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Arch Otolaryngol Head Neck Surg. 2010 Oct;136(10):988-92. doi: 10.1001/archoto.2010.162.

Cystic fibrosis and endoscopic sinus surgery: Relationship between nasal polyposis and likelihood of revision endoscopic sinus surgery in patients with cystic fibrosis.

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1
Department of Otorhinolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10021, USA.

Abstract

OBJECTIVES:

To observe the extent of nasal polyposis endoscopically in a cystic fibrosis population before the first surgical intervention and to grade the extent using a modified Malm scale, to observe patients prospectively and record the need for revision endoscopic sinus surgery (ESS), and to compare this among the individual polyp grading groupings.

DESIGN:

Retrospective medical record review of data collected prospectively.

SETTING:

Tertiary care hospital.

PATIENTS:

Forty-nine consecutive patients with a clinical preoperative diagnosis of cystic fibrosis and sinusitis.

MAIN OUTCOME MEASURES:

Using a modified Malm scale, the extent of polyps was prospectively graded into 3 groups before the first surgical intervention. The number of patients needing revision ESS and the mean time to revision ESS were compared among the 3 groups.

RESULTS:

Forty-nine consecutive patients underwent ESS between 1992 and 2007. We used a 3-stage system for extent of polyposis: 16 patients were noted to have no polyps (grade A), 14 had mild polyposis (grade B), and 19 had extensive polyposis (grade C). During the study, 14 patients required revision surgery: 3 with mild polyps and 11 with extensive polyps. Mean time to revision surgery was 39.7 months for those with grade B and 23.8 months for those with grade C. In the overall statistical analysis, the rate of revision ESS was significantly different among the 3 groups (P < .001). In pairwise comparisons, there were significant differences between those with grades A and C (P < .001) and between those with grades B and C (P = .04) and a trend toward significance between those with grades A and B (P = .052). There were no complications from ESS.

CONCLUSION:

Preoperative grading of nasal polyposis in patients with cystic fibrosis can help assess the future likelihood of revision ESS.

PMID:
20956745
DOI:
10.1001/archoto.2010.162
[Indexed for MEDLINE]
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