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Wierzchowska M, Kalińczak-Górna P, Grześkowiak B, Radajewski K, Burduk J, Burduk P. Bioabsorbable dressing impregnated with betamethasone and ciprofloxacin after endoscopic sinus surgery: A randomized, double-blind, placebo-controlled study. EAR, NOSE & THROAT JOURNAL 2024; 103:NP455-NP460. [PMID: 34911395 DOI: 10.1177/01455613211062457] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In addition to its hemostatic and stabilization role, biodegradable nasal packing can be used as a carrier for drugs after functional endoscopic sinus surgery (FESS). The aim of this study was to compare the influence of biodegradable synthetic polyurethane foam (NasoPore) soaked with ciprofloxacin, or betamethasone, or both to the same foam soaked with saline after FESS. METHODS 120 adults with chronic rhinosinusitis, with and without polyps, directed for bilateral full-house FESS were enrolled for the study. The patients were randomized and blinded into 3 groups, depending on the type of postoperative procedure applied. Thus, NasoPore soaked with antibiotic was provided to the first group; in the second group, the steroid was used; and the combination of both, in the third group. In each case, the aforementioned procedure was administered on one side of the nose, while NasoPore was soaked in saline on the other, at the end of the surgery, respectively. The patients were requested to complete a questionnaire during their postoperative visits at 2, 10, 30, 90, and 180 days, scoring the level of complaints on the VAS scale, separately for each side. The evaluation of the healing process was performed at each visit using rigid endoscopy and subsequently rated on numerical scales. RESULTS Decreased mucosal edema and secretion; reduced Lund-Kennedy score; and favorable influences on facial pressure, nasal blockage, and smell were most evidently seen in the group receiving the antibioticsteroid combination. CONCLUSIONS The application of biodegradable nasal packing with betamethasone and ciprofloxacin in sino-nasal surgery has positive effects not only on the healing process but also impacts patient's comfort. To optimize it, however, further research is needed.
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Affiliation(s)
- Małgorzata Wierzchowska
- Department of Otolaryngology, Phoniatrics and Audiology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Paulina Kalińczak-Górna
- Department of Otolaryngology, Phoniatrics and Audiology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Błażej Grześkowiak
- Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland
| | - Kamil Radajewski
- Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland
| | | | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Nicolaus Copernicus University, Bydgoszcz, Poland
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Zamaili AM, Kueh YC, Mohamad S, Abdullah B. The impact of middle meatal steroid-eluting implants on the postoperative outcomes of chronic rhinosinusitis: A systematic review and meta-analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00047-4. [PMID: 38521652 DOI: 10.1016/j.anorl.2024.02.014] [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: 10/04/2023] [Revised: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 03/25/2024]
Abstract
Endoscopic sinus surgery (ESS) has become an established surgical option in refractory chronic rhinosinusitis (CRS). The goal of this review is to assess the impact of steroid-eluting middle meatal implants after ESS. Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, PUBMED, and GOOGLE SCHOLAR were searched from inception to November 2022. All randomised controlled trials (RCTs) involving adult patients receiving ESS for CRS utilising a steroid-eluting middle meatal implants were eligible. The primary outcome was adhesion or synechiae. The secondary outcomes were mucosal inflammation, polyp reformation, the need for oral steroids and additional surgery, postoperative bleeding, sinus pain and discomfort, postoperative sinus-related infection, and change in intraocular pressure. Fourteen full articles were examined out of 496 potential abstracts. Seven RCTs satisfied the criteria. At 30days, steroid-eluting implants reduced adhesion (OR: 0.28, 95% CI: 0.14 to 0.56; P<0.001), mucosal inflammation (MD: -13.09, 95% CI: -18.22 to -7.97; P<0.001), polyp reformation (OR: 0.31; 95% CI: 0.22 to 0.44; P<0.001), and requirement of additional oral steroid (OR: 0.44; 95% CI: 0.25 to 0.78; P=0.005) or surgery (OR: 0.25; 95% CI: 0.12 to 0.50; P<0.001). While their use for adhesion (OR: 0.24; 95% CI: 0.11 to 0.54; P<0.001) and polyp reformation (OR: 0.24; 95% CI: 0.12 to 0.51; P<0.001) were favourable, there was no difference in mucosal inflammation (MD: -5.68, 95% CI: -12.39 to 1.03; P=0.100) or the need for surgery (OR: 0.96; 95% CI: 0.07 to 12.37; P=0.980) when evaluated after 30days. Overall, the findings suggest that steroid-eluting middle meatal implants improve ESS outcomes by lowering rates of adhesion formation, postoperative medical and surgical interventions, recurrent polyposis, and inflammation, while having no significant negative impact in the immediate postoperative period. More research is needed into the long-term impacts.
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Affiliation(s)
- A M Zamaili
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Y C Kueh
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - S Mohamad
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - B Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Brar T, Brown A, Miglani A, Lal D, Marino MJ. Outcomes of Frontal Sinus Stenting With Steroid Impregnated Microsponge Versus Steroid-Eluting Implant. Am J Rhinol Allergy 2023; 37:679-685. [PMID: 37408359 DOI: 10.1177/19458924231186901] [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] [Indexed: 07/07/2023]
Abstract
BACKGROUND Mometasone-eluting poly-L-lactide-coglycolide (MPLG) is available commercially for frontal sinus ostium (FSO) stenting. An alternative chitosan polymer-based drug delivery microsponge is also available at a lower cost per unit. OBJECTIVE To compare the outcomes of MPLG stents versus triamcinolone-impregnated chitosan polymer (TICP) microsponge in frontal sinus surgery. METHODS Patients who underwent endoscopic sinus surgery from December 2018 to February 2022 were reviewed to identify those with the intraoperative placement of TICP microsponge or MPLG stent in the FSO. FSO patency was evaluated by endoscopy at follow-up. Twenty-two-item sinonasal outcome test (SNOT-22) was also recorded, and complications were noted. RESULTS A total of 68 subjects and 96 FSOs were treated. TICP was first used in August 2021 and MPLG in December 2018. MPLG placement in a Draf 3 cavity was excluded since TICP had not been used during Draf 3 procedure. Both cohorts (TICP 20 subjects, 35 FSOs; MPLG 26 subjects, 39 FSOs) had similar clinical characteristics. At a mean total follow-up of 249.2 days for TICP and 490.4 days for MPLG, FSO patency was 82.9% and 87.1%, respectively (P = .265). At an equivalent follow-up of 130.6 days in TICP and 154.0 days in MPLG, patency was 94.3% and 89.7%, respectively (P = .475). Both groups showed significant reductions in SNOT-22 (P < .001). MPLG demonstrated crusting within the FSO at 1 month (none in TICP). CONCLUSION FSO patency for both stents was similar, although TICP had significantly lower costs per unit. Additional comparative trials may be helpful for guiding clinicians on the appropriate clinical situations for the use of these devices.
