LAUSR

in the adjacent nasal cavity and paranasal sinuses. Certain diseases and anatomical variations of the nasal cavity and paranasal sinuses may affect DCR functional outcomes. For example, anterior ethmoid pneumatization with agger nasi cells and middle turbinate lateralization may be problematic in this context. To improve anatomical success, we usually operate simultaneously on the nasal cavity and the paranasal sinuses when performing endoscopic DCR. Liang et al. [2] suggested that variations in the anterior ethmoid anatomy may contribute to surgical failure after ExDCR. Prakash et al. [3] considered that removal of the anterior end of the middle turbinate might prevent postoperative formation of synechiae between the middle turbinate and the neo-ostial site. Thus, we believe that CT should always be performed prior to DCR to explore both the disease per se and any anatomical variations of the nasal cavity and sinuses. The cited authors do not describe their follow-up time or whether endoscopic DCR on 213 sides of 165 patients was performed by the same surgeon. Surgical experience significantly affects the success rates of both endoscopic sinus surgery and endoscopic DCR. Onerci et al. [4] compared the long-term results of intranasal endoscopic DCR in patients treated by experienced and inexperienced surgeons; the surgical success rates were 94.4 and 58.0%, respectively. The lacrimal sac was incorrectly fenestrated in 12/50 patients treated by inexperienced surgeons but in no patient treated by experienced surgeons. In addition, the follow-up time may affect the assessment of functional success. Long-term functional success rates fall over time because of cicatricial closure, and formation of granulation tissue and ostial synechiae [5, 6]. In addition, the inclusion criteria are not clear. Usually, revision DCR is not particularly successful [7, 8]. Ali et al. [8] reported functional success in 93% of cases who underwent primary DCR but in only 86.9% of those who underwent revision DCR. Dear Editor,