

2.3

Diagnosis of CRS with nasal polyposis

The diagnosis of nasal polyposis was based on the definition of the European academy of allergology and clinical immunology (EAACI) .

Preoperative CT scans of the sinuses were classified using the Lund–Mackay scoring system .

2.4

Treatment and follow-up

Medical treatment was the first therapy introduced at least for 6 months. It was based on topical nasal steroid (budenoside spray) on each nostril every 12 hours and short cures of oral steroid (prednisolone) for 7 days (maximum 3 cures per year).

FESS was performed under general anesthesia, the surgical technique was as described by Messerklinger and the extent of surgery was at least a bilateral unciformectomy with functional anterior ethmoidectomy . Septoplasty and/or inferior turbinoplasty were performed when indicated ( Table 1 ).

Postoperative care was as follows: the nasal packing was removed 2 days post operatively; all patients received amoxicillin and clavulanic acid (1 g/125 mg) twice a day for 10 days and topical nasal steroid on each nostril every 12 hours for 1 year; saline irrigation and endoscopic dressing were performed for 6 weeks.

2.5

Quality of life assessment and endoscopy scores

The rhinosinustis disability index (RSDI), a validated disease-specific instrument, was used to quantify the patient’s symptoms before and 12 months after surgery . Thirty questions were asked and each was scored on 0 to 4 scale (0 = never, 1 = almost never, 2 = sometimes, 3 = almost always, 4 = always). The RSDI was calculated for a total score and for functional, emotional and physical fields ( Table 2 ).

Table 2

Mean change in QOL after endoscopic sinus surgery.

RSDI	Preoperative (mean ± SD)	Postoperative (mean ± SD)	Absolute ∆ (mean ± SD)
Total	86.43 ± 16.103	51.16 ± 18.950	35.28 ± 17.390
Physical	28.60 ± 6.644	15.50 ± 6.642	13.10 ± 6.415
Functional	27.64 ± 5.139	16.64 ± 6.558	11.00 ± 5.660
Emotional	30.19 ± 5.841	19.02 ± 6.653	11.17 ± 6.481

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