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Affiliation(s)
- Tripti Brar
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Adam Brown
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Amar Miglani
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Devyani Lal
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Michael J Marino
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
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Orabi NA, Behnke J, Reyes C, Ramadan HH, Makary CA. Effect of absorbable nasal packing saturated with ciprofloxacin and dexamethasone following endoscopic sinus surgery: A prospective cohort study. Int Forum Allergy Rhinol 2023; 13:1801-1804. [PMID: 36413477 DOI: 10.1002/alr.23114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 08/24/2023]
Affiliation(s)
- Norman A Orabi
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - John Behnke
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Camilo Reyes
- Department of Otolaryngology, Medical College of, Georgia at Augusta University, Augusta, GA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
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Xu M, Wang C, Fang S, Rui X, Ying L, Ma Z, Wang W. Effect of recombinant human acidic fibroblast growth factor on nasal mucosal healing after endoscopic sinus surgery. Am J Otolaryngol 2023; 44:103895. [PMID: 37075695 DOI: 10.1016/j.amjoto.2023.103895] [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: 02/26/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Postoperative nasal treatment is an important factor affecting the outcomes of endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). This study aimed to determine the effect of recombinant human acidic fibroblast growth factor (rh-aFGF) on nasal mucosal healing after ESS. METHODS This study is a prospective, single-blind, and randomized controlled clinical study. Fifty-eight CRS patients with nasal polyps (CRSwNP) with bilateral ESS were enrolled and randomly given 1 mL of budesonide nasal spray and 2 mL of rh-aFGF solution (rh-aFGF group) or 1 mL of budesonide nasal spray and 2 mL of rh-aFGF solvent (budesonide group)-infiltrated Nasopore nasal packing after ESS. Preoperative and postoperative scores for Sino-Nasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS), and Lund-Kennedy were collected and analyzed. RESULTS Forty-two patients completed the 12-week follow-up. Postoperative SNOT-22 scores and VAS scores showed no significant differences between the two groups. In terms of the Lund-Kennedy scores, there was a statistically significant difference between the two groups at the 2-, 4-, 8-, and 12-week postoperative visits, but not at the 1-week visit. Twelve weeks after surgery, the nasal mucosa had completely epithelialized in 18 patients in the rh-aFGF group and in 12 patients in the budesonide group (χ2 = 4.200, P = 0.040). CONCLUSION The combined application of rh-aFGF and budesonide significantly improved postoperative endoscopic appearance in the nasal mucosal healing process.
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Affiliation(s)
- Man Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Chao Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Shengjian Fang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Xiaoqing Rui
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Liyun Ying
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Zhaoxin Ma
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Weihua Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China.
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Gajendran A, Saravanam PK, Jayagandhi S. Efficacy of Triamcinolone Nasal Packing on Post-Operative Outcome in Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:957-961. [PMID: 37206842 PMCID: PMC10188726 DOI: 10.1007/s12070-023-03496-9] [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: 11/09/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction: Endoscopic sinus surgery is a frequently performed surgery for sinonasal polyposis. This includes various complications such as Crusting and synechiae formation etc. which can be reduced or minimised by regular nasal douching and nasal toileting in immediate post operative period. Methods: This study was conducted to assess the quality of life using SNOT 22 score and the efficacy of Triamcinolone Acetate impregnated anterior nasal packing based on the Peri-Operative Sinus Endoscopic (POSE) score and Lund Kennedy score on short and midterm post operative outcomes in patients undergoing Endoscopic Sinus Surgery for sinonasalpolyposis. This study was a prospective observational study comprising of 80 patients diagnosed with sinonasal polyposis. Patients were divided into two groups with 40 patients in group A (non absorbable Triamcinolone Acetate impregnated nasal packing) and 40 patients in group B(non absorbable Saline impregnated nasal packing). Study setting: This study was conducted at a tertiary care centre in South India from July 2017 to July 2019 after EthicsCommitteeapproval. Results of this study showed Improvement in quality of life index in the postoperative period in both Group A (Triamcinolone Acetate) and Group B (saline). Lund Kennedy and Peri operative sinus endoscopy score (POSE) showed statistically significant results with better and early healing among Group A (Triamcinolone Acetate) patients. Conclusion: This shows Triamcinolone Acetate nasal packing in intaoperative period helps to reduce early post operative complications such as edema,crusting and synechiae formation. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03496-9.
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7
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Lim DJ, Tilak A, Skinner D, Bloodworth LF, Zhang S, Grayson JW, Woodworth BA, Cho DY. In vitro release of triamcinolone acetonide from saturated dissolvable sinus dressings. Int Forum Allergy Rhinol 2023; 13:92-95. [PMID: 35815929 PMCID: PMC9812850 DOI: 10.1002/alr.23060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Dong-Jin Lim
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashwini Tilak
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daniel Skinner
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lucian F Bloodworth
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shaoyan Zhang
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica W Grayson
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradford A Woodworth
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Do-Yeon Cho
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Otolaryngology, Department of Surgery, Veterans Affairs, Birmingham, Alabama, USA
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Budhiraja G, Kaur N, Singh H. Role of Triamcinolone Irrigation in Postoperative Outcomes in Patients Operated for Chronic Rhinosinusitis: A Matched-Pair Randomized Controlled Trial. EAR, NOSE & THROAT JOURNAL 2022:1455613221123851. [PMID: 36031846 DOI: 10.1177/01455613221123851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
PURPOSE Endoscopic sinus surgery (ESS) is the standard treatment strategy for chronic rhinosinusitis (CRS) resistant to medical treatment, and it is known to have postoperative complications and recurrences, which in turn result in suboptimal outcomes. Several methods are used to prevent postoperative scarring, adhesions, oedema, infection or recurrences in cavities. The role of steroids in improving postoperative outcomes is well established. They can be administered systemically or locally to enhance drug delivery into paranasal sinuses. In this study, we used triamcinolone irrigation immediately following surgery on one side of the nose, in patients with bilateral disease. The objective of this study was to evaluate the effect of intra-operative triamcinolone irrigation on postoperative outcomes, in patients with bilateral pansinusitis. METHODS It was an interventional randomized controlled study, conducted at a tertiary care centre in North India. The analysis of 58 patients with bilateral pansinusitis was done from September 2020 to August 2021. At the conclusion of ESS, each patient was randomized to receive triamcinolone irrigation (4 ml of 40mg/ml solution) once and followed by merocel (polyvinyl acetal) packing on one side, while the contralateral side was packed with merocel soaked with saline. Nasal cavities were evaluated using a Hopkins rod endoscope in the postoperative 1st, 3rd, 8th and 12th weeks to look for the presence of postoperative crusting, oedema, polypoidal changes, and discharge. Perioperative sinus endoscopic scores (POSE) were used for endoscopic staging. RESULTS The most commonly affected age group was 31-45 years accounting for 39.7%. Males were affected more (63.7%) than the female population (36.3%). There was a reduction in the average POSE scores at the treatment site at all follow-up stages with a significant reduction in crusting, oedema, and scarring in the treatment site (P-value <0.001). CONCLUSION Triamcinolone irrigation effectively improves postoperative outcomes and reduces early postoperative complications in CRS patients.
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Affiliation(s)
- Grace Budhiraja
- Department of ENT, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab
| | - Navjot Kaur
- Department of ENT, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab
| | - Harsimrat Singh
- Department of ENT, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab
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Lee VS, Patel P, O'Brien D, Scangas GA, Campbell RG, Chandra R, Davis GE, Han JK, Le CH, Lee J, Luong AU, Poetker DM, Ramadan H, Setzen M, Smith K, Wise S, Villwock J, Ference E. Indications for Absorbable Steroid-Eluting Sinus Implants: Viewpoint via the Delphi Method. Int Forum Allergy Rhinol 2022; 12:1225-1231. [PMID: 35730163 PMCID: PMC10108565 DOI: 10.1002/alr.23044] [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: 01/17/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/09/2022]
Abstract
Absorbable steroid-eluting sinus implants provide targeted corticosteroid release over a sustained period and are designed to prevent both undesirable adhesion formation and sinus ostia restenosis. Here, we highlight the key evidence of these implants to date and query a group of experts via a Delphi process on the indications and optimal timing for intraoperative or in-office placement of these implants. Six of a total of 12 statements reached consensus and were accepted. Overall, experts largely agree that intraoperative or in-office use of steroid-eluting stents could be considered for patients: (1) who are diabetic or intolerant of oral steroids, (2) undergoing extended frontal sinus surgery, and (3) with recurrent stenosis. Given the lack of expert consensus on other key statements, clinicians should carefully consider these treatment options on a case-by-case basis after shared decision-making.
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Affiliation(s)
- Victoria S Lee
- Department of Otolaryngology - Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Prayag Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Daniel O'Brien
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Raewyn G Campbell
- Department of Otolaryngology Head and Neck Surgery, Macquarie University, Sydney, Australia.,Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rakesh Chandra
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Joseph K Han
- Department of Otolaryngology Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Christopher H Le
- Department of Otolaryngology - Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Jivianne Lee
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Amber U Luong
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hassan Ramadan
- Department of Otolaryngology - Head & Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Michael Setzen
- Michael Setzen Otolaryngology, PC, Great Neck, NY, Weill Cornell Medical College, New York, New York, USA
| | - Kristine Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA
| | - Jennifer Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Elisabeth Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Kaptı HB, Korkmaz H. Evaluation of the efficacy of postoperative triamcinolone in endoscopic dacryocystorhinostomy using lacrimal symptom questionnaire. Int Ophthalmol 2022; 42:2573-2580. [PMID: 35357636 DOI: 10.1007/s10792-022-02305-6] [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: 05/27/2021] [Accepted: 03/10/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the effect of postoperative nasal triamcinolone spray use in primary endoscopic dacryocystorhinostomy using The Lacrimal Symptom Questionnaire. METHODS This study included a series of 50 consecutive retrospective cases with primary endoscopic dacryocystorhinostomy and with silicone stent implantation who were followed up for 6 months postoperatively. Patients using nasal triamcinolone spray for 3 months postoperatively were included in the triamcinolone group. Patients not using triamcinolone were included in the control group. Lacrimal stents were removed 3 months postoperatively. The Lacrimal Symptom Questionnaire (Lac-Q) was performed in the preoperative and postoperative 6th month. Anatomical success, functional success, and changes in lacrimal symptom and social impact scores were compared between the two groups 6 months after surgery. RESULTS Results of 48 endoscopic dacryocystorhinostomies performed on 48 patients (23 triamcinolone group, 25 control group) meeting the inclusion criteria were analyzed. The anatomical success rate (95.7% vs. 84.0%, p = 0.350) and the functional success rate (91.3% vs. 76.0%, p = 0.249) were higher in the triamcinolone group, but this difference was not statistically significant. No complications were observed in the triamcinolone group, whereas complications developed in two patients in the control group (p = 0.490). The mean change in total lac-Q score was 11.0 in the triamcinolone group and 9.0 in the control group (p = 0.011). The mean change in social impact score was 4.0 in the triamcinolone group and 3.0 in the control group (p = 0.005). Mean change in lacrimal symptom score was 6.0 in the triamcinolone group and 6.0 in the control group (p = 0.368) CONCLUSIONS: Our study indicated that postoperative use of triamcinolone spray increases the success rate of endoscopic dacryocystorhinostomy and also revealed that triamcinolone may also lead to greater improvement in quality of life scores than the control group using a validated questionnaire.
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Affiliation(s)
| | - Hakan Korkmaz
- Department of Otorhinolaryngology, Faculty of Medicine, Ordu University, 52200, Ordu, Turkey
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11
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Schilling AL, Cannon E, Lee SE, Wang EW, Little SR. Advances in controlled drug delivery to the sinonasal mucosa. Biomaterials 2022; 282:121430. [DOI: 10.1016/j.biomaterials.2022.121430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/09/2022] [Accepted: 02/17/2022] [Indexed: 12/20/2022]
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12
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McCormick JP, Suh JD, Yang HH, Lee JT, Wang MB. Triamcinolone impregnated bioabsorbable middle meatus packing following endoscopic sinus surgery: a prospective randomized controlled trial. Int Forum Allergy Rhinol 2022; 12:1131-1136. [PMID: 35019237 DOI: 10.1002/alr.22970] [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: 11/29/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Topical steroids are a mainstay in the treatment of chronic rhinosinusitis (CRS). Multiple delivery methods of topical steroids following sinus surgery have been investigated. The purpose of this trial is to evaluate the effect of triamcinolone impregnated absorbable nasal packing on healing following endoscopic sinus surgery. METHODS This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 22 subjects (14 without polyps and 8 with polyps) were enrolled and were randomized to receive triamcinolone impregnated packing in one sinus cavity and normal saline soaked packing in the contralateral sinus cavity. Endoscopic evaluation was completed at the first two post-operative visits, and Lund-Kennedy (LK) endoscopic scores and perioperative sinus endoscopy (POSE) scores were calculated at each visit. RESULTS The results of this study found no significant difference in the appearance of the sinuses at either post-operative visit. Mean LK scores for the triamcinolone and saline groups at the first and second post-op visits were 2.09 ± 1.23 v. 2.18 ± 1.01 (p=0.79) and 1.79 ± 1.08 v. 1.68 ± 1.16 (p = 0.77) respectively. POSE scores were 2.59 ± 1.71 v. 2.68 ± 1.62 (p = 0.86) and 1.74 ± 1.15 v. 1.95 ± 1.22 (p = 0.59). CONCLUSION The results of this study demonstrated no significant difference in healing, crusting, polyps, edema, or secretions between the triamcinolone treated and non-triamcinolone treated sinuses. There were no adverse effects from use of triamcinolone impregnated absorbable packing. Further studies will be necessary to determine the impact of triamcinolone impregnated absorbable packing following endoscopic sinus surgery. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Justin P McCormick
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Hong-Ho Yang
- Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Jivianne T Lee
- Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States of America
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Efficacy of triamcinolone acetonide-impregnated Gelfoam nasal pack in management of chronic sinusitis with nasal polyps following endoscopic sinus surgery: a perfectly matched, placebo-controlled trial study. Eur Arch Otorhinolaryngol 2021; 279:2915-2924. [PMID: 34559269 DOI: 10.1007/s00405-021-07071-2] [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: 07/24/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This perfectly matched, double-blinded, placebo-controlled trial study was performed to investigate the efficacy of triamcinolone acetonide (TAA)-impregnated Gelfoam nasal pack in management of different endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) following endoscopic sinus surgery (ESS). METHODS One hundred and four patients with bilateral CRSwNP undergoing ESS were selected and randomized to receive TAA-soaked nasal packing in one nostril and saline-impregnated dressing contra-laterally. Validated Perioperative Sinus Endoscopy (POSE) scoring system was used to assess the participants' condition at postoperative months 1, 3, 6, 12, and 18. RESULTS The treatment side of eosinophilic CRSwNP (EosCRSwNP) group had significantly better endoscopic scores than the contralateral control side in all follow-up visits (P < 0.05 for all comparisons) except for the first postoperative month. No significant difference was detected between the TAA- and saline-treated nostrils in the non-eosinophilic CRSwNP (nonEosCRSwNP) subgroup during the follow-up period. Intergroup comparisons revealed a borderline better POSE score for the treatment side of the EosCRSwNP group compared with the treatment nostril of the nonEosCRSwNP group at months 12 (P = 0.041) and 18 (P = 0.044). At the end of the study period, the treatment side of the EosCRSwNP group demonstrated better clinical response than the saline-treated side in terms of the total POSE scores (P = 0.019), middle turbinate synechia (P = 0.008), middle meatal narrowing (P = 0.010), ethmoid polypoid changes (P = 0.039), ethmoid polyposis (P = 0.027), ethmoid cavity secretions (P = 0.042), and sphenoid severity (P = 0.018). CONCLUSION TAA-soaked Gelfoam dressing following bilateral ESS was found to be an effective method for treating CRSwNP particularly for the eosinophilic endotype of the disease.
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Ali Akbari Ghavimi S, Gehret PM, Aronson MR, Schipani R, Smith KW, Borek RC, Germiller JA, Jacobs IN, Zur KB, Gottardi R. Drug delivery to the pediatric upper airway. Adv Drug Deliv Rev 2021; 174:168-189. [PMID: 33845038 DOI: 10.1016/j.addr.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
Pediatric upper airway disorders are frequently life-threatening and require precise assessment and intervention. Targeting these pathologies remains a challenge for clinicians due to the high complexity of pediatric upper airway anatomy and numerous potential etiologies; the most common treatments include systemic delivery of high dose steroids and antibiotics or complex and invasive surgeries. Furthermore, the majority of innovative airway management technologies are only designed and tested for adults, limiting their widespread implementation in the pediatric population. Here, we provide a comprehensive review of the most recent challenges of managing common pediatric upper airway disorders, describe the limitations of current clinical treatments, and elaborate on how to circumvent those limitations via local controlled drug delivery. Furthermore, we propose future advancements in the field of drug-eluting technologies to improve pediatric upper airway management outcomes.
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Kao YL, Huang YC, Tsai SC, Lai MT, Kang YN. Effects of implants with steroids after endoscopic sinus surgery: A systematic review with meta-analysis of randomized controlled trials. Int Forum Allergy Rhinol 2021; 11:1663-1675. [PMID: 34132058 DOI: 10.1002/alr.22850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/05/2021] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic rhinosinusitis affects approximately 5%-2% of the general population worldwide. Steroid implants after endoscopic sinus surgery (ESS) have drawn considerable interest for their cost savings, but relevant guidelines indicate that evidence on this topic is of low quality with high heterogeneity. The purpose of this study was to examine the efficacy of steroid implants after ESS by synthesizing relevant randomized controlled trials (RCTs). METHODS Two authors independently assessed the eligibility of potential references from five biomedical databases. They further extracted relevant data from the included studies, including (a) mean, standard deviation, or standard error for Lund-Kennedy endoscopic (LKE) score and Perioperative Sinus Endoscopy (POSE) score and (b) events and sample sizes of each group for further intervention. Data were pooled in a random-effects model, and results were presented as the weighted mean difference (WMD) or risk ratio (RR) with 95% confidence interval (CI) and I2 . RESULTS Eleven RCTs (n = 853) were included and showed that the steroid implant group had lower LKE scores (WMD, -1.19; 95% CI, -1.75 to -0.62; I2 = 0%) and POSE scores (WMD, -1.62; 95% CI, -2.47 to -0.76; I2 = 48%) than the placebo implant group at postoperative week 2. Moreover, the reoperation rate in the steroid implant group was also lower than in the placebo implant group (RR, 0.49; 95% CI, 0.30 to 0.80; I2 = 0%). However, no significant difference was observed in the postoperative oral steroid requirement between both groups. CONCLUSIONS Collectively, steroid implant decreases LKE and POSE among patients receiving ESS in the short term, but long-term effects remain unclear. Patient-based outcomes are worth further discussion in the future.
