Study design: Retrospective cohort study.
Explore This IssueJanuary 2013
Setting: Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
Synopsis: The study surveyed 338 consecutive operations done for 299 CRSwNP patients. No patients were excluded from the consecutive sampling. Patients received either standard endoscopic sinus surgery or a Draf 3 opening of their frontal sinuses. The authors made a distinction between a polyp that occurred and then resolved on medical treatment and a polyp that persisted despite medical treatment. The polyp recurrence rate in patients with follow-up longer than six months was 40 percent, but only half of them had persisting recurrence lasting longer than three months. The most common site of recurrence of nasal polyps was the frontal sinus region. Aspirin-tolerant asthmatic patients had a 1.7 times higher risk of recurrence at any time after the operation. A multivariate analysis failed to show any significant effect on polyp recurrence of fungal allergy, presence of fungus and staphylococcal superantigens.
Although Draf 3 did not completely prevent polyp recurrence, it was a significant factor in reducing persistence of polyps and in reducing the need for revision surgery. It also had a positive economic implication by decreasing the rate of hospitalization and reoperation. One of the difficulties encountered when comparing results was the absence of a definition of polyp recurrence. The authors defined polyp recurrence as the first recorded appearance of a polyp structure during post-operative follow-up anterior endoscopy.
Bottom line: Nasal polyposis is characterized by a high rate of recurrence. The presence of asthma or aspirin intolerance leads to more aggressive recurrence and, in these patients, the Draf 3 drillout procedure becomes a good option for improved long-term outcomes and reduced need for revision surgery.
Reference: Bassiouni A, Wormald PJ. Role of frontal sinus surgery in nasal polyp recurrence. Laryngoscope. 2013;123:36-41.
—Reviewed by Sue Pondrom
Aging Population Changes Frequency, Disease Types Seen by Otolaryngology
What are the effects of an aging population in the U.S. on the general practice of otolaryngologists?
Background: By 2030, the geriatric population (those aged 65 years and older) will comprise almost 20 percent of the population, compared with 12.4 percent in 2000 and 9 percent in 1960. The geriatric population uses a greater relative amount of health care resources, and it is acknowledged that care of the geriatric ear, nose and throat patient will play an increasing role in the practice of otolaryngology. However, there is relatively little literature addressing the effect the aging population will have on the specialty.