Reasons for Failure in Endoscopic Sinus Surgery

Abstract

Despite advances in instrumentation, imaging and the understanding of the pathophysiology of some diseases, “failure” of endoscopic sinus surgery continues to be an important problem. The impact of failed surgery, whether economic, emotional or health-related, is considerable. Technical factors continue to play an important role in failed surgery. In others, poor patient selection is a key issue, particularly in the difficult area of facial pain. In other patients, systemic diseases, including immune deficiency, may contribute to a poor result. In other patients still, repeated “functional”, “ostio-meatal complex” surgery has little prospect of success, particularly when it has been unsuccessfully employed on prior occasions. In this patient group, more extensive surgery may need to be considered. As a corollary of this argument, some patients with advanced disease—predictably difficult to treat—might benefit from more surgically aggressive treatment, even at initial presentation.