Safe treatment of ethmoid sinusitis utilizing minimally invasive ethmoid punch sinusotomy in chronic rhinosinusitis without polyposis patients

Nathalia Velasquez, Andrew Thamboo, Waleed M. Abuzeid, Jayakar V. Nayak

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives/Hypothesis: Current rhinologic practice is devoid of minimally invasive procedures dedicated to the treatment of ethmoid sinusitis to improve ventilation and topical drug delivery. We have recently described a handheld spiral punch to create minimally invasive ethmoid punch sinusotomy (EPS) sites into the ethmoid bulla and basal lamella, which significantly increased irrigant access to the ethmoid sinuses in cadaver models. Here, we conducted a clinical feasibility study to determine the initial safety evaluation of EPS in chronic rhinosinusitis without polyposis (CRSsNP) patients with active ethmoid disease. Study Design: Single-arm, institutional review board–approved observational study. Methods: This study was performed in CRSsNP patients who failed medical management; were candidates for standard, traditional functional endoscopic sinus surgery; and were offered the option of EPS. EPS characteristics (patency, remucosalization) and complications (closure, mucus recirculation) were collected. Alterations in radiographic disease and symptoms after EPS were determined by Lund Mackay (LM) scoring and 22-item Sinonasal Outcome Test (SNOT-22) scoring, which was collected up to 6 months post-procedure. Results: Thirty-two of 40 possible ethmoid compartments (17 of 20 anterior, 15 of 20 posterior) underwent EPS. Twenty-nine of 32 EPS sites remained patent (n = 29, 90.6%), with a minority displaying evidence of restenosis (n = 9, 28.1%) or closure (n = 3, 9.3%). All patent EPS sites had complete remucosalization (n = 29, 100%) with no evidence of mucus recirculation (n = 0, 0%) or other complications secondary to healing or device use. Ethmoid sinus cavities with a pre-EPS LM score of 1 or 2 universally improved to an LM score of 0 following EPS (n = 30 of 30, 100%). SNOT-22 scores significantly improved, with a mean reduction of 33.1 (49.6 ± 7.5 pre-EPS vs 16.5 ± 7.7 post-EPS, p <.0001). Conclusions: This feasibility study demonstrates that EPS appears to be a safe, minimally invasive procedure to treat ethmoid sinusitis in CRSsNP patients unresponsive to medical therapy that establishes ethmoid ventilation, and likely improves effective sinus irrigation. Conducting a clinical trial would be appropriate in assessing a potential role for EPS in the management of this condition. Level of Evidence: 4. Laryngoscope, 127:1268–1275, 2017.

Original languageEnglish (US)
Pages (from-to)1268-1275
Number of pages8
JournalLaryngoscope
Volume127
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Ethmoid Sinusitis
Ethmoid Sinus
Feasibility Studies
Mucus
Ventilation
Laryngoscopes
Therapeutics
Blister
Cadaver
Observational Studies
Clinical Trials
Safety
Equipment and Supplies
Pharmaceutical Preparations

Keywords

  • balloon catheter dilation
  • balloon sinuplasty
  • basal lamella
  • Chronic rhinosinusitis
  • drug delivery
  • ethmoid bulla
  • ethmoid punch
  • ethmoid sinusitis
  • FESS
  • functional endoscopic sinus surgery
  • Lund-Mackay score
  • minimally invasive sinus technique
  • SNOT-22
  • topical irrigation

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Safe treatment of ethmoid sinusitis utilizing minimally invasive ethmoid punch sinusotomy in chronic rhinosinusitis without polyposis patients. / Velasquez, Nathalia; Thamboo, Andrew; Abuzeid, Waleed M.; Nayak, Jayakar V.

In: Laryngoscope, Vol. 127, No. 6, 01.06.2017, p. 1268-1275.

