Objectives: Nasal obstruction is a common presenting symptom in otolaryngology practice. Frequent etiologies include allergic and non-allergic rhinitis, inferior turbinate hypertrophy (HIT), and nasal septal deviation (DNS). This study aimed to evaluate the relationship between major causes of nasal obstruction and their effect on patient-reported quality of life (QoL). Methods: We conducted a retrospective analysis of patients presenting with nasal obstruction who completed the 22-item Sino-Nasal Outcome Test (SNOT-22), the Nasal Obstruction Symptom Evaluation (NOSE) scale, and a visual analog scale (VAS). Patients were categorized into three groups based on etiology: rhinitis, anatomical obstruction, or combined pathology. Results: The study included 170 patients (62% male), with a mean age of 38.4 years. Mean SNOT-22, NOSE, and VAS scores were 38, 61, and 6.5, respectively, with no statistically significant differences observed among the three etiologic groups. QoL outcomes were also comparable across anatomical subgroups, including isolated DNS, HIT, or combined findings. Among SNOT-22 domains, rhinologic symptoms demonstrated the highest burden. Patients with rhinitis exhibited significantly higher rhinologic and ear/facial symptom scores compared with patients with isolated anatomical obstruction (p = 0.04 and p = 0.005, respectively). Strong correlations were observed between SNOT-22, NOSE, and VAS scores across the entire cohort. Conclusions: Nasal obstruction is associated with substantial impairment in multiple domains of quality of life, independent of the underlying etiology. These findings highlight the broad impact of nasal obstruction on patient well-being. Larger prospective studies are warranted to further assess changes in quality of life following medical and surgical interventions.

To examine the success rate of endoscopic decompression surgery in Graves’ ophthalmopathy. This is a retrospective cohort study of all patients who underwent endoscopic decompression surgery at the Rabin Medical Center, Israel, between 2010 and 2022. The data includes post-surgery follow-up time, visual acuity, proptosis outcomes, and post-surgical complications. Thirty patients underwent unilateral or bilateral decompression surgery at our medical centre during the study period, a total of 42 eyes. The mean age at the time of decompression was 49 ± 15.82 years. The reason for surgery was proptosis in twenty-eight patients (93.3

IntroductionChildren with choanal atresia (CA) typically present with nasal obstruction and require surgical intervention to establish a patent airway. Transnasal endoscopic surgery is the preferred treatment approach. However, long-term outcome data are lacking. This study aims to assess the long-term outcomes and quality of life (QoL) after endoscopic repair of CA.MethodsChildren under age 18 years underwent endoscopic repair of CA using mucoperichondrial flaps developed from the nasal septum between 2007 and 2022. Their parents completed two standardized telephonic QoL questionnaires (Hebrew version, Sino-Nasal 5 (SN-5H) and Nasal Obstruction Symptom Evaluation (He-NOSE)).ResultsThe cohort consisted of 40 children, 60% female. Eight had syndromic disease; seven were born prematurely. Mean age at surgery was 25 days for bilateral atresia (65% of patients) and 3.8 years for unilateral atresia. Ten children, most with unilateral CA, needed revision surgery. The mean duration of follow-up was 3.1 years. At the last follow-up, 84.6% of the children had normal choanae, and the remainder had narrowed choanae. Mean time from last follow-up to the parental interview was 5.2 years. SN-5H and He-NOSE scores were similar to those of historical healthy subjects: 1.95 versus 1.76 (P = 0 .4) and 22.3 versus 14.9 (P = 0.08), respectively. Children born prematurely had a higher rate of sinus infections (P = 0 .01) and nasal congestion (P = 0 .05) than children born at term.ConclusionsLong-term follow-up of children who underwent endoscopic repair of CA using mucoperichondrial flaps showed a stable patent nasal passage with normal QoL for both unilateral and bilateral disease.

