The study of functional endoscopic sinus surgery in patients of sinus headache

ABSTRACT
Functional endoscopic sinus surgery has opened up a new horizon in the management of Headache secondary to chronic sinusitis and other paranasal disorder . In this study, we have selected 92 patients of chronic sinonasal disease (allergic/inflammatory/miscellaneous) attending the Department of Otorhinolaryngology, jhalawar medical college ,jhalawar(rajasthan) from July '08 to Oct. '11.
All the patients were pre-operatively evaluated clinically, radiologically as well as endoscopically in order to maintain normal physio-anatomy as much as possible. All 92 patients underwent for endoscopic sinus surgery. Endoscopy in all 92 patients revealed various pathological abnormalities at the middle meatus and anterior ethmoid region. The important findings were mucopurulent discharge in 63.04% of cases, polyps in nose in 71.73% of cases,concha bullosa were noted in 36.96% cases, Enlarged Bulla ethmoidalis were found in 36.96% cases. Radiological evaluation done by coronal section C.T. Scanning, revealed the anterior ethmoid as the most common site of mucosal involvement 45.65%, followed by maxillary 44.56% frontal 19.56% and posterior ethmoid 14.13% and sphenoid region 14.13%. 
After complete preoperative evaluation patients were considered to have chronic rhinosinusitis when they had nasal obstruction, recurrent episodes of mucopurulent secretion and headache, facial pain and pressure. Initially patients were managed medically according to their symptoms and were observed for 6 months. 
The patients who were symptomatic even after medical management were operated upon using the Messerklinger's approach (1978).All the patient were operated under local anaesthesia except who were uncooperative and age less than 12 years. 
In this series all 92 patients followed up carefully over a for minimum 6 months. This same group of patients were also assessed with reference to their dominating symptoms. Each patient was asked to asses his or her preoperative symptoms in order of severity which demonstrated that, headache was leading symptom in 100% cases and 93.47% responded favorably to surgery, nasal obstruction was complained by 84.78% cases and 92.30% responded favorably to surgery, nasal discharge was complained by 78.26% patients and 91.67% responded to surgery; while patients with post-nasal discharge responded well after surgery in 81.82% patients.The overall results reveal that 89.81% patients considered themselves asymptomatic or improved following surgery. No major complication directly related to FESS occurred in this series. 
Hence, over the conventional method, FESS has a number of advantages, besides being more accurate in diagnosis namely access to inaccessible areas of nose and sinuses restoring normal physiology and avoidance of radical surgery. The success depends upon a thorough pre operative endoscopic and CT coronal screening, evaluation and of course upon the efficiency and the skill of the surgeon. Inspite of certain serious complications, of which no surgery is exempt, FESS is undoubtedly the beginning of new era in cases of sinus headache.

Topic: Sinusitis and nasal conditions
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences