A comprehensive study on complications of endoscopic sinus surgery.

The nasal endoscope has revolutionized the diagnosis and treatment of disease of the nose and paranasal sinuses. Functional Endoscopic Sinus Surgery is now the standard of care for surgical treatment of chronic and recurrent sinusitis. It is the most exciting recent development in the field of Otorhinolaryngology. We are now able to discover hitherto unknown areas, detect diseases at the earliest stages, and look around the corners in the nose and actually peep into the sinuses. While operating we have the advantage of good illumination and clear vision with minimally invasive surgery. The endoscope even enhances post operative management in helping rapid healing and early detection of any recurrent diseases. Endoscopic sinus surgery is being done routinely in large number for the cases of chronic sinusitis, who fail medical therapy and for sinonasal polyposis. Patient selection involves a thorough history and physical examination, a trial with medical management, diagnostic nasal endoscopy and CT scan of the paranasal sinuses. This study of 100 patients over the study period from July 2008 to September 2009 included 60 males and 40 females. Patients with chronic sinusitis, refractory to the medical treatment and sinonasal polyposis were taken into the study. Patients with bleeding diathesis, tumors, sellar leions, and orbital lesions were excluded from the study. Maximum number of patients belonged to the 21 – 30 years of age group. In this group, there were 26 males and 16 females. 70 patients were diagnosed as chronic sinusitis and 30 patients had sinonasal polyposis. In the first U.S. study that quantified complications related to endoscopic sinus surgery, Stankiewicz, reported a 6% major and 13% minor complication rate, the most common being synechiae. In a follow-up study, Stankiewicz29 reported on the complication rate of a subsequent group of 90 patients, and noted a rate of 2.4%, which compared favorably with previous reports of complications as reported by Freedman and Kern in 1979 using conventional intranasal methods. This significant drop in the complication rate was attributed to greater operative experience, concurrent cadaveric dissection, and the use of limited ethmoidectomy initially, with gradual progression to more extensive procedures. Several studies have subsequently demonstrated a further decline in the incidence of complications. Dessi noted a 1.2% complication rate for overall complications. The complications both major and minor in this study are comparable to the international standards