BACKGROUND:In benign tumors with potential for malignant transformation, sampling error during pre-operative biopsy can significantly change patient counseling and surgical planning. Sinonasal inverted papilloma (IP) is the most common benign soft tissue tumor of the sinuses, yet it can undergo malignant transformation to squamous cell carcinoma (IP-SCC), for which the planned surgery could be drastically different. Artificial intelligence (AI) could potentially help with this diagnostic challenge. METHODS:CT images from 19 institutions were used to train the Google Cloud Vertex AI platform to distinguish between IP and IP-SCC. The model was evaluated on a holdout test dataset of images from patients whose data were not used for training or validation. Performance metrics of area under the curve (AUC), sensitivity, specificity, accuracy, and F1 were used to assess the model. RESULTS:Here we show CT image data from 958 patients and 41099 individual images that were labeled to train and validate the deep learning image classification model. The model demonstrated a 95.8 % sensitivity in correctly identifying IP-SCC cases from IP, while specificity was robust at 99.7 %. Overall, the model achieved an accuracy of 99.1%. CONCLUSIONS:A deep automated machine learning model, created from a publicly available artificial intelligence tool, using pre-operative CT imaging alone, identified malignant transformation of inverted papilloma with excellent accuracy.

Apophysomyces is a rare mould fungus that causes invasive, often fatal rhino-orbital infection typically in immunocompetent individuals. Several cases have been reported mainly from China, India and Saudi Arabia. Herein, to the best of our knowledge, we describe the first case of imported invasive Apophysomyces variabilis rhino-orbital infection in an Israeli healthy man after travelling to Mecca, Saudi Arabia.

OBJECTIVE:A validated and practical grading system for endoscopic findings is crucial for both clinical care and research when evaluating patients with Hereditary Hemorrhagic Telangiectasia (HHT) who experience epistaxis and nasal complaints. This study aimed to validate a novel, simplified nasal endoscopy grading system in HHT patients. METHODS:The study was conducted at a tertiary referral center for HHT patients. Twenty HHT patients were derived from an earlier double-blinded, placebo-controlled study by our group, investigating the efficacy of topical propranolol gel for treating epistaxis. Patients were examined at three time points, and nasal endoscopies were recorded. The grading system categorized findings into three grades: mild (few punctate lesions), moderate (multiple telangiectasias/large arteriovenous malformations involving the anterior nasal septum), and severe (diffuse involvement of the nasal mucosa with telangiectasias). Three experienced rhinologists, blinded to clinical data, performed the grading. Primary outcomes were the correlation of the grading system with Epistaxis Severity Score (ESS) and Quality of Life (QoL). Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS:54 nasal endoscopy scores from 20 patients were analyzed. There was a significant correlation between the grading system and ESS (r = 0.8, p = 0.006) and QoL (r = -0.42, p = 0.002). Worse ESS and QoL scores were associated with more severe nasal endoscopy grades. The ICC of 0.8 (p < 0.0001) indicated substantial agreement among the three graders. CONCLUSIONS:The novel nasal endoscopy grading system demonstrated a significant correlation with ESS and QoL. Further validation of this novel grading system in larger cohorts is needed. LEVEL OF EVIDENCE: 3:

Purpose To examine the long-term success rate of pediatric endoscopic DCR surgery via telephone questionnaires, as determined by patients and their parents. Methods This is a retrospective cohort study of all patients who underwent DCR surgery at the Schneider Children's Medical Center of Israel between 2010 and 2020. We performed long-term follow-ups to assess the quality of life, surgical complications, and satisfaction with surgical outcomes. Results Our study includes seventy-nine patients with a total of 108 eyes. The mean age at the time of DCR was 7.05 years (Std = 4, min = 0.3, max = 17.7) Mean follow-up time was 5.7 years (Std =2.5, min = 1.4, max = 11.1). Tubes were inserted for a mean of 129 days (Std = 101). Fifty-seven patients (72%) declared they had no complications after surgery, three patients (4%) reported pain after surgery, and 14 patients (17.7%) reported tube extrusion, which occurred 7–21 days after surgery. Forty-four patients (56%) reported no recurrence of symptoms, 29 (37%) complained of mild epiphora, and 18 (23%) reported some ocular discharge. Sixty-eight patients (86%) stated that they did not undergo additional surgery, while the remaining 11 (14%) reported undergoing a revision operation for symptom control. Satisfaction rate (1–7) mean score reported was 6.15 (Std = 1.6). Sixty-two (78%) reported improved quality of life, while 17 (22%) reported no improvement. Our questionnaire results have been compared with the TEARS scores with similar findings. Conclusion Regardless of its etiology, endoscopic DCR surgery in the pediatric population is safe and efficient, with a high long-term patient satisfaction rate, as reported via a telephone questionnaire.

OBJECTIVE:Treatment of sinonasal malignancies most often requires primary or postoperative radiation treatment. Post radiation sinonasal morbidity has been previously described; however, none addressed post-radiation sinus obstruction. Our objective was to investigate the long-term outcomes of post radiation complete isolated sinus opacification (CISO). METHODS:A retrospective analysis of sinonasal cancer patients treated with radiation therapy during the years 2002 to 2022. Clinical, imaging and treatment data were collected from patients' medical records. Only patients with at least 12 months of follow-up and available imaging for review were included. RESULTS:Out of 109 patients, 37 patients were identified to meet the inclusion criteria. Mean follow-up was 58 months. 35% of patients were diagnosed with persistent post radiation CISO with a mean onset of 4 months. All these patients remained asymptomatic, and their imaging remained stable during follow-up with none developing an expanding mucocele. Ethmoid sinus tumor involvement was found to be more prevalent in the CISO group (62% vs. 25%, p-value = 0.048) as well as chemotherapy/immunotherapy (54% vs. 38%, p-value = 0.046). Multivariant analysis revealed that ethmoid sinus involvement (OR = 9.516, p-value = 0.047) and adjuvant therapy, either chemotherapy/immunotherapy (OR = 10.75, p-value = 0.036) were found to be a predictive factor for complete opacification. CONCLUSION:Our study revealed that a substantial number of post-radiation patients develop a stable and persistent CISO, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up. LEVEL OF EVIDENCE:4 Laryngoscope, 134:4232-4238, 2024.

Introduction: The purpose of this study was to investigate whether patient, tumor and radiation therapy factors are associated with development of middle ear effusion (MEE) in nasopharyngeal carcinoma (NPC) patients. Methods: A retrospective review of NPC patients treated between January 2000 and June 2018 at Rabin Medical Center. Patient factors, tumor factors, radiation doses and radiation fields were collected and outlined if needed (middle ear, eustachian tube (ET), tensor veli palatini (TVP) and levator palatini (LVP) muscles), then analyzed and compared between patients with MEE and those without and between sides in patients with unilateral MEE. Results: 73 patients were enrolled. Most were males (71.2%) with advanced stage diseases (78%). At the time of diagnosis 14 patients (19.2%) presented with MEE and in 18 (24.6%) patients post radiation MEE was observed (15 ipsilateral to the tumor and 3 bilateral). Tumor stage, histology and laterality were not associated with development of MEE. Comparison of mean radiation field dosages including - gross target volume (GTV), clinical target volume (CTV) and patient target volume (PTV) showed no association with post radiation MEE. In addition, no difference was found in the radiation doses to the middle ear, ET or the LVP nor the TVP between ears with and without MEE. Conclusions: Postirradiation MEE remains a common adverse effect in NPC patients. Surprisingly, tumor stage, tumor laterality and histology were not associated with MEE. Similar findings were observed for total radiation doses and specific doses to the middle ear, ET and ET muscles.

Background: Endoscopic endonasal skull base surgery has become a viable alternative to open procedures for the surgical treatment of benign and malignant lesions in the sinonasal and skull base regions. As in sinus surgery, skull base surgery may cause crusting and posterior rhinorrhea, particularly when a nasoseptal flap is required for skull base reconstruction. Post-operative radiological sinonasal findings have been reported previously with no clear correlation with intraoperative decision-making. As in open surgery, endoscopic surgery is not standardized and there is variability in the intervention to assist with exposure and skull base repair. These modifications, including middle turbinate resection, nasoseptal flap, fat graft, and maxillary antrostomy have the potential for nasal morbidity. The aim of this study was to evaluate whether specific interventions during surgery or specific patient and tumor characteristics harbor a more significant risk of causing nasal morbidity post-operatively, as demonstrated by post-operative imaging. Methods: A retrospective analysis of all patients who underwent endoscopic endonasal skull base surgery for pituitary lesions at two major referral centers was performed. Data on demographic, clinical, and pathological features were collected, and pre- and post-operative imaging studies (computed tomography (CT) and magnetic resonance imaging (MRI)) were reviewed and scored according to the Lund–Mackay (LM) scoring system. Results: The study included 183 patients. Radiographic evidence of sinusitis was observed in 30 patients (LM score > 4) in post-operative imaging studies. Patients who underwent middle turbinectomy or nasoseptal flap were found to have significantly higher LM scores on follow-up imaging. A nasoseptal flap was found to be associated with an average increase in LM score of 1.67 points and middle turbinectomy with an average increase of 2.21 points. There was no correlation between tumor size and findings that were compatible with sinusitis on post-operative imaging. Conclusions: The findings of the present study suggest that endoscopic endonasal skull base surgery is associated with radiological evidence of sinusitis. Nasoseptal flap reconstruction and middle turbinectomy were strongly associated with radiographic sinusitis and should be judiciously performed during surgery. A clinical correlation is needed for further recommendations.

