Aretrospective review of six-hundred nineteen cases to determine the prevalence and factors associated with revision endoscopic sinus surgery in AFRS vs non-AFRS patients

Abstract

Patients undergoing revision functional endoscopic sinus surgery (rFESS) for refractory chronic rhinosinusitis (CRS) are more likely to be older, have worse pre-operative Lund-Mackay CT scores, and poorer quality-of-life scores than primary FESS patients.

Patients with more aggressive forms of CRS such as CRS with nasal polyposis (CRSwNP) or allergic fungal rhinosinusitis (AFRS) may fare worse in the long term with residual disease and be more likely to seek out tertiary institutions for treatment including rFESS.

Computed tomography (CT) findings most frequently associated with failure of primary FESS were frontal sinus/recess residual bony partitions (91.8%), remnant ethmoid sinus shelves (88.2%) and unopened pneumatized ethmoid cells (77.7%).

Patients with a diagnosis of allergic fungal rhinosinusitis (AFRS) who required rFESS presented with significantly fewer frontal sinus residual bony partitions, residual uncinate process, and ethmoid sinus residual unopened pneumatized cells, than non-AFRS patients, suggesting that intrinsic biological factors were the major contributors to failure of primary FESS.

The factors associated with rFESS are numerous and should be explored further. Other factors that may be important to consider when assessing causes of primary FESS failure may include surgeon skill level as well as the availability of proper instrumentation and support staff in the setting in which the procedure is performed (e.g. tertiary vs community level hospital).

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