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Affiliation(s)
- Yi-Lin Kao
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chen Huang
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shao-Chen Tsai
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ming-Tang Lai
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-analysis Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Institute of Health Policy and Management, College of Public Health, Taipei, Taiwan
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Efficacy of Triamcinolone-Soaked Nasal Packing on Endoscopic Dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 2021; 37:S44-S47. [PMID: 32773515 DOI: 10.1097/iop.0000000000001791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the efficacy of triamcinolone-soaked nasal packing in endoscopic dacryocystorhinostomy (EDCR). METHODS Patients who underwent EDCR between September 2012 and August 2017 were included. They were assigned to triamcinolone (201 eyes) or control (206 eyes) group based on the order of surgery. Granulation occurrence and outcome were assessed at 3 and 6 months postoperatively, respectively. RESULTS The success rates were 94.3% (overall anatomical success), 90.4% (complete anatomical success), 92.1% (overall functional success), and 76.7% (complete functional success). The overall functional success rate was significantly higher in the triamcinolone group (95.0% vs. 89.3%, p = 0.033). The overall anatomical success rate (96.0% vs. 92.7%, p = 0.149) and complete functional success rate (79.6% vs. 73.8%, p = 0.166) were also higher in the triamcinolone group, but this difference was not statistically significant. Granulation occurred in 62 eyes (15.2%); the incidence was significantly lower in the triamcinolone group (10.0% vs. 20.4%, p = 0.003). CONCLUSION The authors suggest that use of triamcinolone-soaked nasal packing in EDCR is effective in significantly reducing the incidence of postoperative granulation and epiphora.
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Tai J, Lee K, Kim TH. Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis. Pharmaceutics 2021; 13:246. [PMID: 33578812 PMCID: PMC7916625 DOI: 10.3390/pharmaceutics13020246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic rhinosinusitis is an upper respiratory disease during which topical drug treatment via the nasal cavity is the most actively utilized therapeutic strategy. In addition to steroids, antibiotics, and antifungal agents, which are widely used in clinical practice, research on novel topical agents to improve the bacterial biofilm or mucociliary clearance remains ongoing. Moreover, owing to the complex structure of the nasal cavity, the effects of nasal drug delivery vary depending on factors related to delivery fluid dynamics, including device, volume, and compounds. In this article, we review methods and compounds that have been applied to chronic rhinosinusitis management and introduce recent advances and future perspectives in nasal drug delivery for upper respiratory diseases.
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Affiliation(s)
| | | | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea; (J.T.); (K.L.)
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Chen YC, Gad SF, Chobisa D, Li Y, Yeo Y. Local drug delivery systems for inflammatory diseases: Status quo, challenges, and opportunities. J Control Release 2021; 330:438-460. [PMID: 33352244 DOI: 10.1016/j.jconrel.2020.12.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
Inflammation that is not resolved in due course becomes a chronic disease. The treatment of chronic inflammatory diseases involves a long-term use of anti-inflammatory drugs such as corticosteroids and nonsteroidal anti-inflammatory drugs, often accompanied by dose-dependent side effects. Local drug delivery systems have been widely explored to reduce their off-target side effects and the medication frequency, with several products making to the market or in development over the years. However, numerous challenges remain, and drug delivery technology is underutilized in some applications. This review showcases local drug delivery systems in different inflammatory diseases, including the targets well-known to drug delivery scientists (e.g., joints, eyes, and teeth) and other applications with untapped opportunities (e.g., sinus, bladder, and colon). In each section, we start with a brief description of the disease and commonly used therapy, introduce local drug delivery systems currently on the market or in the development stage, focusing on polymeric systems, and discuss the remaining challenges and opportunities in future product development.
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Affiliation(s)
- Yun-Chu Chen
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA
| | - Sheryhan F Gad
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Dhawal Chobisa
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Integrated product development organization, Innovation plaza, Dr. Reddy's Laboratories, Hyderabad 500090, India
| | - Yongzhe Li
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning 110016, PR China
| | - Yoon Yeo
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.
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Zhang M, Ryan PJ, Shashinder S. Efficacy of Absorbable Steroid-Impregnated Nasal Packing in Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review. Laryngoscope 2021; 131:1704-1714. [PMID: 33393665 DOI: 10.1002/lary.29350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the efficacy of absorbable steroid-impregnated nasal packing on postoperative outcomes following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS). METHODS A systematic review of the literature was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twelve databases (including Journals@Ovid, Embase®, Medline®, EBM Reviews and Joanna Briggs Institute EBP Database) were searched using relevant keywords and expanded with corresponding MeSH/Emtree terms. Results were narrowed to English articles assessing the efficacy of absorbable packing impregnated with steroids post-production placed at time of surgery under general anesthetic, with hollow-lumen devices and devices inserted in-office excluded. RESULTS Eight studies met criteria and were included in this review. Five evaluated the efficacy of the intervention in only CRS with nasal polyposis (CRSwNP) patients, two included all subtypes of CRS, and one included only CRS without nasal polyposis (CRSsNP). Of the eight studies, four studied the efficacy of Nasopore®, three studied bioabsorbable gels, and one studied bioabsorbable calcium alginate. Four studies applied triamcinolone as the operative steroid, with the other studies utilizing betamethasone, budesonide, mometasone, and dexamethasone. Seven studies demonstrated statistically significant improvements in endoscopic outcomes using validated scoring scales, albeit at differing timepoints. The one study which included only CRSsNP patients failed to find a significant difference. CONCLUSION Steroid-impregnated nasal packing appears to have positive effects on postoperative endoscopic outcomes in CRSwNP patients undergoing FESS. Additional research is needed to evaluate the efficacy of these interventions in more recently defined subtypes of CRS, and whether these interventions differ in their efficacy in eosinophilic and non-eosinophilic CRS. Laryngoscope, 131:1704-1714, 2021.
