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Rizan C, Elhassan HA. Post-sinus surgery insertion of steroid-eluting bioabsorbable intranasal devices: A systematic review. Laryngoscope 2015; 126:86-92. [DOI: 10.1002/lary.25460] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/28/2015] [Accepted: 05/19/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Chantelle Rizan
- Cardiff University School of Medicine; Cardiff United Kingdom
| | - Hassan A. Elhassan
- Department of Otolaryngology; University Hospital of Wales; Cardiff United Kingdom
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Huang Z, Hwang P, Sun Y, Zhou B. Steroid-eluting sinus stents for improving symptoms in chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery. Cochrane Database Syst Rev 2015; 2015:CD010436. [PMID: 26068957 PMCID: PMC11112646 DOI: 10.1002/14651858.cd010436.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Functional endoscopic sinus surgery (FESS) has become a well-established approach for treating patients with chronic rhinosinusitis (CRS) refractory to medical management. However, the surgical outcome may be compromised by postoperative inflammation, polyposis and adhesions, which often require subsequent intervention. Bioabsorbable, steroid-eluting sinus stents are inserted into the nose, sinuses or both following surgery to prevent stenosis of the sinus openings during the postoperative healing period. The slow release of corticosteroid aims to decrease mucosal oedema and expedite wound healing. Whether a steroid-eluting stent offers any beneficial effects in terms of improving sinonasal symptoms has not been systematically reviewed. OBJECTIVES To assess the safety and efficacy of steroid-eluting sinus stent placement in CRS patients after FESS. SEARCH METHODS The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 4); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 May 2015. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing steroid-eluting sinus stents with non-steroid-eluting sinus stents, nasal packing or no treatment in adult CRS patients undergoing FESS. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We identified no RCTs that met our inclusion criteria. Among the 159 records retrieved using our search strategy, 21 trials had the potential to be included given that they had tested sinus stents, spacers and packing materials for patients with CRS undergoing FESS. However, we excluded these trials from the review because they met some but not all of the inclusion criteria. AUTHORS' CONCLUSIONS We are unable to provide evidence to establish whether steroid-eluting sinus stents have potential advantages and disadvantages for patients with CRS undergoing FESS. Future, high-quality RCTs are needed to assess whether or not steroid-eluting sinus stents confer any beneficial effects, over those of surgery alone, when compared to non-steroid sinus stents.
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Affiliation(s)
- Zhenxiao Huang
- Beijing Tongren Hospital, Capital Medical UniversityDepartment of Otolaryngology ‐ Head and Neck SurgeryNo.1, Dong Jiao Min Xiang, Dongcheng DistrictBeijingChina100730
| | - Peter Hwang
- Stanford University School of MedicineDivision of Rhinology, Department of Otolaryngology ‐ Head and Neck SurgeryStanfordCaliforniaUSA
| | - Yan Sun
- Beijing Tongren Hospital, Capital Medical UniversityDepartment of Otolaryngology ‐ Head and Neck SurgeryNo.1, Dong Jiao Min Xiang, Dongcheng DistrictBeijingChina100730
| | - Bing Zhou
- Beijing Tongren Hospital, Capital Medical UniversityDepartment of Otolaryngology ‐ Head and Neck SurgeryNo.1, Dong Jiao Min Xiang, Dongcheng DistrictBeijingChina100730
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Albu S, Trombitas V, Vlad D, Emanuelli E. The influence of spray cryotherapy on wound healing following endoscopic sinus surgery in chronic rhinosinusitis. Laryngoscope 2015; 126:25-32. [PMID: 25780997 DOI: 10.1002/lary.25257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 01/21/2015] [Accepted: 02/17/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to assess the influence of spray cryotherapy on wound healing following endoscopic sinus surgery (ESS). STUDY DESIGN A prospective, randomized, double-blinded, controlled trial. METHODS The study included 22 consecutive adult patients with chronic rhinosinusitis with and without polyps scheduled for bilateral ESS. At the end of the surgical procedure, patients were randomized to the distribution of spray cryotherapy in one middle meatus and saline contralaterally. Outcomes were only measured for endoscopy scores. Thus, postoperative healing and the amount of edema, crusting, secretions, and scarring were assessed using the validated Lund-Kennedy and Perioperative Sinus Endoscopy (POSE) scores. RESULTS There were no baseline differences concerning POSE and Lund-Kennedy scores between the two groups. Nevertheless, a significant difference was recorded at one, 2, 4, 8, and 12 weeks in both POSE (P = .001, P = .012, P = .02, P = .006, P = .001) and Lund-Kennedy (P = .002, P = .005, P = .02, P = .02, P = .03) scores. CONCLUSIONS These preliminary results reveal an improvement in postoperative scores, demonstrating enhanced healing following spray cryotherapy. However, without patient subjective outcomes, the study is limited. Additional studies with longer follow-up and larger samples are needed to describe the effects of cryotherapy on wound healing.
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Affiliation(s)
- Silviu Albu
- IInd Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Veronica Trombitas
- IInd Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Vlad
- IInd Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Enzo Emanuelli
- Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera, Policlinico of Padua, University of Padua, Padua, Italy
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Schlosser RJ, Soler ZM. Evidence-based treatment of chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy 2014; 27:461-6. [PMID: 24274220 DOI: 10.2500/ajra.2013.27.3982] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNPs) is the most challenging form of CRS to treat. Clinical practices vary widely among physicians around the world, often with little evidence to support current therapies. METHODS This study evaluates various medical and surgical treatments with a focus on the highest levels of evidence. Recommendations for various therapies are provided based on consensus panels and evidence-based reviews. RESULTS Therapies with the strongest evidence and recommendations for CRSwNPs include oral steroids and topical nasal steroid sprays. There is also reasonable evidence for surgery, to include perioperative oral steroids and postoperative oral antibiotics for at least 2 weeks. There is little evidence to support other therapies, including commonly used modalities such as oral antibiotics, antihistamines, and immunotherapy. CONCLUSION CRSwNPs is a heterogenous disorder that currently has very few therapies supported by strong evidence. It is likely that in the near future, a more refined understanding of CRSwNPs will permit clinicians to tailor therapies using high-level evidence with improved outcomes.
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Affiliation(s)
- Rodney J Schlosser
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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Matheny KE, Carter KB, Tseng EY, Fong KJ. Safety, feasibility, and efficacy of placement of steroid-eluting bioabsorbable sinus implants in the office setting: a prospective case series. Int Forum Allergy Rhinol 2014; 4:808-15. [PMID: 25224654 DOI: 10.1002/alr.21416] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/05/2014] [Accepted: 08/20/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The outcomes of endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) can be compromised by postoperative inflammation, recurrent polyposis, middle turbinate lateralization, and synechiae, often requiring subsequent interventions. A bioabsorbable steroid-eluting sinus implant placed in the operating room following ESS has been proven safe and effective in 2 randomized controlled trials and a subsequent meta-analysis, for its ability to preserve sinus patency, and reduce medical and surgical interventions. This trial sought to evaluate the safety, feasibility, and outcomes of implants placed in the office after achieving hemostasis. METHODS Twenty patients with CRS underwent ESS including bilateral ethmoidectomy. A steroid-eluting bioabsorbable implant was deployed into each ethmoid cavity in the office within 7 days after ESS. Endoscopic appearance of the ethmoid cavities was evaluated at 1 week, 2 weeks, and 4 weeks postoperatively by the operating surgeon and an independent blinded evaluator. Procedural tolerance was assessed at week 2 using a patient preference questionnaire. The 20-item Sino-Nasal Outcome Test (SNOT-20) questionnaire was completed at baseline, week 2, and week 4. RESULTS In-office placement of steroid-eluting bioabsorbable implants was well tolerated, with 90% of patients very satisfied with the overall experience, and 80% very satisfied with the recovery process. At 1 month, there were no significant adhesions or frank polyposis, and middle turbinate lateralization was only 5%. Compared to baseline, ethmoid sinus inflammation was significantly reduced (p = 0.03), and the mean SNOT-20 score was significantly improved (p < 0.001). CONCLUSION In-office placement of steroid-eluting bioabsorbable implants after achieving hemostasis was well tolerated and might improve local drug diffusion and surgical outcomes.
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Comparison study of the use of absorbable and nonabsorbable materials as internal splints after closed reduction for nasal bone fracture. Arch Plast Surg 2014; 41:350-4. [PMID: 25075356 PMCID: PMC4113693 DOI: 10.5999/aps.2014.41.4.350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 11/22/2022] Open
Abstract
Background The authors sought to compare the use of the nonabsorbable polyvinyl alcohol sponge (PVA, Merocel) and absorbable synthetic polyurethane foam (SPF, Nasopore Forte plus) as intranasal splints after closed reduction of fractured nasal bones during the hospitalization period. Methods The medical records of 111 patients who underwent closed reduction for nasal bone fracture at Sanggye Paik Hospital, Inje University College of Medicine, from 2012 to 2013 were reviewed retrospectively. PVA (group A) or SPF (group B) was packed as an internal splint after closed reduction. The efficacy of the materials was compared and statistically analyzed. Results PVA was used in 82 patients, and SPF was used in 29 patients. The patients in group B complained significantly more of nasal pain on the first day after operation than the patients in group A. Headaches on the operation day were significantly more painful in group B than in group A. Bleeding on the fourth postoperative day was significantly reduced in group B as compared to group A. The patients in group B exhibited significantly more intensive nasal obstruction on the operation day and the following day than the patients in group A. However, on the third and fourth postoperative days, the nasal obstruction in group B was less than that in group A. The pain and bleeding related to the packing material was significantly reduced in group B as compared to group A. Conclusions The use of SPF as an absorbable packing material is a reasonable substitute for the traditional nonabsorbable material.
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Hong SD, Kim JH, Dhong HJ, Kim HY, Chung SK, Chang YS, Sohn JH. Systemic effects and safety of triamcinolone-impregnated nasal packing after endoscopic sinus surgery: a randomized, double-blinded, placebo-controlled study. Am J Rhinol Allergy 2014; 27:407-10. [PMID: 24119605 DOI: 10.2500/ajra.2013.27.3924] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Steroid-infused absorbable nasal dressings after endoscopic sinus surgery (ESS) have been used to improve wound healing and to reduce the recurrence of polyps. However, their systemic effects are not well known. The purpose of this study was to evaluate the systemic effects and safety of steroid-impregnated absorbable nasal packing after ESS. METHODS Patients who underwent bilateral ESS for chronic rhinosinusitis were recruited and randomized into two groups. Ten patients in the triamcinolone (TA) group received a TA (20 mg)-soaked bioabsorbable dressing in both nasal cavities while 10 patients in the control group took saline-impregnated dressing in both nasal cavities. Nasal dressings were not removed until postoperative day 10. Serum cortisol, 12-hour urine cortisol, serum adrenal-corticotropic hormone (ACTH), and serum osteocalcin were measured preoperatively and on postoperative days 2 and 10. Serum cortisol levels were checked 1 day after surgery additionally, while urine cortisol levels were not checked at postoperative day 10. RESULTS All 20 patients completed this study. The serum cortisol levels were significantly suppressed at postoperative days 1 and 2 in the TA group. Serum ACTH and 12-hour urine cortisol levels were lower 2 days after surgery in the TA group, although these changes were not statistically significant. There were no differences in all other parameters between the TA and control groups on postoperative day 10. CONCLUSIONS TA-impregnated nasal dressings suppress serum cortisol levels during the early postoperative period. This systemic effect was recovered gradually and normalized 10 days after the operation.
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Affiliation(s)
- Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Parikh A, Anand U, Ugwu MC, Feridooni T, Massoud E, Agu RU. Drug-eluting nasal implants: formulation, characterization, clinical applications and challenges. Pharmaceutics 2014; 6:249-67. [PMID: 24871904 PMCID: PMC4085598 DOI: 10.3390/pharmaceutics6020249] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/28/2014] [Accepted: 05/07/2014] [Indexed: 12/26/2022] Open
Abstract
Chronic inflammation and infection of the nasal sinuses, also referred to as Chronic Rhinosinusitis (CRS), severely affects patients’ quality of life. Adhesions, ostial stenosis, infection and inflammation relapses complicate chronic sinusitis treatment strategies. Drug-eluting stents, packings or implants have been suggested as reasonable alternatives for addressing these concerns. This article reviewed potential drug candidates for nasal implants, formulation methods/optimization and characterization methods. Clinical applications and important considerations were also addressed. Clinically-approved implants (Propel™ implant, the Relieva stratus™ MicroFlow spacer, and the Sinu-Foam™ spacer) for CRS treatment was an important focus. The advantages and limitations, as well as future considerations, challenges and the need for additional research in the field of nasal drug implant development, were discussed.
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Affiliation(s)
- Ankit Parikh
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
| | - Utkarshini Anand
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
| | - Malachy C Ugwu
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
| | - Tiam Feridooni
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
| | - Emad Massoud
- Queen Elizabeth II (QEII) Health Sciences Centre, 1278 Tower Road, Halifax, NS B3H 2Y9, Canada.
| | - Remigius U Agu
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, 5968 College Street, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
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Rudmik L, Smith TL. Economic Evaluation of a Steroid-Eluting Sinus Implant following Endoscopic Sinus Surgery for Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2014; 151:359-66. [DOI: 10.1177/0194599814533779] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/10/2014] [Indexed: 11/15/2022]
Abstract
Objective This study aimed to evaluate the cost-effectiveness of a mometasone steroid-eluting sinus implant compared to a nonsteroid-eluting sinus implant following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. Study Design Economic evaluation using a decision tree model. Setting Academic and nonacademic otolaryngology practices. Subjects Patients with refractory chronic rhinosinusitis undergoing ESS. Methods The economic perspective was the health care third party payer. Effectiveness and probability data were obtained from a single meta-analysis of 2 randomized, double-blind, controlled trials. Costs were obtained from the Centers for Medicare & Medicaid Services database and wholesale pharmaceutical pricing. Multiple sensitivity analyses were performed including a probabilistic sensitivity analysis. Comparative treatment groups were (1) placement of the mometasone steroid-eluting sinus implant following ESS and (2) placement of a nonsteroid-eluting implant following ESS. The primary outcome was cost per postoperative intervention avoided within 60 days after ESS. Results The mean cost for the steroid-eluting and nonsteroid-eluting sinus implant strategies were $1,572.91 and $365.18, respectively. The steroid-eluting strategy incremental cost-effectiveness ratio was $5,489.68. The sensitivity analysis demonstrated a 74.3%, 87.2%, and 90.5% certainty that the steroid-eluting implant strategy is cost-effective at willingness-to-pay thresholds of $10,000, $25,000, and $50,000, respectively. Conclusion Results from this economic evaluation suggest that placement of a mometasone steroid-eluting sinus implant into the ethmoid cavity following ESS for refractory chronic rhinosinusitis is a cost-effective intervention for preventing a postoperative intervention within 60 days after surgery.
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Affiliation(s)
- Luke Rudmik
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Timothy L. Smith
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
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What is new and promising with drug-eluting stents in sinus surgery? Curr Opin Otolaryngol Head Neck Surg 2014; 22:2-7. [DOI: 10.1097/moo.0000000000000012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dautremont JF, Mechor B, Rudmik L. The role of immediate postoperative systemic corticosteroids when utilizing a steroid-eluting spacer following sinus surgery. Otolaryngol Head Neck Surg 2014; 150:689-95. [PMID: 24482348 DOI: 10.1177/0194599814521373] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Steroid-eluting spacers can improve local drug delivery immediately following endoscopic sinus surgery and reduce the recurrence of inflammation warranting systemic corticosteroids. For chronic rhinosinusitis with nasal polyposis, the need for systemic corticosteroids immediately following endoscopic sinus surgery when using a steroid-eluting spacer has not been studied. STUDY DESIGN A randomized, double-blind, placebo-controlled trial. SETTING Academic rhinology practice. SUBJECTS AND METHODS Chronic rhinosinusitis patients with nasal polyposis who failed medical therapy and elected endoscopic sinus surgery were enrolled. Patients were randomized into either the treatment arm (postoperative prednisone 30 mg daily × 7 days; n = 18) or placebo arm (postoperative placebo pill daily × 7 days; n = 18). Outcomes were evaluated at 1 week, 3 weeks, and 2 months postoperatively. Primary outcome was endoscopic grading at postoperative month 2 using the Lund-Kennedy system. Secondary outcome included disease-specific quality of life using the Sinonasal Outcome Test (SNOT-22) survey. Patient enrollment occurred from January 2012 through February 2013 (NCT01564355). RESULTS Both arms received significant improvement in endoscopic grading and disease-specific quality of life from baseline compared to 2-month follow-up (P < .001). There were no significant differences in mean endoscopic scores between the postoperative prednisone and control groups at 1 week (P = .715), 3 weeks (P = .883), or 2 months (P = .343). There were no significant differences in SNOT-22 scores between groups at all follow-up points (all P > .119). CONCLUSION Minimizing systemic corticosteroid use in patients with chronic rhinosinusitis with nasal polyposis may avoid adverse events. Results from this study suggest that postoperative systemic corticosteroids immediately following endoscopic sinus surgery may not provide improved outcomes when utilizing a steroid-eluting spacer.
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Affiliation(s)
- Jon F Dautremont
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Verim A, Şeneldir L, Naiboğlu B, Karaca ÇT, Külekçi S, Toros SZ, Oysu Ç. Role of nasal packing in surgical outcome for chronic rhinosinusitis with polyposis. Laryngoscope 2014; 124:1529-35. [DOI: 10.1002/lary.24543] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/05/2013] [Accepted: 11/21/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Ayşegül Verim
- Department of Otorhinolaryngology/Head and Neck Surgery; Haydarpaşa Numune Educational and Research Hospital; Istanbul Turkey
| | - Lütfü Şeneldir
- Department of Otorhinolaryngology/Head and Neck Surgery; Haydarpaşa Numune Educational and Research Hospital; Istanbul Turkey
| | - Bariş Naiboğlu
- Department of Otorhinolaryngology/Head and Neck Surgery; Haydarpaşa Numune Educational and Research Hospital; Istanbul Turkey
| | - Çiğdem Tepe Karaca
- Department of Otorhinolaryngology/Head and Neck Surgery; Haydarpaşa Numune Educational and Research Hospital; Istanbul Turkey
| | - Semra Külekçi
- Department of Otorhinolaryngology/Head and Neck Surgery; Kütahya Educational and Research Hospital, Kütahya; Turkey
| | - Sema Zer Toros
- Department of Otorhinolaryngology/Head and Neck Surgery; Haydarpaşa Numune Educational and Research Hospital; Istanbul Turkey
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Kennedy DW. The PROPEL™ steroid-releasing bioabsorbable implant to improve outcomes of sinus surgery. Expert Rev Respir Med 2014; 6:493-8. [DOI: 10.1586/ers.12.53] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lee JT, Han JK. Sinus implants for chronic rhinosinusitis: technology evaluation. Expert Opin Drug Deliv 2013; 10:1735-48. [DOI: 10.1517/17425247.2013.839654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Zhao X, Grewal A, Briel M, Lee JM. A systematic review of nonabsorbable, absorbable, and steroid-impregnated spacers following endoscopic sinus surgery. Int Forum Allergy Rhinol 2013; 3:896-904. [PMID: 23894058 DOI: 10.1002/alr.21201] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/14/2013] [Accepted: 05/16/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Middle meatal (MM) spacers may reduce adhesions following endoscopic sinus surgery (ESS). However, there is no consensus as to which materials and adjuncts are the most effective for this purpose. The primary objective of this study was to examine the effectiveness of absorbable spacers (AS) vs nonabsorbable spacers (NAS) in reducing adhesions following ESS for chronic sinusitis. Secondarily, we assessed steroidal vs nonsteroidal MM spacers in reducing adhesions. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of randomized controlled trials (RCTs) was conducted and a meta-analysis on relevant outcome data was performed. Electronic search was done using OVID MEDLINE, EMBASE, Cochrane Central register of Controlled Trials, and Web of Science. Independent data extraction and evaluation was conducted. RESULTS For our primary objective, 6 RCTs were included in the systematic review. A pooled estimate of relevant trials revealed a nonsignificant trend favoring AS in reducing adhesion formation compared to NAS (Relative Risk (RR), 0.40; 95% confidence interval [CI], 0.15-1.03). This trend was not apparent if NAS are left for greater than 48 hours after ESS. For our secondary objective, we identified 5 RCTs that compared steroidal vs nonsteroidal spacers. Although a pooled analysis could not be achieved due to inconsistent reporting of MM adhesions, 2 studies demonstrated significantly less adhesions in the steroidal spacer group. CONCLUSION Comparison between NAS and AS showed that there was no significant difference in adhesion rates if NAS are used for at least 48 hours after surgery. Steroidal spacers may reduce adhesions, but more consistent data reporting is required for meta-analysis.
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Affiliation(s)
- Xiao Zhao
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario, Canada
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Brandstetter KA, Jurcisek JA, Goodman SD, Bakaletz LO, Das S. Antibodies directed against integration host factor mediate biofilm clearance from Nasopore. Laryngoscope 2013; 123:2626-32. [PMID: 23670606 DOI: 10.1002/lary.24183] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Intranasal resorbable packing, such as Nasopore, is commonly used during sinus surgery despite a paucity of evidence that demonstrates clinical benefit. We theorized that Nasopore supports bacterial growth and biofilm formation. The DNABII family of bacterial nucleic acid binding proteins stabilizes the extracellular polymeric substance of the biofilm, thus protecting bacteria from host defenses and traditional antibiotics. We tested the hypothesis that use of anti-IHF antibodies in conjunction with antibiotics would enhance biofilm eradication from Nasopore. STUDY DESIGN In vitro experiments. METHODS Nontypeable Haemophilus influenzae (NTHI) biofilms were grown on Nasopore. Following 24-hour incubation, biofilms were incubated for an additional 16 hours with either medium alone, naïve rabbit serum, rabbit anti-IHF serum, amoxicillin/clavulanate, or anti-IHF serum + amoxicillin/clavulanate. Computer statistics (COMSTAT) analysis was performed on images of biofilms obtained via confocal microscopy. RESULTS NTHI readily formed a biofilm on Nasopore. Treatment with amoxicillin/clavulanate alone mediated an increase in biomass by 92% to 6.63 μ(2) /μ(3) compared to incubation in sterile medium alone (3.46 μ(2) /μ(3)). Treatment with anti-IHF alone reduced the biomass by 77% to 1.29 μ(2) /μ(3) compared to incubation with naïve rabbit serum (5.53 μ(2) /μ(3)). Anti-IHF + amoxicillin/clavulanate reduced biomass by 88% to 0.66 μ(2) /μ(3) (P <0.02) compared to incubation with naïve rabbit serum. CONCLUSION Antibiotics alone were ineffective in eradicating NTHI biofilms that had formed on Nasopore in vitro. Anti-IHF antibodies plus amoxicillin/clavulanate therapy synergistically reduced biofilm biomass by 88%. These data support clinical studies for the use of anti-IHF combined with antibiotics to reduce biofilm formation on intranasal packing.
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Affiliation(s)
- Kathleyn A Brandstetter
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A
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Wise SK, Den Beste KA, Hoddeson EK, Parkos CA, Nusrat A. Sinonasal epithelial wound resealing in an in vitro model: inhibition of wound closure with IL-4 exposure. Int Forum Allergy Rhinol 2013; 3:439-49. [PMID: 23468432 DOI: 10.1002/alr.21158] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/11/2012] [Accepted: 01/10/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prolonged healing and persistent inflammation following surgery for rhinosinusitis impacts patient satisfaction and healthcare resources. Cytokines interleukin (IL)-4, IL-5, and IL-13 are important mediators in T-helper 2 (Th2) inflammatory rhinosinusitis. Decreased wound healing has been demonstrated with Th2 cytokine exposure, but this has not been extensively studied in sinonasal epithelium. We hypothesized that in vitro exposure of primary sinonasal epithelial cell cultures to Th2 inflammatory cytokine IL-4 and IL-13 would impair wound resealing and decrease expression of annexin A2 at the wound edge. METHODS Following 24-hour exposure to IL-4, IL-5, or IL-13 vs controls, sterile linear mechanical wounds were created in primary sinonasal epithelial cultures (n = 12 wounds per condition). Wounds were followed for 36 hours or until complete closure, and residual wound areas were calculated by image analysis. Group differences in annexin A2 were assessed by immunofluorescence labeling, confocal microscopy, and Western blots. RESULTS Significant wound closure differences were identified across cytokine exposure groups (p < 0.001). Mean percentage wound closure at the completion of the 36-hour time course was 98.41% ± 3.43% for control wounds vs 85.02% ± 18.46% for IL-4 exposed wounds. IL-13 did not significantly impair sinonasal epithelial wound resealing in vitro. Annexin A2 protein levels were decreased in IL-4 treated wounds when compared to control wounds (p < 0.01). CONCLUSION Th2 cytokine IL-4 decreases sinonasal epithelial wound closure in vitro. Annexin A2 is also diminished with IL-4 exposure. This supports the hypothesis that IL-4 exposure impairs sinonasal epithelial wound healing and may contribute to prolonged healing in Th2 inflammatory rhinosinusitis.
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Affiliation(s)
- Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA 30308, USA.
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González-Castro J, Pascual J, Busquets J. National survey on the use of preoperative systemic steroids in endoscopic sinus surgery. Int Forum Allergy Rhinol 2012. [PMID: 23193065 DOI: 10.1002/alr.21122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of preoperative systemic steroids (PSS) in endoscopic sinus surgery (ESS) has been a topic of debate among otolaryngologists for many years now. Until recently, most of the evidence to support PSS use in ESS was largely anecdotal and based on expert opinion. Although some recent randomized and blinded trials have been published, opinions among experts in the field are highly variable. The objective of this study is to identify and report the practice patterns of experts in the field regarding the use of PSS. METHODS A survey instrument was developed using SurveyMonkey® and sent to active members of the American Rhinologic Society (ARS). Responses to questions regarding PSS use, regimen, and benefits were recorded anonymously. RESULTS A total of 173 members answered the questionnaire. Although most respondents believe that there is inadequate evidence to support their use, 88.82% of the study population does use PSS in their practice. The most common diagnosis among respondents for using PSS is chronic rhinosinusitis with polyps (CRSwNP), which is consistent with the literature available. We also found statistically significant differences between PSS use in private vs academic practice, showing a trend toward more aggressive management in academic-affiliated physicians. CONCLUSION The current study shows that most of the respondents in our group do in fact see an advantage in the use of PSS before ESS. The data also highlights the opinion of most experts that more research with higher levels of evidence is still lacking.
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Affiliation(s)
- Javier González-Castro
- Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
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Medina JG, Das S. Sprayable chitosan/starch-based sealant reduces adhesion formation in a sheep model for chronic sinusitis. Laryngoscope 2012; 123:42-7. [PMID: 23070859 DOI: 10.1002/lary.23583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/11/2012] [Accepted: 06/18/2012] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Postoperative adhesion formation after endoscopic sinus surgery (ESS) remains a complication associated with high revision rates. This study determines the efficacy of a sprayable chitosan/starch-based sealant for reducing adhesions in an ESS sheep model for chronic sinusitis. STUDY DESIGN Prospective, blinded, randomized controlled trial. METHODS Sheep (n = 14) with eosinophilic rhinitis (determined by the presence of eosinophilia in nasal secretions) underwent ESS with middle turbinectomies, standardized mucosal injuries created on the lateral nasal wall, and partial thickness wounds created around the ethmoid cell region. Surgery was performed bilaterally (28 nasal cavities). Animals were randomized into treatment with sprayable chitosan/starch-based sealant (n = 7, 14 nasal cavities) or no treatment (n = 7, 14 nasal cavities). Two animals in the treatment group expired due to anesthetic complications associated with the turbinectomies, leaving five animals (10 sites) that completed the study. Presence of adhesions was assessed by endoscopic evaluation at days 14 and 28 after initial surgery. Adhesion formation was confirmed via necropsy of sinus cavities at day 28 after initial surgery. RESULTS Adhesions were observed in all seven control animals, resulting in an 86% (95% confidence interval [CI], 65-100) adhesion rate (12 of 14 sites). The five surviving treatment animals had a 10% (95% CI, 0-33) adhesion rate (one of 10 sites). Treatment with the sprayable chitosan/starch-based sealant resulted in a 76% reduction (95% CI, 32-100) of adhesions (P < .002). CONCLUSIONS In this sheep model for chronic sinusitis, treatment with sprayable chitosan/starch-based sealant reduced adhesion formation by 76% after ESS (P < .002).
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Affiliation(s)
- Jennifer G Medina
- Biomaterials Team, Research and Development, Medtronic Surgical Technologies, Jacksonville, Florida, USA
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Abstract
The Propel mometasone-eluting stent (Intersect ENT, Palo Alto, CA) is the first Food and Drug Administration-approved device for delivering steroid medication into the ethmoid cavity following surgery. The implant is composed of a biodegradable polymer in a lattice pattern that expands in a spring-like fashion to conform to the walls of a dissected ethmoid cavity and contains a total of 370 μg of mometasone furoate designed for gradual release over 30 days. The purpose of this article is to review the mode of action and the evidence supporting the efficacy of this novel technology. Three recently published clinical trials have demonstrated that the mometasone-eluting stent produced statistically significant reductions in inflammation, polyp formation, and postoperative adhesions. In addition, the implant has been found to significantly reduce the need for postoperative administration of oral steroids and to decrease the frequency of postoperative lysis of adhesions. Minimal adverse effects were reported in these trials and included infection, crusting, and granulation tissue formation. Although the placement of steroid-impregnated packing, stents, sponges, and gels has previously been used in the postoperative sinus cavities, the Propel mometasone-eluting stent introduces a new mechanism for localized and controlled delivery of topical therapy directly to the nasal mucosa for chronic rhinosinusitis.
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Affiliation(s)
- Calvin C Wei
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Lee JM, Grewal A. Middle meatal spacers for the prevention of synechiae following endoscopic sinus surgery: a systematic review and meta-analysis of randomized controlled trials. Int Forum Allergy Rhinol 2012; 2:477-86. [DOI: 10.1002/alr.21052] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/03/2012] [Accepted: 03/10/2012] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Nasal polyposis represents the end point of multiple inflammatory pathways and controversy continues as to the exact roles of medical and surgical approaches in the management of nasal polyposis. METHODS A combination of both is often required to manage polyps adequately with surgery and intranasal steroids remaining the mainstay of therapy. RESULTS Fortunately, new technological advances are making surgery safer and more efficient. In the postoperative period, debridement is effective in reducing the formation of adhesions, and topical medications may play a beneficial role in preventing polyp reformation. CONCLUSION Additional investigations into the optimal perioperative medical management is needed to ensure optimal surgical outcomes.
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Affiliation(s)
- Rony K Aouad
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, USA
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Han JK, Marple BF, Smith TL, Murr AH, Lanier BJ, Stambaugh JW, Mugglin AS. Effect of steroid-releasing sinus implants on postoperative medical and surgical interventions: an efficacy meta-analysis. Int Forum Allergy Rhinol 2012; 2:271-9. [PMID: 22550039 DOI: 10.1002/alr.21044] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/20/2011] [Accepted: 01/05/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) can be compromised by postoperative inflammation, polyposis, and adhesions, often requiring subsequent interventions. A bioabsorbable, steroid-releasing sinus implant has been studied in 2 prospective, randomized clinical trials for its ability to preserve sinus patency and reduce medical and surgical interventions after ESS in patients with CRS. The objective of this study was to perform a meta-analysis of the efficacy results from the 2 trials. METHODS The 2 prospective, randomized, double-blinded, multicenter trials enrolled a total of 143 patients utilizing an intrapatient control design. Postoperative day 30 videos were obtained for each patient, randomly ordered, and presented to an independent panel of 3 otolaryngologists for grading of efficacy endpoints. The need for postoperative interventions, formation of polyposis, and adhesions were assessed. Results from the 2 studies were then pooled. RESULTS Implants were successfully placed in all 286 ethmoid sinuses. According to the grading done by the panel, drug-releasing implants reduced postoperative interventions by 35% (p = 0.0008), lysis of adhesions by 51% (p = 0.0016), and oral steroid need by 40% (p = 0.0023), compared to controls. The relative reduction in frank polyposis was 46% (p < 0.0001). CONCLUSION Early postoperative healing is a predictor of longer-term success after sinus surgery. Evaluation of postoperative outcomes by a blinded independent panel demonstrates that steroid-releasing implants that provide a sustained release of corticosteroid improve surgical outcomes by reducing frank polyp formation, sinus adhesions, and middle turbinate lateralization. Steroid-releasing implants reduce the need for surgical intervention, and the need for oral steroid treatment.
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Affiliation(s)
- Joseph K Han
- Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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Vento SI, Blomgren K, Hytönen M, Simola M, Malmberg H. Prevention of relapses of nasal polyposis with intranasal triamcinolone acetonide after polyp surgery: A prospective double-blind, placebo-controlled, randomised study with a 9-month follow-up. Clin Otolaryngol 2012; 37:117-23. [DOI: 10.1111/j.1749-4486.2012.02455.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Effect of polyvinyl acetal sponge nasal packing on post-operative care of nasal polyposis patients: a randomised, controlled, partly blinded study. The Journal of Laryngology & Otology 2012; 126:380-4. [PMID: 22310061 DOI: 10.1017/s0022215111003471] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the effects of routine nasal packing with polyvinyl acetal sponge (Merocel) versus no packing, after endoscopic sinus surgery for nasal polyposis. SUBJECTS AND METHODS This clinical, randomised, controlled trial was performed in an academic tertiary referral centre between 2008 and 2011. Sixty patients with resistant nasal polyposis underwent endoscopic sinus surgery, and were then randomly divided into two groups: packed and non-packed. The amount of bleeding and pain in each group during pack removal was documented. RESULTS There was no significant difference between the two groups in the outcome of surgery and complications. One patient in each group needed extra packing. In the packed group, the mean ± standard deviation pain score on pack removal was 61 ± 3 (using a visual analogue scale in which 0 = no pain and 100 = worst pain imaginable). CONCLUSION This study found no significant difference between polyvinyl acetal packed and non-packed groups, following endoscopic sinus surgery for nasal polyposis. This confirms the findings of similar studies, and supports the reconsideration of routine post-operative packing in selected cases.