To analyze recurrence patterns of chronic sinusitis with nasal polyposis (CRSwNP) in patients who underwent complete FESS and identify predisposing factors for different patterns of recurrence. Retrospective analysis of patients with CRSwNP who underwent complete FESS at our tertiary medical center. Recurrence patterns were classified into edema, polyp and normal endoscopy, as well as into early (within 6 months) and late recurrence. Statistical analysis to identify risk factors for recurrence included univariate, multivariate logistic regression and cox regression models. 114 patients were included with an average follow-up of 27 months. 91

PurposeTo estimate long-term prognosis of chemosensory dysfunctions among patients recovering from COVID-19 disease.MethodsBetween April 2020 and July 2022, we conducted a prospective, observational study enrolling 48 patients who experienced smell and/or taste dysfunction during the acute-phase of COVID-19. Patients were evaluated for chemosensory function up to 24 months after disease onset.ResultsDuring the acute-phase of COVID-19, 80% of patients reported anosmia, 15% hyposmia, 63% ageusia, and 33% hypogeusia. At two years' follow-up, 53% still experienced smell impairment, and 42% suffered from taste impairment. Moreover, 63% of patients who reported parosmia remained with olfactory disturbance. Interestingly, we found a negative correlation between visual analogue scale scores for smell and taste impairments during the acute-phase of COVID-19 and the likelihood of long-term recovery.ConclusionOur study sheds light on the natural history and long-term follow-up of chemosensory dysfunction in patients recovering from COVID-19 disease. Most patients who initially suffered from smell and/or taste disturbance did not reach full recovery after 2 years follow-up. The severity of impairment may serve as a prognostic indicator for full recovery.

This study examines the impact of concomitant mucosal inflammation on clinical manifestations and long-term outcomes of Inverted Papilloma (IP). This retrospective cohort study was conducted in five tertiary medical centers. The included patients underwent an attachment-oriented surgical resection for IP with a minimum follow-up of 3 years. Of 185 patients with IP, 65 patients (35.1

Objectives Orbital complications are the most common complication of acute rhinosinusitis, especially among pediatric patients. While most cases are treated with antibiotics alone, severe presentation may demand surgical intervention. Our goal was to determine which factors predict the need for surgery and to investigate the role of computerized tomography in the decision process. Methods A retrospective review of all children hospitalized between 2001-2018 with orbital complications of acute rhinosinusitis in a university-affiliated children's hospital. Results A total of 156 children were included. Mean age was 7.9 years (1-18 years). Twenty-three children (14.7%) were surgically treated, and the rest were conservatively treated. High fever, ophthalmoplegia and diplopia in association with minimal or no response to conservative treatment were predictive for surgical intervention, as well as higher inflammatory indices. Eighty-nine children (57%) underwent imaging during hospitalization. Presence of a subperiosteal abscess, as well as its size and its location were not found to be predictors for surgery. Conclusion Clinical and laboratory findings in association with minimal or no response to conservative treatment predict the need for surgical intervention in cases of orbital complications of acute rhinosinusitis. As Computerized Tomography scans can have long-term implications in the pediatric population, caution and patience should be practiced when deciding on the timing of imaging in this population. Thus, close clinical and laboratory monitoring should lead the decision-making process in these cases and imaging should be reserved for when the decision for surgery has been made.

