, Sung Min Chung, Myoung Sil Ju The surgical modalities for treatment of chronic maxillary sinusitis have changed in recent years. The radical Caldwell-Luc operation has been replaced by the more conservative endoscopic sinus surgery(ESS). Good clinical results for the ESS technique have been reported(Wigand, 1978 ; Stammberger, 1991 ; Kennedy, 1992), but only a few papers give detailed data on the symptoms(Kamel, 1989 ; Levin, 1990 ; Lund, 1991). From April 1992 to January 1996, a total of 118 patients(primary ESS 62 patients and ESS after previous nasal surgery 56 patients) who underwent ESS at the department of otolaryngology, Ewha womans university Hospital, were evaluated.
Preoperative nasal symptoms, except for nasal discharge were higher in revision cases. The previous most common nasal surgery was polypectomy accounting for 25(44.6%) of the 56 revision cases. All had preoperative CT scans of the ostiomeatal unit area(OMU CT) and severity of inflammatory disease had been graded by CT. In revision cases, 30(53.6%)cases had complete opacification of one or more major sinuses. But in primary ESS cases, 19(30.6%) had findings limited to the osteomeatal complex. Overall, 43(76.8%) patients benefited from ESS in revieion cases, and 58(93.5%) in primary ESS cases. Synechia was the most common complication in revision and primary FESS cases. The difference of outcomes between primary ESS and ESS after previous nasal surgery is explained by the difference of preoperative state of the sinus mucosa.
The author's review of 118 patients showed that there was significant difference in the postoperartive success rate between the primary ESS and ESS after previous nasal surgery.
The pathogenesis of fungus ball has been unclear yet. This study was performed to find a clue to the pathogenesis of fungus ball and to clarify the role of ostiomeatal unit(OMU) obstruction in the fungus ball through the comparative study of fungus ball and chronic bacterial sinusitis.
35 patients with fungus ball(fungus group) and 42 patients with chronic unilateral bacterial sinusitis(bacteria group) were analyzed in terms of radiologic findings and endoscopic findings.
Fungus ball was observed in older patients than chronic bacterial sinusitis(59.7 vs. 41.1). The total Lund scores of bacteria group were higher than those of fungus group(6.0 vs. 4.6)(
This study may suggest that fungus ball is not associated with the obstruction of OMU comparing with chronic bacterial sinusitis and that fungus ball has another pathogenic mechanism different from that of bacterial sinusitis.
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