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Marple BF, Smith TL, Han JK, Gould AR, Jampel HD, Stambaugh JW, Mugglin AS. Advance II. Otolaryngol Head Neck Surg 2012; 146:1004-11. [DOI: 10.1177/0194599811435968] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. Endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) may be compromised by postoperative inflammation, polyposis, and adhesions, often requiring subsequent intervention. To address this issue, the authors investigated the safety and effectiveness of controlled delivery of mometasone furoate to the sinus mucosa via bioabsorbable implants deployed at the time of ESS. Study Design. Prospective, multicenter, randomized, controlled, double-blind trial using an intrapatient control design. Setting. Otolaryngology–head and neck surgery centers; both academic and private practices. Subjects and Methods. The study enrolled 105 patients with CRS undergoing bilateral ethmoidectomy to compare the effect of drug-releasing to non-drug-releasing implants using an intrapatient control design. Postoperative interventions, polyposis, and adhesions were assessed postoperatively. Efficacy was determined through independent analysis of randomized video-endoscopies by 3 blinded sinus surgeons. Safety assessments included ocular examinations. Results. Implants were successfully deployed in all 210 ethmoid sinuses. Compared with control sinuses with non-drug-releasing implants, the drug-releasing implant provided a 29.0% relative reduction in postoperative interventions ( P = .028) and a 52% ( P = .005) decrease in lysis of adhesions. The relative reduction in frank polyposis was 44.9% ( P = .002). Similar reductions were observed in real-time grading performed by the clinical investigators. No clinically significant changes from baseline in intraocular pressure or cataracts were observed. Conclusion. This study provides a high level of evidence that use of steroid-releasing implants that apply a sustained release of corticosteroid improves surgical outcomes by reducing synechiae formation, polyposis, and the need for postoperative interventions, with no observable ocular safety risk.
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Affiliation(s)
| | | | - Joseph K. Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | | | - Henry D. Jampel
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Andrew S. Mugglin
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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Rudmik L, Mace J, Mechor B. Effect of a dexamethasone Sinu-Foam™ middle meatal spacer on endoscopic sinus surgery outcomes: a randomized, double-blind, placebo-controlled trial. Int Forum Allergy Rhinol 2012; 2:248-51. [PMID: 22253199 DOI: 10.1002/alr.21011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/17/2011] [Accepted: 11/22/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Off-label drug eluting middle-meatal spacers have shown promising results for improving clinical outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). This study evaluates a dexamethasone Sinu-Foam™ spacer following ESS for CRS without nasal polyposis (CRSsNP). METHODS Patients with CRSsNP (n = 36) were enrolled into a double-blind, placebo-controlled trial and randomized into either a treatment arm (dexamethasone Sinu-Foam™ mixture; n = 18) or placebo arm (Sinu-Foam™ alone; n = 18). Therapeutic outcomes were evaluated at 1 week, 4 weeks, and 3 months using sinonasal endoscopy and graded using the Lund-Kennedy scoring system. Postoperative care included nasal saline irrigations and a short course of systemic steroids. RESULTS All patients completed the study follow-up period. Both study arms experienced significant improvement in endoscopic grading over the study duration (p < 0.001). There was no difference in average endoscopic scores between the treatment and placebo groups at 1 week, 4 weeks, and 3 months (all p > 0.489). CONCLUSION This study demonstrated that an off-label drug-eluting middle-meatal spacer of dexamethasone and Sinu-Foam™ does not improve endoscopic outcomes in the early postoperative period following ESS when combined with postoperative saline irrigations and a short course of systemic steroids.
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Affiliation(s)
- Luke Rudmik
- Division of Rhinology and Sinus Surgery, Calgary Sinus Center, Department of Otolaryngology-Head and Neck Surgery, University of Calgary, Alberta, Canada.
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Rudmik L, Soler ZM, Orlandi RR, Stewart MG, Bhattacharyya N, Kennedy DW, Smith TL. Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2011; 1:417-30. [PMID: 22144050 DOI: 10.1002/alr.20072] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/02/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND Early postoperative care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several postoperative care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early postoperative care following ESS. METHODS A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early postoperative care strategy; and clearly defined primary clinical end-point. RESULTS This review identified and evaluated the literature on 7 early postoperative care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents. CONCLUSION Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early postoperative care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in postoperative management. These evidence-based recommendations should not necessarily be applied to all postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate care.
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Affiliation(s)
- Luke Rudmik
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA
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Forwith KD, Chandra RK, Yun PT, Miller SK, Jampel HD. ADVANCE: A multisite trial of bioabsorbable steroid-eluting sinus implants. Laryngoscope 2011; 121:2473-80. [DOI: 10.1002/lary.22228] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Advances in the surgical management of chronic sinusitis and nasal polyps. Curr Allergy Asthma Rep 2011; 11:220-9. [PMID: 21302005 DOI: 10.1007/s11882-011-0182-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Current research has only reinforced the belief that chronic rhinosinusitis is a multifactorial and idiosyncratic disease process. Most basic science research on the topic focuses on delineating the many proposed contributing factors and attempting to establish therapeutic targets. In patients whose symptoms do not respond to medical therapy, endoscopic sinus surgery may be offered. Several surgical techniques have been proposed, and it would appear that certain techniques are ideal for certain situations. Recent clinical research has focused on the introduction of new technology and new techniques. Additionally, investigators have looked for ways to optimize current techniques and to determine which patient populations may expect to benefit from which types of interventions.