Objective. The aim of this study was to review the long-term complications associated with treatment of patients with sinonasal malignancies (SNMs) and risk factors for these complications. Methods. A retrospective analysis of all patients treated for SNMs at a tertiary care center between 2001 and 2018. A total of 77 patients were included. The primary outcome measure was post-treatment long-term complications.Results. Overall, long-term complications were identified in 41 patients (53%), and the most common were sinonasal (22 patients, 29%) and orbital/ocular-related (18 patients, 23%). In a multivariate regression analysis, irradiation was the only significant predictor of long-term complications (p = 0.001, OR = 18.86, CI = 3.31-107.6). No association was observed between long-term complications and tumour stage, surgical modality, or radiation dose/modality. Mean radiation dose & GE; 50 Gy to the optic nerve was associated with grade & GE; 3 visual acuity impairment (100% vs 3%; p = 0.006). Radiation therapy for disease recurrence was associated with additional long-term complications (56% vs 11%; p = 0.04). Conclusions. Treatment of SNMs has substantial long-term complications, which are significantly associated with radiation therapy.

Abstract Background Orbitocranial fungal infection (OCFI) is a potentially lethal complication of fungal rhinosinusitis, historically requiring aggressive surgery despite its significant morbidity. Over the past two decades, early use of azole agents has been introduced to support amphotericin B formulations as first-line treatment followed by step down therapy with azoles, demonstrating promising outcomes. To date, there is no data regarding the contribution of surgery in the “azole era” to patients’ survival. We aimed to provide real-life data on azole treatment outcomes and the role of surgery in the current management of OCFI. Methods Data was collected retrospectively from a chart review of the four tertiary participating centers in Israel and Australia between January 1, 2009 and January 1 2020, as well as additional cases identified through a systematic literature review (Fig. 1). The study group included patients with OCFI treated with azole antifungals. Control cases were all treated with amphotericin B. The cranial and orbital involvement was staged based on imaging (Fig. 2). The extent of surgical resection was also classified to allow for inter-group comparison. Flowchart for identification, screening, eligibility, and inclusion for the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Staging of orbitocranial fungal infection used in the study and T1 contrast-enhanced magnetic resonance images illustrating each stage I. Orbital extent: orA - periorbit, lacrimal apparatus; orB - orbital fat; orC - oculomotor muscles; orD – optic nerve, eyeball. II. Cranial extent: crA - pterygopalatine fossa, nasopharynx; crB – temporal/infratemporal fossa; crC – cavernous sinus, dura; crD – brain, spinal cord. Results There were 125 patients in the azole anti-fungal (AAF) group and 153 in the control group (Table 1). Mucorales and Aspergillus were identified in 28% and 72% of AAF cases, respectively, and 67% and 33% of control cases, respectively (p< 0.001). Among patients with cranial extension, 22.6% were operated on in the AAF group and 18.4% in the control group (Table 2). However, meninges and brain resection were performed only in the controls (10.5%) and never in the azole antifungals group (p=0.045). Orbital involvement required surgery in 25.9% of AAF cases and 38.6% of controls (p=0.12). Despite a more aggressive cranial involvement, azole-treated patients’ 3-year mortality was significantly lower than controls (21% vs. 52%, HR 0.27, p< 0.001, Fig. 4). Comparison of the study groups according to the orbitocranial fungal infection extent a. cranial extent; b. orbital extent Kaplan Meier curve on the orbitocranial fungal infection specific survival during up to 3 years of follow-up *Categorical variables are presented in n (%); **Continuous variables are represented as mean (±SD); ªAcquired immunodeficiency syndrome; bHematologic disease leading to immune compromised status; *Including 6 patients with both Mucorales and Aspergillus Univariate analysis of the study groups' main characteristics Conclusion Despite less aggressive surgical intervention for cranial involvement, OCFI patients treated with azoles had a higher survival rate, suggesting we may improve morbidity with a more conservative surgical approach in conjunction with azole treatment. The same trend is emerging for orbital involvement. Surgery for rhino-orbital-cerebral mycosis patients. Disclosures Sharon C. Chen, PhD MBBS, F2G PTy LTd: Advisor/Consultant|F2G PTy LTd: Grant/Research Support

