Outcomes of Endoscopic Sinus Surgery in Geriatric Patients: An Institutional Study
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ORIGINAL ARTICLE
Outcomes of Endoscopic Sinus Surgery in Geriatric Patients: An Institutional Study Anubhuti Dhanuka1 • Khageswar Rout1 • Debasis Jena1
Received: 5 April 2020 / Accepted: 10 August 2020 Association of Otolaryngologists of India 2020
Abstract The aim of this study was to investigate the efficacy and safety of Endoscopic Sinus Surgery (ESS) as a treatment modality for chronic rhinosinusitis refractory to maximal medical therapy in the elderly population. ESS has gained importance over the past 2–3 decades. A prospective review of outcome was done in fifty seven patients over age of 60 years who underwent ESS. They were evaluated preoperatively and postoperatively at 3, 6, and 12 months with a rigid nasal endoscopy scoring system, and the Sino Nasal Outcome Test-20 questionnaire. Data analysis was performed using the Student’s t test to compare mean scores. All complications were noted. All of the patients in the study reported postoperative symptomatic improvement. And it was concluded that ESS in the geriatric population is a safe and effective treatment modality for rhinosinusitis which is refractory to medical therapy. Keywords ESS Geriatric SNOT-20 Rhinosinusitis
Introduction As the size of the geriatric population has increased in developing countries, the illnesses of older people have become more important. A previous survey data ranked sinusitis as the sixth most common chronic condition of
& Khageswar Rout [email protected] 1
Department of Otorhinolaryngology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
elderly persons, occurring more frequently than cataract, diabetes, and general visual impairment [1]. The most common clinical manifestations of chronic sinusitis in older persons are nasal congestion, postnasal drip, impaired olfactory function, sore throat and pyrexia of unknown origin [2]. Adequate antibiotic therapy with other auxiliary treatments is the first step in the management of geriatric sinusitis [2]. If the patient fails to respond to medical management, surgical treatment might be indicated [3]. Predisposing factors in elderly include nasal and paranasal mucosal changes such as atrophy of the nasal mucosa, decreased mucus production, excessive crusting and a decreased mucociliary clearance. The supporting fibro-fatty tissues of the nose can atrophy, with a potential loss of support of nasal structures (i.e. narrowed nasal valve) and associated nasal obstruction. There is also an increased incidence of epistaxis and olfactory impairment in the elderly [4–6]. Over the last 30 years a functional endoscopic operative approach to chronic sinus disease has developed and it has become a widely accepted treatment modality. Endoscopic sinus surgical techniques focus on minimizing removal of normal mucous membrane and critical paranasal sinus structures, thereby minimizing trauma and preserving the mucociliary function [7]. There are very few studies regarding endoscopic sinus surgery in geriatric patients. In the current study, n
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