Balloon Sinuplasty Efficiency in Maxillary Rhinosinusitis.

Korábbi kezelés

• Previous nasal surgery

Más betegség

• Non-invasive fungal balls and invasive fungal disease
• Systemic vasculitis and granulomatous disease
• Severe systemic diseases
• Malignancies
• No signs of mucosal disease at nasoendoscopy during the asymptomatic period

Egyéb

• Chronic rhinosinusitis with nasal polyps
• Notable inflammation in the ethmoidal, sphenoidal or frontal sinuses along with maxillary sinusitis
• Sinonasal tumor
• Maxillary rhinosinusitis caused by a dental problem
• Facial pain caused by other etiologies
• Cystic fibrosis
• Gross immunodeficiency
• Congenital mucociliary problems
• Pregnancy
  • Definitions:
  • Recurrent acute maxillary rhinosinusitis:
• 4 or more episodes (< 12 weeks) of acute rhinosinusitis with typical symptoms per year and no persistent symptoms between the rhinosinusitis episodes (Chan and Kuhn 2009)
• The diagnosis of the recurrent episodes of acute rhinosinusitis have been made with the following criteria:
  • Increase of symptoms after 5 days or persistent symptoms after 10 days and
  • During the episode, 2 or more symptoms, one of which should be either nasal blockage/obstruction or nasal discharge (anterior/posterior nasal drip)
  • +/- facial pain/pressure
  • +/- reduction or loss of smell (Fokkens et al. 2012) and either
  • Signs of mucopurulent discharge primarily from the middle meatus seen in anterior rhinoscopy or nasoendoscopy and/or
  • Oedema/mucosal obstruction primarily seen in the middle meatus in anterior rhinoscopy or nasoendoscopy and/or
  • Signs of mucopurulent discharge seen in the nasopharynx or posterior oropharynx and/or
  • Signs of acute maxillary sinusitis is seen in sinus X-rays or CT/CBCT scans and/or
  • Signs of acute maxillary sinusitis seen in the sinus ultrasound
• At most, minor signs of inflammation in the maxillary sinuses and/or ostiomeatal complex in CT/CBCT scans during the asymptomatic period
  • Maximum 2-3 mm mucosal thickness in maxillary sinus medial and lateral wall
  • Chronic maxillary rhinosinusitis:
• Presence of typical symptoms of chronic rhinosinusitis for equal or longer than 12 weeks
  • 2 or more symptoms, one of which should be either nasal blockage/obstruction or nasal discharge (anterior/posterior nasal drip)
  • +/- facial pain/pressure
  • +/- reduction or loss of smell and either
  • Endoscopic signs of mucopurulent discharge primarily from middle meatus and/or
  • Endoscopic signs of oedema/mucosal obstruction primarily in middle meatus and/or
  • Inflammatory mucosal changes within the ostiomeatal complex and/or sinus in the CT/CBCT scans and the changes are limited mainly into maxillary sinuses (Fokkens et al. 2012)
  • The patients are not recruited in the study while they are having an exacerbation of chronic rhinosinusitis or an ongoing acute rhinosinusitis. Neither are the follow-up visits carried out during these episodes but postponed later. This way it can be ensured that the preoperative evaluation and the follow-up evaluation correspond with each other.

• Patients at least 18 years old and younger than 70 years old
• Patients willing to participate in the study
• Patients whose diseases fill the definitions of chronic or acute recurrent maxillary rhinosinusitis
• Patients with chronic maxillary rhinosinusitis has not responded to a 3-month trial of topical corticosteroid treatment
• SNOT-22 points 8 or more in chronic maxillary rhinosinusitis
• In recurrent acute maxillary rhinosinusitis, no SNOT-22 point limits are used
• Modified Lund-Mackay inclusion criteria in chronic rhinosinusitis group:
  • Maxillar 0-2
  • Anterior Ethmoid 0-2
  • Posterior Ethmoid 0-1
  • Sphenoid 0-1
  • Frontal 0-1
  • Ostiomeatal complex 0 or 2