Medical and Surgical Decision Making for Functional Endoscopic Sinus Surgery (FESS) Failures

PROGRAM DESCRIPTION: Functional endoscopic sinus surgery (FESS) is well established as the surgical paradigm of choice for management of medically refractory chronic rhinosinusitis (CRS). Robust data has demonstrated efficacy with subjective symptom relief and endoscopic control of the disease process. However, a select subset of patients continues to suffer from persistent symptoms with ongoing infection and inflammation despite previous surgery and appropriate medical therapy. Optimal evaluation and management of CRS refractory to previous treatment remains an important clinical challenge in otolaryngology. The focus of this course is to outline a systematic, rationale approach to diagnostic evaluation for the failed FESS patient. Common surgical issues contributing to failure, such as maxillary recirculation, incomplete surgery, and synechia formation will be reviewed. The role of extended approaches, including medial maxillectomy and endoscopic modified Lothrop, for enhanced topical access will be discussed. The medical management strategy for refractory CRS, including the role of cultures, antibiotics, standard and off-label steroid therapies, and ASA desensitization will be elucidated. The emerging role of new anti-inflammatory biologic therapies in the treatment strategy will the outlined. Potential benefits and risks associated with common medical therapies will be reviewed. The role of surgical decision making in this patient population will also be reviewed, including the impact of surgery on long-term success of medical therapy. Pertinent case scenarios will be incorporated into the presentations to provide practical pearls to the practitioners to elevate the care of this challenging patient group. The expert series will be delivered by internationally recognized rhinologists with tertiary referral based clinical practices focused on management of FESS failures.