he Indication, Pre-Surgical, Post-Surgical treatment and outcome of Endoscopic Sinus Surgery (ESS) in the ENT department at harrogate district hospital According to the European position paper on rhinosinusitis and nasal polyps (EPOS 2020)

Background: Today, Endoscopic surgery of the Paranasal sinuses involves the use of optic systems – endoscopes and / or microscopes – and so allows the use of operative techniques that incorporates functional aspect of mucosal physiology and related anatomical structures. These procedures can therefore also be classified as functional operations. The European position paper on rhinosinusitis and nasal polyps (EPOS 2020) was formed during the COVID-19 period to become a benchmark for all future Endoscopic Sinus surgeries to adhere to in both pre and post-surgical.

 

I assessed 33 patients in the ENT department at Harrogate District Hospital from March 2018 – March 2020. These patients (20 Males & 13 Females) varied in age from 16-81, indication, whether they received pre-surgical treatment and whether they received post-surgical treatment (Steroid +/- Antibiotics for up to 6 weeks). The outcome showed poor adherence to the EPOS 2020 guidelines so further measures were put in place at this establishment including the following:

 

• All future cases of CRS should be classified as per the new classification portrayed in EPOS 2020.
• Positive outcome of the Endoscopic sinus Surgery was assessed solely by discharging the patient with no further follow up. One of the qualities of life assessment methods used in EPOS 2020 was via SNOT22. This assessment method should be used in future cases.
• In EPOS 2020 Immediate Pre-operative steroids have been shown to decrease blood loss, operating time and improve the surgical field. Significance has to be given to the use of Immediate pre-operative steroids in future cases.
• As mentioned above, Non Th2 CRS has been shown to respond well to clarithromycin in EPOS 2020 however due to potential side effects other medications are often used i.e. Doxycycline. Guidelines set out in EPOS 2020 regarding the use of clarithromycin in Non Th2 CRS should be adhered to.
• Post-operative steroids have been shown to be extremely effective to reduce the recurrence of polyps in EPOS 2020. This will become a mainstay in clinical practice in future cases.

 

Author(s): Jafar Shakir

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