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Affiliation(s)
- Michael Zhang
- Department of Otolaryngology, Head & Neck Surgery, Gosford Hospital, NSW Health-Central Coast Local Health District, Gosford, New South Wales, Australia.,School of Medicine and Public Health-Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter J Ryan
- Department of Otolaryngology, Head & Neck Surgery, Gosford Hospital, NSW Health-Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Singh Shashinder
- Department of Otolaryngology, Head & Neck Surgery, Gosford Hospital, NSW Health-Central Coast Local Health District, Gosford, New South Wales, Australia.,School of Medicine and Public Health-Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
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Kumarasamy G, Ramli RR, Singh H, Abdullah B. Tualang honey versus steroid impregnated nasal dressing following endoscopic sinus surgery: a randomized controlled trial. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 18:433-438. [PMID: 34187130 DOI: 10.1515/jcim-2020-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 07/09/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Recurrence rate of nasal polyps is high following endoscopic sinus surgery. To improve the surgical outcome, steroid impregnated nasal dressing is used postoperatively We aimed to compare the effect of Tualang honey impregnated nasal dressing with steroid impregnated nasal dressing on wound healing and surgical outcomes in post endoscopic sinus surgery patients. METHODS A prospective, randomized, controlled trial was carried out at two tertiary hospitals. 32 patients diagnosed with chronic rhinosinusitis and had underwent endoscopic sinus surgery were enrolled. The study group received 2 mL of Tualang honey nasal dressing and the control group received nasal dressing with 2 mL of triamcinolone 20 mg/mL as positive control. A 2 cm nasal dressing was placed longitudinally into the middle meatuses of both nasal cavities. Postoperative healing assessments of edema, crusting, secretions, scarring and symptoms were performed at postoperative day 7, 14, 28 and at 3 months using Sinonasal Outcome Test 22 questionnaire and modified Lund-Kennedy scoring system. RESULTS There were no significant differences noted in the scores of Sinonasal Outcome Test 22 and modified Lund-Kennedy at Day 7, 14 and 28 (p>0.05) for both groups. At 3rd month, patients in the triamcinolone group had lesser symptoms and better endoscopic findings (p<0.05). CONCLUSION Tualang honey is not as effective as steroid in achieving good wound healing and surgical outcomes in post endoscopic sinus surgery patients. Thus, it is not suitable as a substitute for steroid to reduce symptoms and prevent recurrence of disease.
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Affiliation(s)
- Guhan Kumarasamy
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ramiza Ramza Ramli
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Harvinder Singh
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Jalan Raja Ashman Shah, Ipoh, Perak, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Feng Z, Li M, Jin X, Zheng Y, Liu J, Zhao L, Wang Y, Li H, Zuo D. Design and characterization of plasticized bacterial cellulose/waterborne polyurethane composite with antibacterial function for nasal stenting. Regen Biomater 2020; 7:597-608. [PMID: 33365145 PMCID: PMC7748449 DOI: 10.1093/rb/rbaa029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
A nasal stent capable of preventing adhesions and inflammation is of great value in treating nasal diseases. In order to solve the problems of tissue adhesion and inflammation response, we prepared plasticized bacterial cellulose (BCG) and waterborne polyurethane (WPU) composite with antibacterial function used as a novel nasal stent. The gelation behavior of BCG could contribute to protecting the paranasal sinus mucosa; meanwhile, the WPU with improved mechanical property was aimed at supporting the narrow nasal cavity. The thickness, size and the supporting force of the nasal stent could be adjusted according to the specific conditions of the nasal. Thermogravimetric analysis, contact angle and water absorption test were applied to investigate the thermal, hydrophilic and water absorption properties of the composite materials. The composite materials loaded with poly(hexamethylene biguanide) hydrochloride maintained well antibacterial activity over 12 days. Animal experiments further revealed that the mucosal epithelium mucosae damage of BCG-WPU composite was minor compared with that of WPU. This new type of drug-loaded nasal stent can effectively address the postoperative adhesions and infections while ensuring the health of nasal mucosal, and thus has an immense clinical application prospects in treating nasal diseases.
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Affiliation(s)
- Zhaoxuan Feng
- School of Material Science and Engineering, University of Science and Technology Beijing, Beijing, China
| | - Minglu Li
- School of Material Science and Engineering, University of Science and Technology Beijing, Beijing, China
| | - Xing Jin
- Department of Otorhinolaryngology, Peking University Third Hospital, Beijing, China
| | - Yudong Zheng
- School of Material Science and Engineering, University of Science and Technology Beijing, Beijing, China
| | - Junxiu Liu
- Department of Otorhinolaryngology, Peking University Third Hospital, Beijing, China
| | - Liang Zhao
- Research Center for Bioengineering and Sensing Technology, University of Science and Technology Beijing, Beijing 100083, China
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Yansen Wang
- School of Material Science and Engineering, University of Science and Technology Beijing, Beijing, China
| | - Hao Li
- School of Material Science and Engineering, University of Science and Technology Beijing, Beijing, China
| | - Danlin Zuo
- School of Material Science and Engineering, University of Science and Technology Beijing, Beijing, China
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Lelegren MJ, Bloch RA, Lam KK. Intraoperative Applications of Topical Corticosteroid Therapy for Chronic Rhinosinusitis. EAR, NOSE & THROAT JOURNAL 2020; 100:320-328. [PMID: 33170026 DOI: 10.1177/0145561320970100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To provide an overview of recent techniques and technologies for the application of topical corticosteroid therapy immediately following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). METHODS A comprehensive search in the PubMed and Google Scholar databases was conducted to identify publications between January 2000 and December 2019 detailing clinical trials that have evaluated the efficacy and safety of intraoperative applications of topical corticosteroids for CRS. RESULTS A total of 21 articles, all of which highlight a variety of corticosteroid-infused products, including Propel corticosteroid-eluting stents, NasoPore, Merocel, SinuBand, calcium alginate, and bioresorbable gel-type products, are included for review. Propel stents are the only devices that have achieved level 1A evidence in terms of efficacy and have data to support their safety. The remaining products have shown mixed results in terms of efficacy and safety. CONCLUSION A wide range of techniques and technologies have been introduced to enhance the topical delivery of corticosteroids into the neosinuses after ESS for CRS. Regarding efficacy, there is level 1A evidence to support the use of Propel stents. Most of the remaining strategies show some degree of efficacy. Direct comparisons across the different strategies are limited owing to the varied uses of delivery vectors, corticosteroid choices, and doses of corticosteroids. Propel stents and SinuBand have sufficient data to support systemic and ocular safety, whereas the remaining products have limited data to support their safety.
