Endoscopic physiologic approach to allergy-associated chronic rhinosinusitis: A preliminary study

Patients with allergy-associated chronic rhinosinusitis respond poorly to functional endoscopic sinus surgery (FESS), probably because of the altered nasosinus ventilatory physiology and the increased contamination of the nasosinus mucosa by the offending allergens. With this in mind, we describe the concept and technique of functional endoscopic nasosinus surgery (FENS) in such cases. The advantages of this technique are that it preserves the uncinate process, it limits ethmoidal exenteration via a transbullar approach, and it simultaneously corrects both septal and lateral wall pathologies. The aim of our randomized prospective study was to subjectively and objectively compare the efficacy of FESS and FENS in 64 patients with allergy-associated chronic rhinosinusitis. Subjective assessment was ascertained by visual analog scores, and objective assessment was made by nasal endoscopy. In this preliminary study, we found that FENS was superior to FESS in treating chronic sinusitis associated with nasal allergy.