Please use this identifier to cite or link to this item:
Type: Thesis
Title: Frontal sinus surgery: indications and outcomes in chronic rhinosinusitis.
Author: Naidoo, Yuresh Sirkari
Issue Date: 2014
School/Discipline: School of Medicine
Abstract: The research described in this PhD thesis follows an extensive literature review of the role of the medical and surgical management of CRS. Despite the utilization of surgery to alleviate the symptoms of CRS refractory to medical therapy, there are clear deficiencies in our understanding of what type of surgery to perform, and how extensive this surgery should be so as to maximize long-term symptom alleviation and control. Particular controversy exists regarding addressing the frontal sinus with a wide variety of philosophies employed, but with limited scientific rationale to support such approaches. Chapter two describes a prospective study to validate a quality of life tool, the Adelaide Disease Severity Score. This study showed a simple 5 question tool directly related to sinus symptoms and visual analogue quality of life score correlated very highly with other more complex rhinological quality of life tools – the SNOT 20/22. It further correlated with radiological disease burden (Lund Mackay CT score) and endoscopic disease (Lund Kennedy endoscopic score) burden. This study validated our use of this tool to measure quality of life and symptom improvement in patients undergoing surgery. Chapter three describes a detailed retrospective study of the outcomes of primary frontal sinus surgery. This is the largest study in the literature of primary frontal surgery and forms the basis to support an approach where the diseased frontal sinus should be addressed surgically to optimize long-term outcomes. It also identified that certain anatomical factors such as a narrow frontal ostium seemed to play a role in persistence of symptoms. This raised questions as to whether these outcomes were as successful for revision and extended frontal sinus surgery. Were there identifiable risk factors for success and failure? The fourth chapter describes the outcomes of primary and revision standard frontal sinus surgery and investigates which patient, anatomical and disease factors were poor prognostic factors for failure. It identified a select cohort of patients that would benefit not just from frontal sinus surgery, but extended frontal sinus surgery (EMLP) in the first instance. The final chapter investigates the outcomes of extended frontal sinus surgery (EMLP) and seeks to determine the risk factors for its success and failure. This study found that the EMLP had excellent outcomes in the majority of patients, but there was a significant minority of patients that had persistence of symptoms. The relevance of the host immune system response to sinonasal microorganisms, and anatomical risk factors was also explored and lays open the basis for further study.
Advisor: Wormald, Peter-John
Dissertation Note: Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2014
Keywords: frontal sinus surgery; sinusitis; lothrop; outcomes
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
Appears in Collections:Research Theses

Files in This Item:
File Description SizeFormat 
01front.pdf206.67 kBAdobe PDFView/Open
02whole.pdf8.05 MBAdobe PDFView/Open
  Restricted Access
Library staff access only621.46 kBAdobe PDFView/Open
  Restricted Access
Library staff access only8.93 MBAdobe PDFView/Open

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.