Skip to main content Accessibility help

Predictors of disease progression after endoscopic sinus surgery in patients with chronic rhinosinusitis

  • K Tsuzuki (a1), K Hashimoto (a1), K Okazaki (a1), H Nishikawa (a2) and M Sakagami (a1)...



This study aimed to determine the predictors of disease progression after functional endoscopic sinus surgery in patients with chronic rhinosinusitis.


A total of 281 adult chronic rhinosinusitis patients who underwent primary bilateral functional endoscopic sinus surgery between 2007 and 2017 and had at least 12 months of follow-up endoscopic evaluation were examined. Patients were divided into eosinophilic (n = 205) and non-eosinophilic chronic rhinosinusitis groups (n = 76). In order to determine adverse factors, post-operative endoscopic appearance scores were analysed in relation to the pre- and intra-operative findings using multiple regression analyses.


The post-operative course of eosinophilic cases deteriorated over time, like the early period for non-eosinophilic cases. Frontal sinus polyps recurred early in eosinophilic chronic rhinosinusitis. Multivariate analyses indicated young adulthood, asthma, high computed tomography score and frontal sinus polyps as significant adverse predictors.


Early, appropriate estimation of sinonasal conditions appears to be crucial for successful surgical management of chronic rhinosinusitis.


Corresponding author

Author for correspondence: Dr Kenzo Tsuzuki, Department of Otorhinolaryngology – Head and Neck Surgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan E-mail: Fax: +81 798 41 8976


