Medical or surgical intervention is required in order to treat fronto-sinonasal polyposis. In addition to immunotherapy, medical treatment for nasal allergies includes intranasal corticosteroids, saline irrigation, systemic decongestants, topical vasoconstrictors, mucolytics, and antihistamines for people who suffer from this condition [10].
Endoscopic transnasal techniques, which are less destructive but at least as successful, have replaced open approaches as the major surgical method for treating chronic frontal sinusitis [11].
This study demonstrated that there is no significant difference between the two studied groups (group A for anterior ethmoidectomy without identification of frontal sinus ostium and group B for anterior ethmoidectomy with identification of frontal sinus ostium) regarding age and sex.
Abuzeid et al. [12] conducted a study to evaluate the effectiveness of ethmoidectomy alone for the treatment of chronic frontal sinusitis, which is consistent with our findings. In a prospective multi-center trial, adults with chronic rhinosinusitis who had computed CT evidence of frontal sinusitis were split into two groups: (1) endoscopic sinus surgery (ESS) incorporating ethmoidectomy but excluding frontal sinusotomy and (2) ESS incorporating frontal sinusotomy. Regarding age and sex, there is no discernible difference between the two study groups [12].
In agreement with our results, Mobashir et al. [13] aimed to assess different approaches addressing frontal sinus disease in twenty-four patients with chronic frontal sinusitis resistant to medical treatment for a period not less than 12 weeks. Their study included 24 patients. Six patients (25 %) were males and 18 patients (75 %) were females. Their age ranged from 20 to 58 with a mean age of 33.54±12 years old [13].
Ismail et al. [14] conducted an interventional randomized controlled clinical trial on 30 patients with chronic rhinosinusitis and nasal polyposis, and their findings are consistent with ours. Each patient underwent a nasal obstruction scale evaluation (NOSE) evaluation, nasal endoscopic examination, Lund-Mackay CT score, and pulmonary function test before and 3 months after FESS. The patients in this study were 22 men (73.3%) and 8 women (26.7%), ranging in age from 20 to 63. The median (IQR) age was 39 (31.5–50.3) [14].
This study reported that there is no significant difference between the two studied groups regarding complaints. All patients in group A had nasal obstruction, while in group B, 95% of patients had nasal obstruction. In group A, 35% of patients had headache and facial pain compared with 40% of patients in group B who had headache and facial pain. In group A, 77.5% of patients had hyposmia compared with 75% of patients in group B who had hyposmia. In group A, 67.5% of patients had postnasal secretion compared with 72.5% of patients in group B. Eighty percent of patients in group A had rhinorrhea, while in group B, 85% had rhinorrhea. Cough was present in 85% of cases in group A and in 87.5% of cases in group B.
In agreement with our results, Mobashir et al. [13] showed that all patients complained of headache/facial pain, 79.2% of hyposmia and nasal obstruction, 70.8% of postnasal secretions, 20.8% of rhinorrhea, and 12.5% of cough. The studied patients had irrelevant past history, history of asthma, or trauma [13].
In agreement with our results, Al Shamy et al. [15] showed CRS symptoms among the studied group, 66.7% of the patients presented with nasal obstruction and postnasal discharge, most of the studied group (83.3%) presented with facial pain or headache, and 75% presented with hyposmia. Only 8.3% of the studied group presented with cough as a related symptom of CRS, while 4.2% presented with asthma [15].
Our study showed that CT score and sinonasal endoscopy score were statistically significantly improved postoperatively as compared to the preoperative score.
In line with our findings, Deepthi et al. [16] investigated the correlations between subjective symptom severity and objective endoscopic and radiologic findings in CRS and compared them prior to and following FESS. An analysis of prospectively collected data from 20 individuals who underwent FESS at a tertiary care medical facility and were monitored for at least 6 months following surgery. Preoperatively, at 8 weeks and 6 months after surgery, and based on endoscopic and CT findings, the RSI questionnaire, Lund-Mackay system, and other scores were recorded. Before surgery, there was a significant positive association between the three variables, especially between the endoscopic and radiological ratings (P 0.01 in all three). Even at the 6-month mark, all three metrics’ postoperative improvement was statistically significant (P 0.001) [16].
In agreement with our results, Ismail et al. [14] showed that the study group parameters were put in comparison preoperatively and 3 months postoperatively. Most of the studied patients have a nasal endoscopic score of 2 (26.7%) or 3 (66.7%) before FESS with a median (IRR) of [3 (2, 3)], while postoperative all of them had a score of 0 with a median (IQR) of 0 (0–0) with a statistically significant difference (P=0.001). Furthermore, the Lund-Mackay sinus CT grading was statistically significantly decreased postoperatively compared to preoperative scores [20.5 (18.8–23) vs. 2 (2–4)] (P=0.001) [14].
Abuzeid et al. [12] demonstrated that considerable postoperative improvement for endoscopy scores was recorded for both subgroups with and without frontal sinusotomy, which is consistent with our findings. Additionally, subgroup comparisons showed similar improvement amplitudes (P=0.396) [12].
This study showed that there is no significant difference between the two studied groups regarding complications. In group A, 12.5% of patients had bleeding complications, and in group B, 7.5% of patients had bleeding complications. In group A, 17.5% of patients had sinusitis, and in group B, 12.5% of patients had sinusitis. CSF leak was present in 2.5% of the patients in group A with no patients in group B having a CSF leak. In group A, 5% of patients had orbital complications compared with 1 (2.5%) patient in group B.
In disagreement with our results, Mobashir et al. showed that as regards postoperative complications, no major complications (significant hemorrhages, orbital complications, or cerebrospinal fluid leak) occurred [13].
There is no significant difference between the two studied groups regarding recurrence. Recurrence occurred in 5% of patients in group A and in 2.5% of patients in group B.
Contrary to our findings, Bassiouni et al. (17) found that when patients in the standard ESS group (n = 199) were followed up for more than 6 months, the recurrence rate was 42%. When this cohort was tracked for more than a year, this number jumped to 49%. When patients were observed for more than 6 months after having a complete sphenoethmoidectomy, maxillary clearance, and a Draf 3 opening of their frontal sinuses (n = 139), there was a recurrence rate of 35%. For individuals who were followed up for more than 12 months, this stayed at 36% [17].
One of the limitations in our study was that the follow-up period was short (only 3 months). We recommend that it should be minimally 6 months in any upcoming study.