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Affiliation(s)
- Matthew J Lelegren
- Department of Otolaryngology-Head & Neck Surgery, 6040Eastern Virginia Medical School, Norfolk, VA, USA
| | - Randall A Bloch
- Department of Otolaryngology-Head & Neck Surgery, 6040Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kent K Lam
- Department of Otolaryngology-Head & Neck Surgery, 6040Eastern Virginia Medical School, Norfolk, VA, USA
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Li W, Lu H, Wang H, Sun X, Wang D. Efficacy and safety of steroid-impregnated implants following sinus surgery: A meta-analysis. Laryngoscope 2019; 130:2754-2759. [PMID: 31755990 DOI: 10.1002/lary.28388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/13/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The purpose of this meta-analysis was to discuss the efficacy and safety of bioabsorbable steroid-impregnated implants following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) patients. METHODS PubMed, Cochrane, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were comprehensively searched for studies comparing the experimental group (bioabsorbable steroid-impregnated implants) with the control group (bioabsorbable nonsteroid-impregnated implants). Lund-Kennedy scores, Perioperative Sinus Endoscopy (POSE) scores, polyp change, significant adhesion, middle turbinate lateralization, and adverse events were extracted from the final eligible studies. RevMan 5.3 software was used to analyze the data. RESULTS Eight randomized controlled trials were included in our analysis. The experimental group showed no significant differences from the control group in Lund-Kennedy scores (weighted mean difference (WMD) -0.40; 95% confidence interval [confidence interval (CI)] -1.05 to -0.62; P = 0.23). The experimental group had lower POSE scores compared with the control group, and there was a significant difference (WMD -1.88; 95% CI -2.32 to -1.43, P < 0.00001). The pooled results also demonstrated significant differences in polyp change, significant adhesion, and middle turbinate lateralization between the two groups. In addition, there was no significant difference with respect to adverse events between the two groups (odds ratio (OR) 0.38; 95% CI: 0.07 to 2.03; P = 0.26). CONCLUSION Bioabsorbable steroid-impregnated implants following ESS are effective in improving the endoscopic appearance of the healing process, and the safety profile appears to be favorable for the treatment of CRS patients. LEVEL OF EVIDENCE 1A Laryngoscope, 2019.
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Affiliation(s)
- Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Hanyu Lu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Huan Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xicai Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
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Stefan MM, Rabie NA, Sobhy TS, Maarouf AM. Effect of steroid-releasing sinus implants after endoscopic sinus surgery (ESS) on postoperative outcomes: A meta-analytical study. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2019. [DOI: 10.4103/ejo.ejo_92_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized, double blind, placebo-controlled study. Braz J Otorhinolaryngol 2019; 85:473-480. [PMID: 29807811 PMCID: PMC9443042 DOI: 10.1016/j.bjorl.2018.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Endoscopic sinus surgery can lead to crusting or synechiae formation, which can affect the healing process. Objective The aim of our study was to compare the influence of steroid versus antibiotic versus saline solution impregnated absorbable nasal spacers on postoperative wound healing and patient satisfaction. Methods Eighty patients, 33 women and 47 men, were enrolled in this study. At the end of the surgery, two pieces of 4 cm biodegradable material were applied in each ethmoid cavity. One of them was impregnated with saline solution, while the second one with steroid, or with antibiotic. Results We observed statistically significant differences in the Lund–Kennedy score between the control and both treatment groups: for the Antibiotic-group on days 10 and 30 (p = 0.009; p = 0.009) and for the Steroid-group on day 90 (p = 0.008). The extended endoscopic appearance of nasal mucosa indicated statistically significant differences in crust formation on day 10 comparing the steroid and control dressing (p = 0.025), in secretion type on days 10 and 30 comparing the antibiotic and control dressing (p = 0.003; p = 0.016) and additionally for steroid and control on day 90 (p = 0.046). On Day 90 we observed statistically significant differences in the absence of mucosal edema in the S-group compared to controls (p = 0.007). Conclusions The results of this study reveal the significant positive influence of steroid- and antibiotic-impregnated biodegradable nasal packing on the postoperative healing process and patient satisfaction compared to the saline soaked dressing.
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Effects of Bupivacaine Versus Bupivacaine Plus Dexamethasone-Soaked Nasal Packing After Endoscopic Nasal Surgery. J Craniofac Surg 2019; 30:1174-1177. [DOI: 10.1097/scs.0000000000005227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Differential effects of postoperative oral corticosteroid on eosinophilic vs. non-eosinophilic CRSwNP subtypes. Am J Otolaryngol 2019; 40:22-29. [PMID: 30249374 DOI: 10.1016/j.amjoto.2018.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/02/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE The efficacy of postoperative oral corticosteroids on surgical outcomes in chronic rhinosinusitis with nasal polyps (CRSwNP) patients following endoscopic sinus surgery (ESS) remains controversial. This study evaluated the potential benefits of postoperative oral corticosteroids on surgical outcomes in CRSwNP patients and investigated the differential effects on eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (NECRSwNP). MATERIALS AND METHODS Patients with bilateral CRSwNP who underwent ESS were enrolled and randomized to receive either oral prednisolone (30 mg/day) or placebo for 2 weeks after surgery. Visual analog scale (VAS) and Sino-Nasal Outcome Test 22 (SNOT-22) scores were chosen as the subjective outcomes, evaluated at preoperative baseline and 1, 3, and 6 months postoperatively. Lund-Kennedy Endoscopic Scores (LKESs) were used as the objective outcome, evaluated at preoperative baseline and at 2 weeks and 2, 3, and 6 months postoperatively. RESULTS In total, 100 patients with bilateral CRSwNP were enrolled, of whom only 82 completed the 6-month follow-up. The subjective outcomes showed no significant difference at each follow-up points. Of the objective outcomes, the corticosteroid group reporting a trend of improvement in LKESs at 6 months postoperatively (p = 0.05). After stratification by tissue eosinophils, only patients with NECRSwNP (<10 eosinophils/HPF) demonstrated a significant improvement in LKESs at 3 months postoperatively (p = 0.03). CONCLUSIONS Postoperative oral corticosteroids did not provide additional improvements in VAS and SNOT-22 scores; nevertheless, a trend of LKES improvement was noted at 6 months postoperatively. After stratification by tissue eosinophils, this effect was significant only among NECRSwNP patients at 3 months follow-up.
