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. 2023 Feb;43(1):42-48.
doi: 10.14639/0392-100X-N1984.

Surgical management of chronic rhinosinusitis with nasal polyps under local anaesthesia: indications and results

Clémence Mimari #  1 , Thomas Radulesco #  2 , Martin Penicaud  1 , Patrick Dessi  1 , Justin Michel  2
Affiliations

Surgical management of chronic rhinosinusitis with nasal polyps under local anaesthesia: indications and results

Clémence Mimari et al. Acta Otorhinolaryngol Ital. 2023 Feb.

Abstract
in English, Italian

Objective: Our objective was to specify the indications and duration of effectiveness of Awake Patient Polyp Surgery (APPS) in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Secondary objectives were to evaluate complications and Patient-Reported Experience (PREMs) and Outcome Measures (PROMs).

Methods: We collected information regarding sex, age, comorbidities and treatments. Duration of effectiveness was the duration of non-recurrence defined by the time between APPS and a new treatment. Nasal Polyp Score (NPS) and Visual Analogic Scales (VAS, from 0/10 to 10/10) for nasal obstruction and olfactory disorders were assessed preoperatively and one month after surgery. PREMs were evaluated using a new tool: the APPS score.

Results: Seventy-five patients were enrolled (SR = 3.1, mean age = 60.9 ± 12.3 years). 60% of patients had a previous history of sinus surgery, 90% had stage 4 NPS and more than 60% had overuse of systemic corticosteroids. Mean time of non-recurrence was 31.3 ± 2.3 months. We found a significant improvement (all p < 0.001) for NPS (3.8 ± 0.4 vs 1.5 ± 0.6), VAS obstruction (9.5 ± 1.6 vs 0.9 ± 1.7) and VAS olfactory disorders (4.9 ± 0.2 vs 3.8 ± 1.7). Mean APPS score was 46.3 ± 5.5/50.

Conclusions: APPS is a safe and efficient procedure in the management of CRSwNP.

Trattamento chirurgico in anestesia locale della rinosinusite cronica con poliposi nasale: indicazioni e risultati.

Obiettivo: Descrivere indicazioni e risultati dell’intervento di polipectomia nasosinusale in anestesia locale (APPS) in pazienti con rinosinutite cronica polipoide (CRSwNP). Obiettivo secondario è la valutazione delle complicanze post-operatorie, dell’esperienza soggettiva del paziente (PREMs) e la misurazione dell’outcome terapeutico (PROMs).

Metodi: L’efficacia del trattamento è stata definita come intervallo di tempo in assenza di recidiva, stimato come il tempo tra due trattamenti successivi. La clinica è stata quantificata applicando il Nasal Polyp Score (NPS) e la Visual Analogic Scales (VAS) per ostruzione nasale e disturbi olfattivi, valutati prima e un mese dopo la procedura. La PREM è stata valutata utilizzando un nuovo strumento: l’APPS score.

Risultati: Sono stati inclusi 75 pazienti. Il tempo medio in assenza di recidiva è stato di 31,3 ± 2,3 mesi. In seguito ad APPS sono stati documentati miglioramenti significativi (p < 0,001) per NPS (3,8 ± 0,4 vs 1,5 ± 0,6), VAS per ostruzione nasale (9,5 ± 1,6 vs 0,9 ± 1,7), VAS per disturbi olfattivi (4,9 ± 0,2 vs 3,8 ± 1,7). L’APPS score medio è stato di 46,3 ± 5,5/50.

Conclusioni: APPS si è rivelata essere una procedura sicura ed efficace nel trattamento della CRSwNP.

Keywords: endoscopic sinus surgery; inflammatory nasal disease; local anesthesia; nasal polyps; sinusitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curve of non-recurrence after APPS. X-axis represents the number of months of postoperative follow-up. Y-axis represents the percentage of non-recurrence. Each step corresponds to a recurrence, each vertical line corresponds to a last news date.
Figure 2.
Figure 2.
Graphical presentation of mean APPS score. Values range from 3.9 to 4.9/5 for better visibility.
See this image and copyright information in PMC

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