Endoscopic sinus surgery for allergic rhinosinusitis. The use of postoperative local nasal immunotherapy [LNIT]

ABSTRACT

Higher recurrence rates were reported following endoscopic surgery in allergic patients. Steroids have been frequently used postoperatively in these particular patients. However, steroids are well known to cause undesirable local and systemic effects. This study was carried out to study the effect of postoperative local nasal immunotherapy [LNIT] in improving the results of endoscopic surgery in allergic patients. A total of sixty adult patients with allergic rhinosinusitis were included in the study. Preoperative evaluation included clinical evaluation, allergy tests and CT scans of the paranasal sinuses. At the time of surgery, tiny biopsies were taken from the mucosa of the inferior turbinate. Patients were prospectively randomized into one of two groups [30 patients in each]; the first group received postoperative LNIT, and the second group [control group] continued the standard postoperative care until the time of final evaluation. The patients were followed up for 9 months. The follow up criteria included symptom score, total loratidine intake and electron microscopic examination of nasal biopsies. Endoscopic sinus surgery followed by LNIT significantly decreased the scores of all symptoms. The postoperative scores of the LNIT group were significantly less than those of the control group. Postoperative examination of the nasal mucosa of the LNIT group showed regression of the allergic changes and a clear suppression of the IgE-mediated allergic reaction. LNIT can-be a viable postoperative alternative to topical steroids in allergic patients undergoing endoscopic sinus surgery