Revision Endoscopic Sinus Surgery: Long-Term Group

12)          27 / M           30 months post-FESS     Polyps, sinusitis (2 ethmoidal, 1 frontal & 1 sphenoidal)
Polypectomy, ESS + frontal sinusostomy, sphenoidostomy (LA)
No major complication. No injury to orbit or cranium.                  Follow-up 6 years 1 month

13a)         27 / M          21 months post-FESS     Polyps, sinusitis (2 ethmoidal, 2 frontal & 1 sphenoidal)
Polypectomy), ESS + frontal sinusostomy, sphenoidostomy (GA)
No major complication No injury to orbit or cranium.

13b)         same           15 months later               Sinusitis (2 ethmoidal, 1 frontal & 1 sphenoidal)
ESS + partial middle turbinectomy, frontal sinusostomy, sphenoidostomy (LA)
No major complication. No injury to orbit or cranium.                  Follow-up in total 5 years 9 months

14)          24 / M           61 months post-FESS    Polyps, sinusitis (2 ethmoidal, 2 frontal & 1 sphenoidal)
Polypectomy, ESS + frontal sinusostomy, sphenoidostomy (GA)
No major complication. No injury to orbit or cranium. Follow-up 5 years 10 months

15)          64 / F           71 months post-FESS     Polyps, sinusitis (2 ethmoidal, 2 frontal & 1 sphenoidal)
Polypectomy, ESS + frontal sinusostomy, sphenoidostomy (LA)
No major complication. No injury to orbit or cranium.                  Follow-up 6 years 2 months

16)          39 / M          53 months post-FESS     Polyps, sinusitis (2 ethmoidal, 2 maxillary)
Polypectomy, ESS + middle antrostomy, inferior antrostomy (LA)
No major complication. No injury to orbit or cranium.                  Follow-up 9 years 2 months

DISCUSSION COMMENTS AND SUGGESTIONS

Introduction

Before sinus surgery, patients with chronic sinusitis with or without nasal polyps may seek information on medium-
term and/or long-term symptomatic outcomes of Functional Endoscopic Sinus Surgery (FESS) and they may ask about Revision Endoscopic Sinus Surgery (RESS).

Anyhow, this basic research happened for more than a reason; it happened because of patients’ questions and some
of their questions are given below in transliterated Thai [English translation].

Adult Patient: “Pom Ja Dee K’hun Mai Lung P’ha Tud?” [ Will I get better after operation?” ]

Adult Patient: “Arkarn K’hong Pom Ja Hai Mai Lung P’ha Tud?” [ Will my symptom(s) resolve after operation? ]

Adult Patient: “P’ha Tud Ki K’hruang?” [ How many operations? ]

Adult Patient: “Siang Mai?” [ Risks ? ]

Adult Patient: “Ja Tong Ma Truad Nan Tao Rai?” [ How long must I come for follow-ups? ]

Adult Patient: “Rok Ja Hai Mai?” [ Disease(s) will disappear? ]

Adult Patient: “Sinus Arai Ti P’ha Yark” [ Which sinuses are difficult for operations? ]

Adult Patient: “Me K’hum Torp Mai?” [ Are there solutions? ]

This research involved “pre-FESS”, “post-FESS” and “RESS” patients and one otorhinolaryngologist, and contains some weaknesses. [Explanations are given]:
1) Selection and sample bias [But the author wanted to know only his patients’ symptoms]
2) Simple answers in questionnaires [But practical and achievable]
3) No visual analogue 1-100 score [In a developing country, four-level graded answers i.e. no, mild, moderate and severe are very answerable and may be adequate for the purpose of this study]
4) No SNOT and endoscopy score [This research started before days of SNOT]
5) No grading of polyps [Is there a perfect volumetric grading of polyps?]
6) No detailed analysis of CTs and no L-M scoring system [Most CTs available in this series were screening CTs or limited CTs because of cost]
7) Lack of full details on operations [This paper is more about symptoms than operations]
8) Lack of statistics [That is why this paper is not published in a journal]
9) No “exact” test [Two contingency tables for small sample sizes e.g. Medium-Term group vs Long-term group,
really needed?]