Background: Chronic rhinosinusitis (CRS) is a major Ear, Nose and Throat disease and there are higher numbers of refractory cases poorly responding to medical and surgical treatment. Laryngopharyngeal reflux (LPR) is said to be the important cause for same.
Aims and Objectives: This study aims to study the incidence of LPR in patients of refractory CRS. This study also aims to study the impact of proton pump inhibitors (PPI) (effective treatment of LPR) given as adjuvant therapy along with functional endoscopic sinus surgery (FESS) in patients with refractory CRS.
Materials and Methods: A total of 40 patients of refractory CRS taken up for the study were evaluated for signs and symptoms of LPR. They were then divided into two groups of 20 each - study group and control group. All the patients in both groups were evaluated for signs and symptoms of CRS. All these patients underwent FESS. Post-surgery patients in the study group were given intranasal steroids (INS) along with PPI (tablet pantoprazole) whereas in control group were put on INS without PPI. The patients were followed monthly for 3 months for improvement in signs and symptoms of CRS and patientÂ’s relief and comfortability levels.
Results: 45% of patients of refractory CRS had LPR with the posterior larynx being mainly involved. The major signs and symptoms of CRS were nasal obstruction, nasal discharge, and nasal polyps. There was more improvement in nasal obstruction, nasal discharge, and post-nasal discharge in patients of study group with PPI as compared to control group without PPI. There was better relief of symptoms in patients given PPI as compared to control group and this improvement was more marked at 3rd post-operative visit after 3 months.
Conclusion: There is a strong association between refractory CRS and LPR. PPI are an effective drug for refractory CRS when given as adjuvant therapy along with FESS.
Key words: Chronic Rhinosinusitis; Diagnostic Nasal Endoscopy; Diagnostic Laryngoscopy; Functional Endoscopic Sinus Surgery; Laryngopharyngeal Reflux; Proton Pump Inhibitors
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