| Functional endoscopic sinus surgery for chronic rhinosinusitis. | |
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MedLine Citation:
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PMID: 16856048 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Rhinosinusitis is a well-recognised clinical syndrome affecting patients of all ages and gender. FESS has now become a well-established strategy, comprising several techniques, for the treatment of chronic rhinosinusitis refractory to medical treatment. OBJECTIVES: The aim of this review was to assess the effectiveness of functional endoscopic sinus surgery as a treatment for patients with chronic rhinosinusitis. SEARCH STRATEGY: The Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to January 2006) and EMBASE (1974 to January 2006) were searched. Reference lists were handsearched and experts in the field contacted to identify further studies. SELECTION CRITERIA: Randomised controlled trials. Inclusion criteria were any of the following criteria singly or in combination: patients with chronic rhinosinusitis diagnosed by a health professional; patients with sinusitis symptoms for more than 12 weeks; endoscopic evidence of sinusitis or radiological evidence of sinusitis. Exclusion criteria were immune suppression; cystic fibrosis; Wegener's disease; previous sinus surgery or sinonasal malignancy. DATA COLLECTION AND ANALYSIS: All studies meeting the inclusion criteria underwent validity assessment and the data were extracted independently by the two authors. Comparisons were:FESS versus medical treatmentFESS versus conventional sinus surgeryFESS + medical treatment versus medical treatmentFESS + medical treatment versus conventional sinus surgery + medical treatment MAIN RESULTS: The three included studies were randomised controlled trials. The evidence available does not demonstrate that FESS, as practiced in the included trials, is superior to medical treatment with or without sinus irrigation in patients with chronic rhinosinusitis. A middle meatal antrostomy fashioned by FESS was also not shown to be superior to an inferior meatal antrostomy formed by traditional sinus surgery techniques, although the small sample size in the study does not exclude a type II error. In one study there was a relapse rate of 2.4% in the FESS and sinus irrigation group compared to 5.6% in the sinus irrigation only group. The relapse rates were not mentioned in the other studies. There were no major complications such as orbital injury or cerebrospinal fluid leak reported in any of the included trials. AUTHORS' CONCLUSIONS: FESS as currently practiced is a safe surgical procedure. The limited evidence available suggests that FESS as practiced in the included trials does not confer additional benefit to that obtained by medical treatment (+/- sinus irrigation) in chronic rhinosinusitis. More randomised controlled trials comparing FESS with medical and other treatments, with long-term follow up, are required. |
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Authors:
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H S Khalil; D A Nunez |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Review Date: 2006-07-19 |
Journal Detail:
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Title: Cochrane database of systematic reviews (Online) Volume: - ISSN: 1469-493X ISO Abbreviation: Cochrane Database Syst Rev Publication Date: 2006 |
Date Detail:
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Created Date: 2006-07-20 Completed Date: 2006-10-16 Revised Date: 2012-03-27 |
Medline Journal Info:
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Nlm Unique ID: 100909747 Medline TA: Cochrane Database Syst Rev Country: England |
Other Details:
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Languages: eng Pagination: CD004458 Citation Subset: IM |
Affiliation:
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Derriford Hospital, Department of Otolaryngology, Derriford Road, Plymouth, UK PL6 8DH. khalil@entplymouth.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Chronic Disease Endoscopy / methods* Humans Randomized Controlled Trials as Topic Rhinitis / drug therapy, surgery* Sinusitis / drug therapy, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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