About Prof. Han Demin
Prof. Han Demin is a leading rhinologist at the Eye & ENT Hospital of Fudan University, specialising in functional endoscopic sinus surgery (FESS), nasal polyps, skull base rhinology, and sinonasal tumours. He is a national authority on FESS and olfactory disorders in China. His multicentre research programme spanning 2,000 patients across ten tertiary hospitals underpins the Chinese Guidelines on Chronic Rhinosinusitis Diagnosis and Treatment (2023 Edition), which established FESS as the first-line surgical treatment for CRS and secured its inclusion in national health insurance reimbursement. His innovations in miniaturised powered instrumentation and electromagnetic navigation have earned five national invention patents and the National Science and Technology Progress Award (Second Class, 2021).
Case Overview
Mr. Zhao (pseudonym), a 44-year-old man, presented to Prof. Han's clinic with a four-year history of bilateral nasal obstruction, mucopurulent discharge, facial pressure, and progressive anosmia. He had completed two courses of antibiotics and intranasal corticosteroids without sustained benefit, and had undergone conventional sinus surgery at a regional hospital two years earlier with recurrence within twelve months. Nasal endoscopy confirmed bilateral recurrent nasal polyps with near-complete obstruction of the middle meati; CT sinuses showed opacification of all paranasal sinuses bilaterally with evidence of prior surgery. SNOT-20 score was 72/110, reflecting severe symptom burden. Prof. Han recommended revision FESS with electromagnetic navigation guidance, miniaturised powered instrumentation, and a structured perioperative medical protocol. Operative time was 65 minutes; blood loss was 28 mL. At one-year follow-up, SNOT-20 had improved to 11; olfaction had partially recovered (Sniffin' Sticks score improved from 4 to 9); nasal endoscopy confirmed patent sinuses with healthy mucosa and no polyp recurrence. Mr. Zhao reflected: "I had the surgery before and it came back within a year. I had given up hope. Prof. Han's team explained exactly what had gone wrong and what they would do differently. A year later I can breathe, I can smell again, and the polyps have not come back. I feel like a different person."
Diagnostic Workup
Nasal endoscopy: bilateral recurrent nasal polyps, Lund-Kennedy endoscopy score 8/8; middle meati near-completely obstructed bilaterally; mucopurulent secretions. CT sinuses (Lund-Mackay score 22/24): bilateral pansinusitis with opacification of maxillary, ethmoid, frontal, and sphenoid sinuses; evidence of prior ethmoidectomy with residual disease; no intracranial or intraorbital extension. Olfactory testing (Sniffin' Sticks): score 4/16 — severe hyposmia. Allergy testing: house dust mite sensitisation confirmed. Tissue eosinophil count on prior biopsy: 42 eosinophils per high-power field — consistent with eosinophilic CRS with nasal polyps (eCRSwNP), a subtype associated with high recurrence risk. SNOT-20: 72/110. Multidisciplinary review — rhinology, allergy, and respiratory medicine — confirmed the diagnosis and operative plan.
Prof. Han's pre-operative assessment: This is recurrent eosinophilic CRS with nasal polyps — the highest-recurrence-risk CRS subtype. The prior surgery addressed anatomy but not the underlying eosinophilic mucosal disease. Revision FESS with electromagnetic navigation is required to safely navigate the altered post-surgical anatomy; the miniaturised powered system will reduce blood loss and operative time. Perioperative medical therapy — topical budesonide and low-dose macrolide — is as important as the surgery itself in this phenotype.
Treatment Strategy and Course
Diagnosis: Recurrent eosinophilic CRS with nasal polyps (eCRSwNP), bilateral pansinusitis, severe anosmia — prior surgery failed; high recurrence risk; altered post-surgical anatomy.
Treatment principle: revision FESS with electromagnetic navigation and miniaturised powered instrumentation, combined with structured perioperative medical therapy — restoring sinus ventilation and drainage, preserving functional mucosa, and suppressing eosinophilic inflammation to prevent recurrence.
- Electromagnetic navigation: Real-time instrument positioning displayed against pre-operative CT; anatomical localisation error <0.5 mm; critical structures (anterior ethmoid artery, optic nerve canal) mapped and avoided throughout
- Miniaturised powered instrumentation: 2.9 mm microdebrider; polyp removal and sinus opening with mucosal preservation; blood loss 28 mL (vs 100 mL with conventional instruments)
- Surgical extent: Bilateral complete ethmoidectomy, maxillary antrostomy, frontal sinusotomy (Draf IIa), sphenoidotomy; all sinuses opened and ventilated; diseased mucosa removed, functional mucosa preserved
- Perioperative medical therapy: Topical budesonide nasal irrigation commenced day 7 postoperatively; low-dose clarithromycin for 12 weeks; allergen immunotherapy for house dust mite initiated at 6 weeks
- Structured follow-up: Endoscopic debridement at 1 week and 1 month; endoscopy and olfactory testing at 3, 6, and 12 months
- One-year outcomes: SNOT-20 72 → 11; Sniffin' Sticks 4 → 9; Lund-Kennedy endoscopy score 8 → 1; no polyp recurrence; sinuses patent on endoscopy
Prof. Han's clinical reflection: SNOT-20 from 72 to 11, olfaction partially restored, no recurrence at one year — this is what revision FESS with the correct perioperative protocol achieves in eosinophilic CRS. The navigation system made the revision anatomy safe. The miniaturised instrumentation preserved the mucosa that drives recovery. The medical therapy addressed the eosinophilic disease that the first surgery left untreated. Surgery and medicine together — neither alone is sufficient in this phenotype.
Expert Commentary — Prof. Han Demin
1. Mucosal Preservation and the Functional Principle in FESS
The defining principle of functional endoscopic sinus surgery is mucosal preservation: the goal is not radical clearance of all diseased tissue, but restoration of sinus ventilation and drainage while retaining the functional epithelium that drives mucociliary clearance and mucosal healing. Prof. Han's "three-step" approach for CRS with nasal polyps — polyp removal, ostial enlargement, mucosal preservation — operationalises this principle. In his multicentre cohort of 2,000 patients, FESS achieved an 85% improvement in SNOT-20 at one year (vs 60% for conventional surgery; P<0.01) and a recurrence rate of 12% (vs 30% for conventional techniques). For eosinophilic CRS with nasal polyps — the highest-recurrence subtype — FESS combined with structured postoperative medical therapy achieved a 5-year control rate of 78%, approaching the international benchmark of 80%.
2. Electromagnetic Navigation and Miniaturised Instrumentation
The anatomical complexity of the paranasal sinuses — and the proximity of the anterior skull base, orbit, and optic nerve — makes surgical precision the central safety requirement in FESS, particularly in revision cases where prior surgery has altered landmarks. Prof. Han's electromagnetic navigation system integrates real-time instrument tracking with intraoperative CT, constraining anatomical localisation error to <0.5 mm and enabling continuous visualisation of critical structures throughout the procedure. In complex cases (revision sinusitis, sphenoid cysts, sinonasal tumours), navigation reduced operative time to 60 minutes (vs 90 minutes conventionally) and intraoperative blood loss by 50%. The 2.9 mm miniaturised microdebrider — developed by Prof. Han's team and protected by national patents — addresses the access limitations of conventional instruments in narrow sinus cavities, reducing mean blood loss from 100 mL to 30 mL. Together, these innovations reduced intraoperative CSF leak from 2.5% to 0.3% and orbital injury from 1.2% to 0.1%.
3. Perioperative Medical Therapy: The Critical Complement to Surgery
Surgery restores anatomy; medical therapy controls the underlying mucosal inflammatory disease. In eosinophilic CRS with nasal polyps, postoperative topical corticosteroid irrigation (budesonide) suppresses eosinophilic inflammation and promotes mucosal healing; low-dose macrolide antibiotics (clarithromycin) modulate innate immune responses and reduce postoperative adhesion formation — reducing the adhesion rate from 25% to 8% in Prof. Han's series. Prof. Han's identification of the "critical repair window" (postoperative months 3–6) — the period of maximal mucosal regeneration during which topical therapy has greatest impact — provides the biological rationale for the structured follow-up protocol and the timing of medication adjustments. Allergen immunotherapy for sensitised patients provides additional long-term disease modification beyond the surgical and pharmacological interventions.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Mr. Zhao throughout his pathway at the Eye & ENT Hospital of Fudan University, providing priority consultation coordination with Prof. Han's rhinology team, bilingual interpretation across all consultations and multidisciplinary review, bilingual explanation of the eCRSwNP diagnosis, revision FESS plan, navigation system, and perioperative medical protocol, coordination of CT, endoscopy, olfactory testing, and allergy assessment with bilingual results communication, bilingual surgical consent, and structured follow-up scheduling.
For international patients with chronic sinusitis, nasal polyps, anosmia, or sinonasal tumours — particularly those with recurrent or complex disease requiring specialist rhinological assessment — Prof. Han Demin's team offers access to one of China's most advanced endoscopic sinus surgery programmes. CMCS ensures that expertise is accessible, in the patient's language, with every step coordinated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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