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Is Endoscopic Sinus Surgery Contraindicated for Smokers?

by Sheri J. Polley •

Smokers May Have Other Confounding Factors

Marvin P. Fried, MD, Program Director and University Chairman of the Department of Otorhinolaryngology-Head and Neck Surgery at Albert Einstein College of Medicine and Montefiore Medical Center in New York, acknowledged, The literature tends to favor that smoking predicts a negative outcome for endoscopic sinus surgery.

He also acknowledged that smokers may have a propensity to have more symptoms of recurrent infection or nasal obstruction and may not heal as well following surgery. He further stated, The overwhelming number of articles show that kids who are exposed to smoke, or adults who smoke, don’t do as well as nonsmokers following surgery and, also, that smoking along with infection, pollution, allergies, and fungus all are some of the predisposing factors to sinus disease.

Dr. Fried also agreed that it is always preferable that patients quit smoking-for a variety of reasons. However, in his opinion, the indications and contraindications for endoscopic sinus surgery are the same for smokers and nonsmokers. If the patient suffers from symptoms of recurrent infection or nasal obstruction that have not responded to medical treatment, he considers surgical intervention regardless of whether or not the patient is a smoker. He stated, If a patient needs sinus surgery, I would not withhold it simply because he or she is a smoker. There is so much benefit from surgery that smoking alone is not a prohibitive factor.

He further opined, Bad surgical technique is a worse issue, in my opinion, than whether or not the patient is a smoker.

Dr. Kountakis cautioned that the Medical College of Georgia study did have some limitations. The patients involved in the study were all treated at a single institution. The study was based on short-term (three- and six-month) follow-up. Continued smoking may well affect patients’ long-term symptomatology and increase the need for revision surgery for smokers. He states that additional studies, including longer-term follow-up, are needed to draw more solid conclusions regarding the true benefits of endoscopic sinus surgery for smokers. He concluded, This is only a short-term study. We will continue to follow the patients and see what happens long-term.

References

  1. Smith TL, Mendolia-Loffredo S, Loehrl T, et al. Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 2005;115:2199-2205.

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  2. Friedman M, Bliznikas D, Vidyasagar R, et al. Long-term results after endoscopic sinus surgery involving frontal recess dissection. Laryngoscope 2006;116:573-9.

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