A Prospective Study of Role of Fess in Management of Recurrent Nasal Polyposis

Background and objectives: Nasal Polyps are the most frequent and very prevalent nasal masses, which the otorhinolaryngologists come across. The uncertain etiologies of this condition have contributed greatly to a wide range of treatment, none of which has been uniformly successful or universally accepted. Hence, this literature looks at the various causes of recurrence of nasal polyposis and also compares the efficacy of conventional and endoscopic endonasal polypectomy in terms of safety, recurrence and postoperative morbidity.

Materials and methods: The present study was conducted in the Department of Otorhinolaryngology in Vydehi Institute of Medical Sciences and Research Centre from April 2009 to March 2011.

Data for this study was collected. All clinically confirmed cases of recurrent nasal polyposis Cases selected were subjected to a complete examination according to the defined proforma.Detailed history was taken and clinical examination done. Acute infections were treated on medical line and then taken up for surgery. All patients received a course of antibiotics starting one day prior to surgery. The patients were treated either by conventional polypectomy or Functional Endoscopic Sinus Surgery (FESS).The patients were discharged when fit and were strictly called for follow-up on the first week, third week, 2nd month, 4th month, 6th month and 1 year from date of surgery.

Results: Fifty cases having nasal polyposis were selected and subjected to surgical management. The cases were divided into 2 groups. The first 25 cases were identified as Group-1 and were subjected to surgical management using conventional polypectomy. Similarly, the next 25 cases were identified as Group-2 and were subjected to surgical management using Functional Endoscopic Sinus Surgery (FESS).

The salient observations of this study are as follows:

1. Age: The age of the patients ranged from 6-65 years with a mean age of 31.5 years. In case of antrochoanal polyp, the average age was 20 years.

2. Sex: A male preponderance is seen with a male: female ratio of 2.57:1.

3. Complaints: Majority of the patients presented with complaints of nasal obstruction and nasal discharge, followed by headache, sneezing, anosmia and postnasal drip.

4. Diagnosis: Out of 50 cases, 31 patients presented with Ethmoidal polyp and 19 patients presented Antrochoanal polyp.

5. Complications: Bleeding (<50 ml), was the most common intraoperative and postoperative complication.

6. Recurrence: Recurrence was seen in 36% cases with conventional polypectomy and 12% cases with functional endoscopic sinus surgery (FESS), which indicates low recurrence in case of patients who underwent FESS.

Conclusion: Nasal polyposis is a prevalent disease and is known for its recurrence. Functional ndoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. Functional endoscopic sinus surgery revolutionized the management of chronic inflammatory sinus diseases. In nasal polyposis, there is no doubt that the polypoidal mucosa needs to be completely removed to prevent recurrence. Endoscopic technique can help achieve this goal and also preserve the healthy mucosa and its physiological function of mucociliary mechanism. Also, patients usually experience only minimal discomfort. Functional endoscopic sinus surgery has better success rates than conventional polypectomy and is less traumatic to the patients. The complication rate for this procedure is lower than that for conventional sinus surgery.