Sinonasal Cavity Synechiae Common in ESS Patients With CRS

How common are synechiae in chronic rhinosinusitis (CRS) patients who have endoscopic sinus surgery (ESS)?

Background: Synechiae are one of the most common unwanted outcomes after ESS for CRS, with an incidence ranging from 10 to 40 percent. Up to 50 percent of revision ESS patients present with synechiae in the middle meatus.

Study design: Prospective, multi-institutional cohort of 286 adult patients, enrolled between July 2004 and May 2012, before and after undergoing ESS for CRS.

Setting: Medical University of South Carolina, University of Calgary, Stanford University, Medical College of Wisconsin and Oregon Health and Science University.

Synopsis: The sinus-specific (maxillary antrostomy, total or partial ethmoidectomy, sphenoidotomy, frontal sinusotomy) and ancillary (inferior turbinate submucous resection, partial middle turbinate resection, septoplasty) procedures performed on each patient at the time of surgery were recorded for this study. All study patients were asked to complete two disease-specific health-related quality of life surveys during initial enrollment and at follow-up visits. At six-month follow-up, 55 patients presented with synechiae, and 231 patients had no evidence of scarring. No significant differences in demographic characteristics, amount of time for follow-up or comorbidities were seen between groups. Patients who developed synechiae were more likely to have had prior ESS. No significant differences were seen in post-operative synechiae incidence between patients undergoing unilateral or bilateral maxillary antrostomy, partial or total ethmoidectomy, sphenoidotomy, frontal sinus surgery, inferior turbinate submucous resection or partial middle turbinate resection. Patients undergoing concurrent septoplasty at the time of ESS had a decreased post-operative synechiae incidence. Patients in the synechiae group had significantly less improvement in scores for total rhinosinusitis disability index (RSDI), as well as for RSDI physical and emotional subscores. The main limitation was the lack of site-specific synechiae information.

Bottom line: Sinonasal cavity synechiae commonly occur after ESS, particularly in patients undergoing revision surgeries.

Citation: Henriquez OA, Schlosser JR, Mace JC, Smith TL, Soler ZM. Impact of synechiae after endoscopic sinus surgery on long-term outcomes in chronic rhinosinusitis. Laryngoscope. 2013;123:2615-2619.

—Reviewed by Amy Eckner