Hide All

Dr K Tsuzuki takes responsibility for the integrity of the content of the paper



Hide All
1Fokkens, WJ, Lund, VJ, Mullol, J, Bachert, C, Alobid, I, Baroody, F et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 2012;23:1298
2Rosenfeld, RM, Andes, D, Bhattacharyya, N, Cheung, D, Eisenberg, S, Ganiats, TG et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg 2007;137(suppl 3):S131
3Hummel, T, Whitcroft, KL, Andrews, P, Altundag, A, Cinghi, C, Costanzo, RM et al. Position paper on olfactory dysfunction. Rhinol Suppl 2017;54(suppl26):130
4Haruna, S, Otori, N, Yanagi, K, Moriyama, H. Eosinophilic sinusitis [in Japanese]. Oto-Rhino-Laryngol Tokyo 2001;44:195201
5Shin, SH, Ye, MK, Kim, JK, Cho, CH. Histological characteristics of chronic rhinosinusitis with nasal polyps: recent 10-year experience of a single center in Daegu, Korea. Am J Rhinol Allergy 2014;28:95–8
6Borish, L, Rosenwasser, L, Steinke, JW. Fungi in chronic hyperplastic eosinophilic sinusitis: reasonable doubt. Clin Rev Allergy Immunol 2006;30:195204
7Shah, SA, Ishinaga, H, Takeuchi, K. Pathogenesis of eosinophilic chronic rhinosinusitis. J Inflamm (Lond) 2016;13:11
8Lopez, AF, Begley, CG, Williamson, DJ, Warren, DJ, Vadas, MA, Sanderson, CJ. Murine eosinophil differentiation factor. An eosinophil-specific colony-stimulating factor with activity for human cells. J Exp Med 1986;163:1085–99
9Otto, BA, Wenzel, SE. The role of cytokines in chronic rhinosinusitis with nasal polyps. Curr Opin Otolaryngol Head Neck Surg 2008;16:270–4
10Ishitoya, J, Sakuma, Y, Tsukuda, M. Eosinophilic chronic rhinosinusitis in Japan. Allergol Int 2010;59:239–45
11Tokunaga, T, Sakashita, M, Haruna, T, Asaka, D, Takeno, S, Ikeda, H et al. Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC study. Allergy 2015;70:9951003
12Ikeda, K, Shiozawa, A, Ono, N, Kusunoki, T, Hirotsu, M, Homma, H et al. Subclassification of chronic rhinosinusitis with nasal polyp based on eosinophil and neutrophil. Laryngoscope 2013;123:19
13Sakuma, Y, Ishitoya, J, Komatsu, M, Shiono, O, Hirama, M, Yamashita, Y et al. New clinical diagnostic criteria for eosinophilic chronic rhinosinusitis. Auris Nasus Larynx 2011;38:583–8
14Senior, BA, Kennedy, DW, Tanabodee, J, Kroger, H, Hassab, M, Lanza, D. Long-term results of functional endoscopic sinus surgery. Laryngoscope 1998;108:151–7
15Rudmik, L, Smith, TL. Evidence-based practice: postoperative care in endoscopic sinus surgery. Otolaryngol Clin North Am 2012;45:1019–32
16Tsuzuki, K, Hashimoto, K, Okazaki, K, Sakagami, M. Post-operative course prediction during endoscopic sinus surgery in patients with chronic rhinosinusitis. J Laryngol Otol 2018;132:408–17
17Tsuzuki, K, Hinohira, Y, Takebayashi, H, Kojima, Y, Yukitatsu, Y, Daimon, T et al. Novel endoscopic scoring system after sinus surgery. Auris Nasus Larynx 2014;41:450–4
18Lund, VJ, Mackay, IS. Staging in rhinosinusitis. Rhinology 1993;31:183–4
19Takebayashi, H, Tsuzuki, K, Oka, H, Fukazawa, K, Daimon, T, Sakagami, M. Clinical availability of a self-administered odor questionnaire for patients with olfactory disorders. Auris Nasus Larynx 2011;38:6572
20Lund, VJ, Kennedy, DW. Quantification for staging sinusitis. The staging and therapy group. Ann Otol Rhinol Laryngol Suppl 1995;167:1721
21Kobayashi, Y, Asako, M, Ooka, H, Kanda, A, Tomoda, K, Yasuba, H. Residual exhaled nitric oxide elevation in asthmatics is associated with eosinophilic chronic rhinosinusitis. J Asthma 2015;52:1060–4
22Yoshida, K, Takabayashi, T, Imoto, Y, Sakashita, M, Narita, N, Fujieda, S. Reduced nasal nitric oxide levels in patients with eosinophilic chronic rhinosinusitis. Allergol Int 2019;68:225–32
23Larsen, K, Tos, M. The estimated incidence of symptomatic nasal polyps. Acta Otolaryngol 2002;122:179–82
24Szucs, E, Ravandi, S, Goossens, A, Beel, M, Clement, PA. Eosinophilia in the ethmoid mucosa and its relationship to the severity of inflammation in chronic rhinosinusitis. Am J Rhinol 2002;16:131–4
25Saito, T, Tsuzuki, K, Yukitatsu, Y, Sakagami, M. Correlation between olfactory acuity and sinonasal radiological findings in adult patients with chronic rhinosinusitis. Auris Nasus Larynx 2016;43:422–8
26Hashimoto, K, Tsuzuki, K, Okazaki, K, Sakagami, M. Influence of opacification in the frontal recess on frontal sinusitis. J Laryngol Otol 2017;131:620–6
27Kuhn, FA. Chronic frontal sinusitis: the endoscopic frontal recess approach. Oper Tech Otolayngol Head Neck Surg 1996;7:222–29
28Okushi, T, Mori, E, Nakayama, T, Asaka, D, Matsuwaki, Y, Ota, K et al. Impact of residual ethmoid cells on postoperative course after endoscopic sinus surgery for chronic rhinosinusitis. Auris Nasus Larynx 2012;39:484–9
29Simmen, D, Raghavan, U, Briner, HR, Manestar, M, Schuknecht, B, Groscurth, P et al. The surgeon's view of the anterior ethmoid artery. Clin Otolaryngol 2006;31:187–91
30Yang, YX, Lu, QK, Liao, JC, Dang, RS. Morphological characteristics of the anterior ethmoidal artery in ethmoid roof and endoscopic localization. Skull Base 2009;19:311–17
31Kim, KS, Kim, HU, Chung, IH, Lee, JG, Park, IY, Yoon, JH. Surgical anatomy of the nasofrontal duct: anatomical and computed tomographic analysis. Laryngoscope 2001;111:603–8



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed