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Abdelhamid HI, Awad AMM, Albadea AMA, Khaled IA, El-Anwar MW, El-Ahl MAS. A novel technique with butterfly splint for middle turbinate stabilization in sinus surgery. Eur Arch Otorhinolaryngol 2024; 281:1325-1330. [PMID: 37966539 DOI: 10.1007/s00405-023-08322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To assess the efficacy of newly designed butterfly splint with special technique for middle turbinate stabilization in preventing adhesion following bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). STUDY DESIGN Prospective, double-blind, randomized controlled. SETTING University hospitals. METHODS Following ESS, in cases of traumatized and/or unstable middle turbinates, newly designed butterfly plastic splint was randomly inserted in the middle meatus of one nasal side, while no splint was inserted in the other (control). Patients were followed up on after 1 week, 1 month, and 6 months. Endoscopic examination and a visual analog scale were used to evaluate each side of the nasal cavity for adhesion, crusting, pus, pain, nasal obstruction, and nasal discharge. RESULTS Thirty patients (60 nasal sides) were included. For all investigated parameters, there was no significant difference between the splinted and non-splinted sides at the first week visit. Adhesion was found significantly less in the splinted sides (3%) than the non-splinted sides (27%) after 1 month (P = 0.038). The adhesion rate in the splinted sides remained 3% at the 3 month follow-up visit, however, in the non-splinted sides, the rate increased up to 30% (P = 0.007). Throughout the follow-up visits, all other investigated parameters remained statistically insignificant between both sides. CONCLUSIONS The newly designed butterfly plastic splints to avoid middle turbinate adhesion is safe and effective in both reducing middle meatal adhesion with low complication rate in CRSwNP patients undergoing ESS and middle turbinate stabilization in its intermediate position.
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Affiliation(s)
- Hoda Ismael Abdelhamid
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali Mohammad Mohammad Awad
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amany Mohamed Abd Albadea
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ibrahim Ahmed Khaled
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Magdy Abdalla Syed El-Ahl
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Zheng L, Chen Z, Jin J, Deng Y, Fu L, Zhang W, Xiang R, Guo B, Tao Z, Xu Y. The efficacy of steroid-eluting stents on the local inflammation of chronic rhinosinusitis with nasal polyposis after endoscopic sinus surgery: a multicenter prospective longitudinal study. Eur Arch Otorhinolaryngol 2023; 280:5417-5431. [PMID: 37665343 DOI: 10.1007/s00405-023-08158-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Attenuating local inflammation of chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS) was crucial. Corticosteroids were generally exploited to ameliorate the postoperative state of CRSwNP. This study aims to verify the efficacy of steroid-eluting stents on the local inflammation of CRSwNP following ESS. METHODS 57 CRSwNP were enrolled from September 2021 to April 2022. 30 were with stents, and 27 were without stents after ESS. Eosinophilic cationic protein (ECP), myeloperoxidase (MPO), eosinophil, and neutrophil levels in nasal secretions, as well as visual analog scale (VAS) and modified perioperative sinus endoscopy (POSE) scores, were assessed preoperatively and after 2, 4, 8, and 12 weeks. RESULTS All subjects of CRSwNP exhibited reduced results of eosinophil levels, neutrophil levels, nasal obstruction, nasal discharge, loss of smell, and total VAS scores after 12 weeks compared to the preoperative ones (p < 0.05). Compared with control subjects, CRSwNP with stents acquired lower levels of ECP, MPO, loss of smell, total VAS, and POSE scores at four follow-up visits, as well as reduced eosinophil and neutrophil levels in nasal secretions after 12 weeks (p < 0.05). Correlation analysis revealed that postoperative ECP and MPO levels of CRSwNP in nasal secretions correlated strongly with eosinophil and neutrophil levels, respectively, as well as POSE scores (r > 0.6). CONCLUSION These findings indicated that steroid-eluting stents might be an acclaimed option for CRSwNP in alleviating local inflammation to acquire a superior state after ESS.
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Affiliation(s)
- Li Zheng
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Centre, Renmin Hospital of Wuhan University, Wuhan, China
- Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhe Chen
- Department of Otolaryngology-Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jing Jin
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Centre, Renmin Hospital of Wuhan University, Wuhan, China
- Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuqin Deng
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Centre, Renmin Hospital of Wuhan University, Wuhan, China
- Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lisheng Fu
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Centre, Renmin Hospital of Wuhan University, Wuhan, China
- Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Zhang
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Centre, Renmin Hospital of Wuhan University, Wuhan, China
- Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Xiang
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Centre, Renmin Hospital of Wuhan University, Wuhan, China
- Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bei Guo
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Wuhan, Wuhan, China.
| | - Zezhang Tao
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Centre, Renmin Hospital of Wuhan University, Wuhan, China.
- Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Yu Xu
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Centre, Renmin Hospital of Wuhan University, Wuhan, China.
- Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
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Razali RA, Vijakumaran U, Fauzi MB, Lokanathan Y. Maximizing Postoperative Recovery: The Role of Functional Biomaterials as Nasal Packs-A Comprehensive Systematic Review without Meta-Analysis (SWiM). Pharmaceutics 2023; 15:pharmaceutics15051534. [PMID: 37242776 DOI: 10.3390/pharmaceutics15051534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Numerous biomaterials have been developed over the years to enhance the outcomes of endoscopic sinus surgery (ESS) for patients with chronic rhinosinusitis. These products are specifically designed to prevent postoperative bleeding, optimize wound healing, and reduce inflammation. However, there is no singular material on the market that can be deemed the optimal material for the nasal pack. We systematically reviewed the available evidence to assess the functional biomaterial efficacy after ESS in prospective studies. The search was performed using predetermined inclusion and exclusion criteria, and 31 articles were identified in PubMed, Scopus, and Web of Science. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess each study's risk of bias. The studies were critically analyzed and categorized into types of biomaterial and functional properties, according to synthesis without meta-analysis (SWiM) guidelines. Despite the heterogeneity between studies, it was observed that chitosan, gelatin, hyaluronic acid, and starch-derived materials exhibit better endoscopic scores and significant potential for use in nasal packing. The published data support the idea that applying a nasal pack after ESS improves wound healing and patient-reported outcomes.
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Affiliation(s)
- Rabiatul Adawiyah Razali
- Centre for Tissue Engineering & Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Ubashini Vijakumaran
- Centre for Tissue Engineering & Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering & Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering & Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
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Khafagy Y, Ghonim M, Elzayat S, Elgendy A. Comparison between the endoscopic scores of bolgerization versus partial resection of the middle turbinate for management of the postoperative lateralization in the early follow-up period after endoscopic frontal sinusotomy: A randomized controlled study. Am J Otolaryngol 2021; 42:102998. [PMID: 33780901 DOI: 10.1016/j.amjoto.2021.102998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Frontal sinusotomy is a challenging procedure that needs meticulous handling due to its unique anatomical position. Postoperative middle turbinate lateralization is critical comorbidity for the success rate, and many techniques are adopted to prevent it. The study aimed to compare the effect of middle turbinate bolgerization and partial resection on the postoperative endoscopic scores and assess their impact on the middle meatus and the frontal recess outcome. PATIENT AND METHODS This prospective study was conducted on forty-one patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis. Nasal cavities were randomized so that partial middle turbinate resection technique was done alternately with bolgerization approach in every patient. Each participant acted as their control. Both sides were compared using Lund Kennedy Endoscopic Score (LKES) and Perioperative Sinus Endoscopy Score (POSE) at the baseline, 1st, 3rd, and 12th-month intervals postoperatively. Also, middle turbinate status was assessed at the end of the 12th-month interval using POSE score. RESULTS The total frontal sinus patency rate was 82.9% (63/76 operated sinus). Baseline scores, LKES (3.79 ± 0.777 vs 4.05 ± 0.769, p = 0.142, for the side of resection and the side for bolgerization respectively) and POSE (1.79 ± 0.413 vs 1.82 ± 0.393, p = 0.777, for the side of resection and the side for bolgerization respectively). Regarding LKES, the differences between both operated sides were fluctuating with p values: 0.001*, 0.171, and 0.044* for the 1st, 3rd, and 12th months follow-up intervals, respectively. Regarding the POSE score of the frontal sinus, the difference between both groups was steadily increasing with p values: 0.318, 0.119, and 0.017* for the 1st, 3rd, and 12th months follow-up intervals. The middle turbinate's POSE score at the 12th month was significantly higher in the side allocated for bolgerization (p-value = 0.008*). CONCLUSION Partial middle turbinate resection showed favorable endoscopic outcomes than bolgerization at the 12th month follow up period in patients undergoing primary ESS for chronic frontal sinusitis.
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Khafagy Y, Ghonim M, Elgendy A, Elzayat S. The prognostic variables affecting the frontal sinusotomy patency outcome and how to manage: A prospective study. Clin Otolaryngol 2021; 46:969-975. [PMID: 33745238 DOI: 10.1111/coa.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The study aimed to assess the factors affecting the frontal sinus patency after endoscopic frontal sinusotomy. DESIGN A prospective cohort study. SETTING Tertiary centre hospital. MAIN OUTCOME MEASURES Fifty patients with refractory chronic frontal sinusitis (83 operated frontal sinuses) had frontal sinusotomy and followed up for six months. Multiple operative factors were included the type of the procedure, intraoperative sinus findings, degree of mucosal preservation and middle turbinate stability. Other factors were also assessed, including smoking, the presence of allergic rhinitis, asthma, gastroesophageal reflux and other associated medical comorbidities. RESULTS The sinus patency success rate was 75.9%. There was a significant difference regarding the intraoperative anteroposterior sinus ostium diameter (5.36 ± 1.45 mm vs 8.88 ± 2.38 mm, P-value: .001* in the failed group and the success group, respectively). There was a significant association between the patency outcome and the presence of associated medical comorbidities (P-value: .001*), the presence of allergic rhinitis (P-value: .001*), the degree of sinus mucosal preservation (P-value: .012*) and the degree of middle turbinate stability (P-value: .001*). The multivariate analysis showed that the intraoperative anteroposterior diameter of the sinus ostium, middle turbinate stability and presence of allergic rhinitis were significant predictors (P-value: .012*, .042* and .013*, respectively). CONCLUSION Sinuses with anteroposterior ostium diameters less than 5.36 mm are more susceptible to restenosis. The flail middle turbinate increases the risk of postoperative middle meatus synechia and frontal sinus patency failure. The presence of allergic rhinitis has a negative impact on the patency outcome.
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Affiliation(s)
- Yasser Khafagy
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Ghonim
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Elgendy
- Department of Otorhinolaryngology, Faculty of Medicine, Kafrelsheikh University, Kafr el-Sheikh, Egypt
| | - Saad Elzayat
- Department of Otorhinolaryngology, Faculty of Medicine, Kafrelsheikh University, Kafr el-Sheikh, Egypt
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Khafagy Y, Ghonim M, Elgendy A, Elzayat S. The impact of bolgerization versus partial resection of the middle turbinate on frontal sinusotomy patency outcome: A randomised controlled study. Clin Otolaryngol 2021; 46:954-960. [PMID: 33730409 DOI: 10.1111/coa.13758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/09/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to compare the effects of middle turbinate resection vs bolgerization on the incidence of middle meatus synechia and their prognostic value on the patency outcomes after frontal sinusotomy. DESIGN A randomised controlled study. SETTING Tertiary centre hospital. MAIN OUTCOME MEASURES Thirty-eight patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis were included. Partial middle turbinate resection was alternated with bolgerization in both nasal cavities of every patient. The Lund-Kennedy endoscopic scores (LKESs) for both sides were compared at the first, third and sixth months postoperatively. Middle meatus synechia was assessed using the visual analogue score (VAS). Sinus patency was assessed at the end of the sixth month using a 70° nasal endoscope. RESULTS The sinus patency outcome was significantly higher in the resected group (34\38) than the bolgerized group (26\38), (P = .047*). The VAS scores suggested that the middle turbinate bolgerization group showed a significantly higher incidence of middle meatal synechia than the partial middle turbinate resection group (4.47 ± 2.617 vs 3.29 ± 2.301; P = .040*). CONCLUSION Middle turbinate resection showed more favourable results than bolgerization concerning the sinus patency outcome after frontal sinusotomy. It also showed a lower incidence of middle meatus synechia postoperatively.
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Affiliation(s)
- Yasser Khafagy
- Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Ghonim
- Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Elgendy
- Otorhinolaryngology, Faculty of medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Saad Elzayat
- Otorhinolaryngology, Faculty of medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Odat H, Al-Qudah M, Alzoubi F, Bani-Ata M, Hamouri S, Al-Alawneh M, Al-Ameri M, Al-Domaidat D, Tanash M. Assessing effects of modification of middle meatal silastic splint after endoscopic sinus surgery for nasal polyps: A randomized controlled study. Ann Med Surg (Lond) 2020; 58:172-176. [PMID: 32994980 PMCID: PMC7501477 DOI: 10.1016/j.amsu.2020.08.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 10/31/2022] Open
Abstract
Purpose To investigate the efficacy of middle meatal silastic splint in preventing adhesions after bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP), and to assess nasal symptoms and endoscopic findings in splinted and non-splinted sides. Methods After completion of ESS, silicon silastic splints were randomly inserted in the middle meatus of one nasal side, while no stent in the other side (control). The surgeon was blinded to the side selection, and splint insertion until removal after 1 week. Patients were followed -up after 1 week, 1 and 6 months. Each side of the nasal cavity was assessed for adhesions, crusting, pus, pain, nasal obstruction, and nasal discharge by endoscopic examination and visual analogue scale. Results Forty-nine patients (98 nasal sides) were included. At the 1st week visit, there was no significant difference between the splinted and non-splinted sides for all investigated parameters.After 1- month, adhesions were seen in 10% of the splinted sides, while it was in 26% of the non-splinted sides (P = 0.037).At the 6 -month follow-up visit, the adhesions rate remained 10% in the splinted sides, however the rate increased to 32% in the non-splinted sides (P = 0.007). All other examined parameters remained statistically insignificant between both sides throughout the follow -up visits. Conclusions Middle meatal silastic splint is significantly reducing middle meatal adhesions with low complication rate in CRSwNP patients undergoing ESS. Our results support its usage when the middle turbinate is unstable or traumatized during surgery.
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Affiliation(s)
- Haitham Odat
- Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan
| | - Mohannad Al-Qudah
- Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan
| | - Firas Alzoubi
- Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan
| | - Majid Bani-Ata
- Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan
| | - Shadi Hamouri
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan
| | - Mohammad Al-Alawneh
- Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan
| | - Mohammad Al-Ameri
- Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan
| | - Derar Al-Domaidat
- Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan
| | - Mahmoud Tanash
- Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan
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Yaniv D, Shlossberg L, Yaniv E. A Prospective Study on the Safety and Effectiveness of a Composite Sinus Stent for Use After Endoscopic Sinus Surgery. Am J Rhinol Allergy 2018; 33:17-25. [PMID: 30284455 DOI: 10.1177/1945892418803101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The composite sinus stent was developed to support the nasal walls, stabilize the middle turbinate, and prevent adhesions following endoscopic sinus surgery (ESS). OBJECTIVE This study sought to assess its safety and effectiveness. METHODS A prospective clinical trial was conducted in a single medical center in 2016-2018. The study included 30 patients (64% males) with a mean age of 41.9 years, who were scheduled for bilateral ESS, were randomized to undergo composite sinus stent implantation for 14 to 28 days or middle meatus placement of a Telfa tampon for 2 to 3 days. Telfa is a nonadherent absorbent dressing that has been compared favorably with other packs for use following ESS. Both groups received the same postoperative treatment. Outcomes were evaluated endoscopically by the principal investigator and also by an independent investigator blinded to the intervention the patient had and by self-report questionnaires at 3 and 12 weeks postoperatively. RESULTS The stent was successfully implanted and removed in all 29 treated sinuses, without complications. None of the stents showed granulation tissue or crusting. Compared to the tampon group, the stent group had significantly less inflammation (mean visual analog scale scores 0.2 vs 4.2 at 12 weeks, P = .01). The probability of having adhesion was 9.3 times greater in the control group compared to the study group ( P = .026), and middle turbinate lateralization rate at 12 weeks was 3.8% versus 44% in the study group and the control group, respectively, at 12 weeks ( P = .006). Patients who underwent stent implantation experienced higher symptomatic improvement (Sino-Nasal Outcome Test 22 of -37.13 vs -28.07, P = .01, in study and control groups, respectively). During stent implantation (2-4 weeks), patients did not suffer from any discomfort. CONCLUSIONS The composite sinus stent is safer and more effective than the Telfa tampon in maintaining sinus cavity patency and promoting healing following ESS.
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Affiliation(s)
- Dan Yaniv
- 1 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,2 Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Lena Shlossberg
- 1 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Yaniv
- 1 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,3 Department of Otorhinolaryngology, Herzliya Medical Center, Herzliya, Israel
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Hartl TT, Ospina J, Janjua A. Silastic "Spring" Spacers for Use Following Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2018; 71:233-237. [PMID: 31275836 DOI: 10.1007/s12070-018-1459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
The prevention of middle turbinate lateralization, and middle meatal synechiae formation, is the key to maintain a patent ostiomeatal complex following endoscopic sino-nasal surgery (ESS). Different techniques have been described to prevent this undesirable outcome, however, most of them are invasive, expensive, uncomfortable and/or obstructive. We present our technique to modified silastic sheets to circumvent these problems and improve ventilation and drainage of sinuses after surgery. The aim of this paper is to present how this silastic sheeting can be easily customized to the shape of the ethmoid cavity after ESS, allowing for ventilation of the aerated sinonasal cavities and at the same time preventing problematic synechiae/scar formation. A practical and easy technique to customize silastic stents following ESS is presented. Silastic sheets could be easily customized of the ethmoid cavity after ESS providing an excellent alternative to reduce middle turbinate lateralization and synechiae formation.
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Affiliation(s)
- Trevor T Hartl
- Department of Surgery, Otolaryngology - Head and Neck Surgery, University of British Columbia, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Javier Ospina
- Department of Surgery, Otolaryngology - Head and Neck Surgery, University of British Columbia, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Arif Janjua
- Department of Surgery, Otolaryngology - Head and Neck Surgery, University of British Columbia, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
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Manji J, Habib ARR, Macias-Valle L, Finkelstein A, Alsaleh S, Dadgostar A, Al-Asousi F, Okpaleke C, Javer AR. Comparing the efficacy of Silastic and gloved-Merocel middle meatal spacers for functional endoscopic sinus surgery: a randomized controlled trial. Int Forum Allergy Rhinol 2018; 8:948-954. [PMID: 29601150 DOI: 10.1002/alr.22119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/11/2018] [Accepted: 03/01/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Spacers are inserted into the middle meatal space (MMS) following functional endoscopic sinus surgery (FESS) to prevent lateralization of the middle turbinate, scarring, and synechiae. Our objective was to determine if the incidence of postoperative synechiae, facial pain/discomfort, pain during spacer removal, scarring, and discharge differed between nasal cavities receiving Silastic or gloved-Merocel (GM) spacers following FESS. METHODS A double-blind, randomized controlled trial (RCT) was conducted in adults requiring bilateral FESS for chronic rhinosinusitis (CRS) ± nasal polyposis. Participants served as their own controls, with each subject receiving both a Silastic and GM spacer. Spacers were inserted into the MMS during FESS and left in situ for 6 days. Participants were reviewed at 6 days, 5 weeks, and 12 weeks postoperatively. The presence of synechiae and scarring were evaluated endoscopically. Inflammation, discharge, and pain during spacer removal were assessed using a visual analogue scale (VAS). RESULTS Forty-eight participants (96 nasal cavities) were recruited. Preoperatively, Lund-Mackay computed tomography (CT) scores were similar between Silastic-treated and GM-treated cavities (6.38 ± 2.35 vs 6.18 ± 2.17). The incidence of synechiae and scarring did not differ significantly between spacers up to 12 weeks postoperatively. Pain during spacer removal was significantly greater for Silastic than GM spacers (2.13 ± 1.34 vs 1.51 ± 1.23, p = 0.020). Facial pain prior to removal and extent of discharge did not differ significantly between spacers. CONCLUSION Following FESS, patients report less pain during removal of GM than Silastic spacers. However, the likelihood of synechiae and scarring did not differ between either of the spacers.
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Affiliation(s)
- Jamil Manji
- St. Paul's Sinus Centre, Vancouver, BC, Canada
| | | | - Luis Macias-Valle
- St. Paul's Sinus Centre, Vancouver, BC, Canada
- Hospital Español de México, Facultad Mexicana de Medicina Universidad La Salle, Mexico City, Mexico
| | - Andres Finkelstein
- St. Paul's Sinus Centre, Vancouver, BC, Canada
- Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Saad Alsaleh
- St. Paul's Sinus Centre, Vancouver, BC, Canada
- Otolaryngology-Head & Neck Surgery Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
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