Research output: Contribution to journalArticle

@article{4a7e66572ce64b50b3578826a115c877,
title = "Safe treatment of ethmoid sinusitis utilizing minimally invasive ethmoid punch sinusotomy in chronic rhinosinusitis without polyposis patients",
abstract = "Objectives/Hypothesis: Current rhinologic practice is devoid of minimally invasive procedures dedicated to the treatment of ethmoid sinusitis to improve ventilation and topical drug delivery. We have recently described a handheld spiral punch to create minimally invasive ethmoid punch sinusotomy (EPS) sites into the ethmoid bulla and basal lamella, which significantly increased irrigant access to the ethmoid sinuses in cadaver models. Here, we conducted a clinical feasibility study to determine the initial safety evaluation of EPS in chronic rhinosinusitis without polyposis (CRSsNP) patients with active ethmoid disease. Study Design: Single-arm, institutional review board–approved observational study. Methods: This study was performed in CRSsNP patients who failed medical management; were candidates for standard, traditional functional endoscopic sinus surgery; and were offered the option of EPS. EPS characteristics (patency, remucosalization) and complications (closure, mucus recirculation) were collected. Alterations in radiographic disease and symptoms after EPS were determined by Lund Mackay (LM) scoring and 22-item Sinonasal Outcome Test (SNOT-22) scoring, which was collected up to 6 months post-procedure. Results: Thirty-two of 40 possible ethmoid compartments (17 of 20 anterior, 15 of 20 posterior) underwent EPS. Twenty-nine of 32 EPS sites remained patent (n = 29, 90.6{\%}), with a minority displaying evidence of restenosis (n = 9, 28.1{\%}) or closure (n = 3, 9.3{\%}). All patent EPS sites had complete remucosalization (n = 29, 100{\%}) with no evidence of mucus recirculation (n = 0, 0{\%}) or other complications secondary to healing or device use. Ethmoid sinus cavities with a pre-EPS LM score of 1 or 2 universally improved to an LM score of 0 following EPS (n = 30 of 30, 100{\%}). SNOT-22 scores significantly improved, with a mean reduction of 33.1 (49.6 ± 7.5 pre-EPS vs 16.5 ± 7.7 post-EPS, p <.0001). Conclusions: This feasibility study demonstrates that EPS appears to be a safe, minimally invasive procedure to treat ethmoid sinusitis in CRSsNP patients unresponsive to medical therapy that establishes ethmoid ventilation, and likely improves effective sinus irrigation. Conducting a clinical trial would be appropriate in assessing a potential role for EPS in the management of this condition. Level of Evidence: 4. Laryngoscope, 127:1268–1275, 2017.",
keywords = "balloon catheter dilation, balloon sinuplasty, basal lamella, Chronic rhinosinusitis, drug delivery, ethmoid bulla, ethmoid punch, ethmoid sinusitis, FESS, functional endoscopic sinus surgery, Lund-Mackay score, minimally invasive sinus technique, SNOT-22, topical irrigation",
author = "Nathalia Velasquez and Andrew Thamboo and Abuzeid, {Waleed M.} and Nayak, {Jayakar V.}",
year = "2017",
month = "6",
day = "1",
doi = "10.1002/lary.26493",
language = "English (US)",
volume = "127",
pages = "1268--1275",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - Safe treatment of ethmoid sinusitis utilizing minimally invasive ethmoid punch sinusotomy in chronic rhinosinusitis without polyposis patients

AU - Velasquez, Nathalia

AU - Thamboo, Andrew

AU - Abuzeid, Waleed M.

AU - Nayak, Jayakar V.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objectives/Hypothesis: Current rhinologic practice is devoid of minimally invasive procedures dedicated to the treatment of ethmoid sinusitis to improve ventilation and topical drug delivery. We have recently described a handheld spiral punch to create minimally invasive ethmoid punch sinusotomy (EPS) sites into the ethmoid bulla and basal lamella, which significantly increased irrigant access to the ethmoid sinuses in cadaver models. Here, we conducted a clinical feasibility study to determine the initial safety evaluation of EPS in chronic rhinosinusitis without polyposis (CRSsNP) patients with active ethmoid disease. Study Design: Single-arm, institutional review board–approved observational study. Methods: This study was performed in CRSsNP patients who failed medical management; were candidates for standard, traditional functional endoscopic sinus surgery; and were offered the option of EPS. EPS characteristics (patency, remucosalization) and complications (closure, mucus recirculation) were collected. Alterations in radiographic disease and symptoms after EPS were determined by Lund Mackay (LM) scoring and 22-item Sinonasal Outcome Test (SNOT-22) scoring, which was collected up to 6 months post-procedure. Results: Thirty-two of 40 possible ethmoid compartments (17 of 20 anterior, 15 of 20 posterior) underwent EPS. Twenty-nine of 32 EPS sites remained patent (n = 29, 90.6%), with a minority displaying evidence of restenosis (n = 9, 28.1%) or closure (n = 3, 9.3%). All patent EPS sites had complete remucosalization (n = 29, 100%) with no evidence of mucus recirculation (n = 0, 0%) or other complications secondary to healing or device use. Ethmoid sinus cavities with a pre-EPS LM score of 1 or 2 universally improved to an LM score of 0 following EPS (n = 30 of 30, 100%). SNOT-22 scores significantly improved, with a mean reduction of 33.1 (49.6 ± 7.5 pre-EPS vs 16.5 ± 7.7 post-EPS, p <.0001). Conclusions: This feasibility study demonstrates that EPS appears to be a safe, minimally invasive procedure to treat ethmoid sinusitis in CRSsNP patients unresponsive to medical therapy that establishes ethmoid ventilation, and likely improves effective sinus irrigation. Conducting a clinical trial would be appropriate in assessing a potential role for EPS in the management of this condition. Level of Evidence: 4. Laryngoscope, 127:1268–1275, 2017.

