Postoperative rhinosinusitis and microbiological outcomes following endoscopic endonasal approaches - A retrospective analysis of 300 patients

Sep 29, 2026

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Endoscopic endonasal approaches (EEAs) can effectively treat skull base lesions, yet postoperative rhinosinusitis has limited characterization. This retrospective study evaluated 300 patients treated at a tertiary center from July 2015 to May 2019, defining postoperative rhinosinusitis by purulent discharge on endoscopic examination. Mucus aspirates underwent bacterial culture to assess microbiological species and antibiotic use. Postoperative rhinosinusitis occurred in 59.7%, with prior endonasal surgery as a key predictor (OR 2.54).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

1. Introduction

2. Methods

2.1. Study population and setting

2.2. Postoperative rhinosinusitis definition and microbiological analysis

2.3. Statistical analysis

3. Results

4. Conclusion

J Chin MedAssoc Original article Postoperative rhinosinusitis and microbiological outcomes following endoscopic endonasal approaches: A retrospective analysis of 300 patients Yu-Wen Huanga,b, Wei-Hsin Wangb,c,*, Ming-Ying Lana,b,* aDepartment of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cDivision of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: Endoscopic endonasal approaches (EEAs) are an efficient way to manage skull base lesions; however, studies regarding postoperative rhinosinusitis are limited. This study analyzed the incidence of postoperative rhinosinusitis, the associated risk factors, microbial species, and antibiotic usage in patients who underwent EEA. Methods: Patients who underwent EEAs at a tertiary referral hospital between July 2015 and May 2019 were retrospectively evaluated. Postoperative rhinosinusitis was defined as the presence of a purulent nasal discharge on postoperative endoscopic examination. The mucopus was aspirated and subjected to bacterial culture analysis. The culture results of various groups were analyzed. Results: This study included 300 patients, and the incidence of post-EEA rhinosinusitis was 59.7% . History of endonasal surgery was an independent predictive factor for post-EEA rhinosinusitis (odds ratio [OR]: 2.54 [1 .28-5.05], p = 0 .007) . Lesions in the anterior skull base were associated with prolonged use of antibiotics for rhinosinusitis during postoperative care (OR: 3.91 [1 .32-11.52], p = 0 .013) . Staphylococcus aureus was the most common causative pathogen (52 .3%), followed by methicillin-resistant S. aureus (MRSA) (20 .7%), Pantoea dispersa (14 .4%), and Pseudomonas aeruginosa (52 .3%) . P. aeruginosa was more significant in the complex reconstruction group than in the control group. While most patients with post-EEA rhinosinusitis experienced a transient clinical course, one female patient underwent endoscopic sinus surgery (ESS) for prolonged rhinosinusitis. Conclusion: Rhinosinusitis is common in the postoperative stage of the EEA. As it usually lasts for a short duration and is treatable with proper medication, aggressive nasal care during the postoperative period is required to prevent related nasal morbidities. Keywords: Endoscopic endonasal approach; Microbiology; Rhinosinusitis; Skull base 1. INTRODUCTION Advances in endoscopic technology and techniques have facilitated the emergence of endoscopic endonasal approaches (EEAs) through the transnasal corridor over the past several decades, *Address correspondence. Dr. Ming-Ying Lan, Department of OtolaryngologyHead and Neck Surgery, Taipei Veterans General Hospital, Taipei, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: mingyinglan@gmail.com](ROC. E-mail address: mingyinglan@gmail.com) (M.-Y. Lan); Dr. Wei-Hsin Wang, Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: weihsin0103@gmail.com](ROC. E-mail address: weihsin0103@gmail.com) (W.-H. Wang). Author contributions: Dr. Wei-Hsin Wang and Dr. Ming-Ying Lan contributed equally to this work. Conflicts of interest: Dr. Ming-Ying Lan, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2025) 88: 162-169. Received July 23, 2024; accepted September 18, 2024. doi: 10. 1097/JCMA.0000000000001192 Copyright © 2024, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommon

FAQs

How was postoperative rhinosinusitis defined in this study?

Postoperative rhinosinusitis was defined as the presence of purulent nasal discharge on postoperative endoscopic examination.

What factors were associated with postoperative rhinosinusitis after EEA?

A history of endonasal surgery independently predicted postoperative rhinosinusitis (OR 2.54). Lesions in the anterior skull base were associated with prolonged antibiotic use during postoperative care (OR 3.91).

Which microorganisms were most common among causative pathogens?

Staphylococcus aureus was most common (52.3%), followed by MRSA (20.7%) and Pantoea dispersa (14.4%). The study also reported Pseudomonas aeruginosa as a significant pathogen.

Sep 29, 2026

Uploaded by Theodore