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More Y, Willen S, Catalano P. Management of early nasal polyposis using a steroid-impregnated nasal dressing. Int Forum Allergy Rhinol 2011; 1:401-4. [PMID: 22287473 DOI: 10.1002/alr.20067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/27/2011] [Accepted: 03/31/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Oral corticosteroids are the mainstay of medical management of sinonasal polyposis. However, systemic steroid-related side effects can be significant in both the short-term and long-term. Topical targeted steroids in optimal concentrations to the affected mucosa present an attractive alternative. The objective of this study was to compare the efficacy of steroid impregnated absorbable nasal dressing with oral steroids in the management of early nasal polyposis after endoscopic sinus surgery. METHODS A total of 21 symptomatic patients with nasal polyposis presenting with endoscopic findings of early polyposis received triamcinolone-impregnated (20 mg/mL) nasal dressing (Nasopore; Stryker Canada). A control group of 20 similar patients were treated with a short course of oral steroids. Evaluation was based on Sinonasal Assessment Questionnaire (SNAQ-11) and Perioperative Sinus Endoscopy (POSE) score at baseline, 4-week, and 8-week follow-up intervals. RESULTS At baseline, 4 weeks, and 8 weeks mean SNAQ scores were 18.42, 8.76, and 9.42 in the study group and 19.35, 7.15, and 7.60 in the control group, respectively. Mean POSE scores were 12.14, 5.04, and 6.04 in the study group and 13.52, 5.01, and 5.52 in the control group, respectively. No significant difference was found between the groups at 4 and 8 weeks in either SNAQ (p = 0.129, p = 0.235) or POSE (p = 0.803, p = 0.795) scores. CONCLUSION Triamcinolone-impregnated absorbable nasal dressing is comparable to oral steroids in the management of early nasal polyposis after sinus surgery.
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Affiliation(s)
- Yogesh More
- Department of Otolaryngology, St. Elizabeth's Medical Center, Brighton, MA, USA
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Abstract
AbstractIntroduction:This article reviews the literature pertaining to bismuth iodoform paraffin paste.Overview:Bismuth iodoform paraffin paste is used in most otolaryngology departments on a daily basis. Questions about its properties are common in postgraduate otolaryngology examinations. This article reviews bismuth iodoform paraffin paste's current and historical usage, constituents, properties, side effects, and radiographic properties, and its alternatives in otological and rhinological practice.
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84
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In response to Are routine dissolvable nasal dressings necessary following endoscopic sinus surgery?. Laryngoscope 2011. [DOI: 10.1002/lary.21802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Okushi T, Yoshikawa M, Otori N, Matsuwaki Y, Asaka D, Nakayama T, Morimoto T, Moriyama H. Evaluation of symptoms and QOL with calcium alginate versus chitin-coated gauze for middle meatus packing after endoscopic sinus surgery. Auris Nasus Larynx 2011; 39:31-7. [PMID: 21571464 DOI: 10.1016/j.anl.2011.02.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 01/29/2011] [Accepted: 02/01/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Nasal packing is used to control postoperative bleeding and wound healing, and it also exerts a very strong influence on the comfort of the patient. Sorbsan(®) (calcium alginate) is an absorbent packing that shows a potent hemostatic effect and is able to maintain wound surfaces in a moist environment by absorbing and gelling the wound exudate. The aim of this study was to evaluate the early symptoms and QOL with Sorbsan(®) versus Beschitin-F(®) (chitin-coated gauze) for middle meatus packing after endoscopic sinus surgery (ESS). METHODS We performed a cohort study of 40 patients who underwent ESS. Following ESS, the patients were randomly allocated into two groups of 20 patients each who underwent insertion of either Sorbsan(®) or Beschitin-F(®) into the middle meatus. A daily diary was used to record the symptoms and QOL, measured using visual analogue scales, before the ESS and on each day thereafter. Postoperative bleeding and local infection were also recorded. RESULTS The scores for each of the symptoms of nasal pain, headache, nasal bleeding and postnasal drip were statistically significantly lower in the Sorbsan(®) group. The scores for each of the QOL parameters, including the effect on their stay in the hospital and sleep disturbance, were also significantly lower in the Sorbsan(®) group. There were no findings of postoperative hemorrhage or local infection in either group. CONCLUSION Sorbsan(®) packing did not cause any major complications and has the potential to reduce nasal pain and suffering in post ESS patients compared with gauze packing.
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Affiliation(s)
- Tetsushi Okushi
- Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
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Jonnalagadda S, Yu VM, Catalano PJ. A feasibility study to evaluate a novel drug delivery technique through nasal/sinus mucosa using a biodegradable polymer in a guinea pig model. Otolaryngol Head Neck Surg 2011; 144:978-81. [PMID: 21493337 DOI: 10.1177/0194599811398783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Targeted topical pharmaceuticals have fewer side effects than systemic therapy and present an interesting option to treat chronic sinus disease. A simple, dependable, resorbable drug delivery mechanism has been elusive. The goal of this study is to examine the feasibility of a novel bioresorbable synthetic polymer for drug delivery in nose and sinuses. STUDY DESIGN Feasibility study. SETTING Animal study. SUBJECTS AND METHODS Polyurethane sponges soaked in either triamcinolone or gentamicin were placed in the ethmoid cavities of 14 guinea pigs via an external approach; 2 additional animals served as controls. Serum levels of each drug were assayed at intervals up to 21 days. Histopathological examination of the relevant sinonasal anatomy of each animal was performed after 21 days. RESULTS Serum levels of each drug were detectable between days 1 and 21. There were no significant differences in the histopathological examination of nasal mucosa in guinea pigs in which either drug was applied compared with control animals in which the bioabsorbable material was soaked in saline. The polyurethane sponge did not cause any foreign body reaction, granuloma, or polypoidal change to the sinus mucosa. Two animals developed a subclinical infection at the surgical site. CONCLUSION The targeted use of topical pharmaceuticals via a synthetic bioresorbable nasal sponge dressing in this guinea pig model demonstrated minimal systemic absorption and minimal histopathological changes. This technology is currently under investigation in human clinical trials.
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Safety and efficacy of a novel bioabsorbable, steroid-eluting sinus stent. Int Forum Allergy Rhinol 2011; 1:23-32. [DOI: 10.1002/alr.20020] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 09/17/2010] [Accepted: 10/05/2010] [Indexed: 11/07/2022]
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