PURPOSE:To provide real-life data on azole treatment outcomes and the role of surgery in the current management of invasive fungal rhinosinusitis complicated by orbitocranial fungal infection (OCFI).METHODS:Data was collected retrospectively from a chart review from four participating centers and a systematic literature review. The study group included patients with OCFI treated with azole antifungals. The control cases were treated with other antifungal agents. The cranial and orbital involvement degree was staged based on the imaging. The extent of the surgical resection was also classified to allow for inter-group comparison.RESULTS:There were 125 patients in the azole-treated group and 153 in the control group. Among the patients with OCFI cranial extension, 23% were operated on in the azole-treated group and 18% in the control group. However, meninges and brain resection were performed only in the controls (11% of patients) and never in the azole antifungals group. Orbital involvement required surgery in 26% of azole-treated cases and 39% of controls. Despite a more aggressive cranial involvement, azole-treated patients' mortality was significantly lower than in controls, with an OCFI-specific mortality rate of 21% vs. 52%. A similar, though not statistically significant, trend was found for the extent of the orbital disease and surgery.CONCLUSION:Despite less aggressive surgical intervention for cranial involvement, OCFI patients treated with azoles had a higher survival rate. This finding suggests we may improve morbidity with a more conservative surgical approach in conjunction with azole treatment. The same trend is emerging for orbital involvement.

BackgroundThe long‐term impact of rhinitis and chronic rhinosinusitis (CRS) on general health and medical services utilization in young adults have been limitedly studied.MethodsA case–control study in the Israeli Defense Forces, between the years 2005 and 2019, of all individuals with either rhinitis or CRS and a matched cohort of healthy individuals with a minimum of 5 years of consecutive follow‐up.ResultsThe study groups included 617 patients with rhinitis and 296 patients with CRS and 2739 healthy controls with an average age of 28 years. During a mean follow‐up of 8 years, a significant fraction of patients in both study groups were diagnosed with asthma compared to the control group, (26.1% and 23.3% vs. 3.7%, respectively; CI 95%: 12.1%–14.9%, p < 0.0001). 7.6% of patients with rhinitis developed CRS. Significantly increased loss of productivity and medical system utilization were noted in the study groups compared to controls (p < 0.0001). Moreover, deterioration in general health, manifested as loss of physical fitness for combative service was observed in a third of patients during follow‐up.ConclusionsRhinitis and CRS significantly impact productivity and medical service utilization in young adults, as well as general health associated with development of asthma and impairment of physical fitness. A minority of rhinitis patients develop CRS overtime, further affecting this patient group. These patients should be followed up and managed to improve disease control and associated outcomes.Level of Evidence3 Laryngoscope, 133:3299–3303, 2023

Objectives: Acute invasive fungal rhinosinusitis has been associated with high mortality rates. We aimed to explore the contribution of novel detection and treatment methods on the outcome of immunosuppressed children with acute invasive fungal rhinosinusitis. Design: Retrospective observational cohort study. Setting: A tertiary children’s hospital. Participants: The records of all children with a hematologic or oncologic disease who developed AIFR between 2005-2020 were reviewed. Results: Thirty-four patients were included. Aspergillosis and mucormycosis were diagnosed in 20 patients (59%) and 12 patients (35%), respectively. Panfungal polymerase chain reaction (PCR) was associated with a change of treatment in 36% of patients. Aggressive surgical approach was adopted and 71% of the patients underwent multiple surgical procedures. Overall, 26% of patients died of disease, however no disease-specific death occurred since 2012. Diagnosis using panfungal PCR (p=.04) and treatment with novel antifungal medications (p=.017) were significantly associated with disease-specific survival. Conclusions: Enhanced fungal detection using panfungal PCR and treatment with novel antifungal agents, combined with rapid diagnosis and treatment, aggressive surgical approach and better control over the underlying oncological disease, may significantly improve the outcome of immunosuppressed children with acute invasive fungal rhinosinusitis.

BACKGROUND:Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients.OBJECTIVE:To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians.METHODS:Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018.RESULTS:We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups.CONCLUSIONS:Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.