AB - Objectives/Hypothesis: Current rhinologic practice is devoid of minimally invasive procedures dedicated to the treatment of ethmoid sinusitis to improve ventilation and topical drug delivery. We have recently described a handheld spiral punch to create minimally invasive ethmoid punch sinusotomy (EPS) sites into the ethmoid bulla and basal lamella, which significantly increased irrigant access to the ethmoid sinuses in cadaver models. Here, we conducted a clinical feasibility study to determine the initial safety evaluation of EPS in chronic rhinosinusitis without polyposis (CRSsNP) patients with active ethmoid disease. Study Design: Single-arm, institutional review board–approved observational study. Methods: This study was performed in CRSsNP patients who failed medical management; were candidates for standard, traditional functional endoscopic sinus surgery; and were offered the option of EPS. EPS characteristics (patency, remucosalization) and complications (closure, mucus recirculation) were collected. Alterations in radiographic disease and symptoms after EPS were determined by Lund Mackay (LM) scoring and 22-item Sinonasal Outcome Test (SNOT-22) scoring, which was collected up to 6 months post-procedure. Results: Thirty-two of 40 possible ethmoid compartments (17 of 20 anterior, 15 of 20 posterior) underwent EPS. Twenty-nine of 32 EPS sites remained patent (n = 29, 90.6%), with a minority displaying evidence of restenosis (n = 9, 28.1%) or closure (n = 3, 9.3%). All patent EPS sites had complete remucosalization (n = 29, 100%) with no evidence of mucus recirculation (n = 0, 0%) or other complications secondary to healing or device use. Ethmoid sinus cavities with a pre-EPS LM score of 1 or 2 universally improved to an LM score of 0 following EPS (n = 30 of 30, 100%). SNOT-22 scores significantly improved, with a mean reduction of 33.1 (49.6 ± 7.5 pre-EPS vs 16.5 ± 7.7 post-EPS, p <.0001). Conclusions: This feasibility study demonstrates that EPS appears to be a safe, minimally invasive procedure to treat ethmoid sinusitis in CRSsNP patients unresponsive to medical therapy that establishes ethmoid ventilation, and likely improves effective sinus irrigation. Conducting a clinical trial would be appropriate in assessing a potential role for EPS in the management of this condition. Level of Evidence: 4. Laryngoscope, 127:1268–1275, 2017.

KW - balloon catheter dilation

KW - balloon sinuplasty

KW - basal lamella

KW - Chronic rhinosinusitis

KW - drug delivery

KW - ethmoid bulla

KW - ethmoid punch

KW - ethmoid sinusitis

KW - FESS

KW - functional endoscopic sinus surgery

KW - Lund-Mackay score

KW - minimally invasive sinus technique

KW - SNOT-22

KW - topical irrigation

UR - http://www.scopus.com/inward/record.url?scp=85013067855&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013067855&partnerID=8YFLogxK

U2 - 10.1002/lary.26493

DO - 10.1002/lary.26493

M3 - Article

C2 - 28194802

AN - SCOPUS:85013067855

VL - 127

SP - 1268

EP - 1275

JO - Laryngoscope

JF - Laryngoscope

SN - 0023-852X

IS - 6

ER -