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Hudon MA, Wright ED, Fortin-Pellerin E, Bussieres M. Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized controlled trial. J Otolaryngol Head Neck Surg 2018; 47:67. [PMID: 30409178 PMCID: PMC6225688 DOI: 10.1186/s40463-018-0313-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/09/2018] [Indexed: 01/03/2023] Open
Abstract
Background Chronic rhinosinusitis (CRS) affects up to 16% of the population. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. The value of resecting the middle turbinate to optimize surgical outcomes has been hypothesized but remains controversial and unproven. Whether the middle turbinate should be left in place or resected is controversial. Our objective is to determine if middle turbinectomy improves objective surgical outcomes after ESS. Methods Sixteen patients (15 men, 15 primary surgery) undergoing bilateral complete ESS for CRS with nasal polyposis were recruited. Nasal cavities were randomized so that middle turbinectomy was performed on one side while the middle turbinate was preserved on the other. Each participant acted as their own control. Nasal cavities were compared using Perioperative Sinus Endoscopy (POSE) and Lund-Kennedy (LKES) scores pre-operatively, and at 1, 3 and 6 months after ESS. Results were analyzed using Wilcoxon signed-rank test. Results Pre-operatively, the POSE (12.4 ± 2.9 vs 12.8 ± 2.6, p = 0.33, for the preserved side and the resected side, respectively) and LKES (5.0 ± 1.0 vs 4.8 ± 1.2, p = 0.33) scores were similar between sides. During follow up, resection was associated with more crusting at 1 month following ESS (1.0 ± 0.7 vs 0.4 ± 0.6, p = 0.02). There was a small, but statistically significant, difference between the nasal cavities at 3 months, where the resected side showed better endoscopic appearance (2.0 ± 2.2 vs 3.4 ± 2.8, p = 0.01). No difference was found at 6 months. Frontal sinus scores were similar between sides at 6 months (0.7 ± 0.5 vs 0.7 ± 0.5, p = 1.00). Conclusion Our results show no sustained objective endoscopic benefit of routine middle turbinectomy, at least within the first six postoperative months, in patients undergoing primary ESS for CRS with polyposis. Trial registration NCT, NCT02855931. Registered 16 August 2016.
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Affiliation(s)
- Marc-Antoine Hudon
- Université de Sherbrooke, 580 Rue Bowen S, Sherbrooke, QC, J1G 2E8, Canada
| | - Erin D Wright
- University of Alberta, Room 1E4, W.C.M. Health Sciences Centre, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | | | - Marie Bussieres
- Université de Sherbrooke, 580 Rue Bowen S, Sherbrooke, QC, J1G 2E8, Canada.
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Zhao KQ, Yu YQ, Yu HM. Effects of mometasone furoate-impregnated biodegradable nasal dressing on endoscopic appearance in healing process following endoscopic sinus surgery: a randomized, double-blind, placebo-controlled study. Int Forum Allergy Rhinol 2018; 8:1233-1241. [PMID: 30281941 DOI: 10.1002/alr.22213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/27/2018] [Accepted: 08/31/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Postoperative care is an important factor affecting the outcome of endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). The aim of this study was to test the effect of mometasone furoate (MF)-soaked biodegradable nasal dressings (BNDs) on endoscopic appearance in CRS patients with nasal polyps (CRSwNP) after ESS. METHODS This study was a prospective, randomized, double-blinded, placebo-controlled study. A total of 64 CRSwNP patients with bilateral ESS were enrolled and randomly given 4 mL or 8 mL of MF-soaked BNDs (NasoPore) in 1 nasal cavity and the same amount of normal saline-soaked BNDs in the contralateral side. The BNDs were removed on the 7th or 14th postoperative day. Perioperative sinus endoscopy (POSE) and Lund-Kennedy scores were collected, on the 7th or 14th postoperative days and at 1, 2, and 3 postoperative months. RESULTS The POSE and Lund-Kennedy scores showed that in the 4-mL, 1-week group, no significant differences between the sides treated with MF-soaked BNDs and the normal saline-soaked control were observed at any postoperative visits. In the 4-mL, 2-week group, significant differences were found at the 2-week and 1-month postoperative visits but not at the 2-month and 3-month visits. In the 8-mL, 1-week group, significant differences were found at the 1-week, 1-month, and 2-month postoperative visits but not at the 3-month visit. In the 8-mL, 2-week group, significant differences were found at all postoperative visits. CONCLUSION This study reveals that MF-impregnated BNDs improve the endoscopic appearance in the healing process of CRSwNP after ESS.
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Affiliation(s)
- Ke-Qing Zhao
- Department of Otorhinolaryngology and Head and Neck Surgery, Eye & ENT Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, PR China
| | - Yi-Qun Yu
- Department of Otorhinolaryngology and Head and Neck Surgery, Eye & ENT Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, PR China
| | - Hong-Meng Yu
- Department of Otorhinolaryngology and Head and Neck Surgery, Eye & ENT Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, PR China
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Konno W, Kashiwagi T, Tsunemi Y, Goto K, Haruna S. Long-term postoperative control of eosinophilic chronic rhinosinusitis recurrence by inserting a steroid-eluting, sinus-bioabsorbable device reduces the dosage of oral steroid. Auris Nasus Larynx 2018; 46:365-373. [PMID: 30241892 DOI: 10.1016/j.anl.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/01/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We employed a steroid-eluting, sinus-bioabsorbable device for local treatment after surgery for eosinophilic chronic rhinosinusitis (ECRS). One year later, we investigated its efficacy in suppressing recurrence and reducing the use of oral steroids. METHODS At one year after ECRS surgery, both 18 cases treated with a postoperative steroid-eluting, sinus-bioabsorbable device (Post-ST group) and 25 cases receiving conventional postoperative therapy (Post-Con group) showed significant improvement in the nasal symptoms (nasal obstruction, nasal discharge and olfactory dysfunction), CT score and threshold test (discrimination test). RESULTS The olfactory dysfunction, CT score and threshold test were significantly improved in the Post-ST group compared with the Post-Con group, but the polyp score was not. The mean total number of oral steroid tablets ingested during one year after surgery was 24.3±2.8 tablets in the Post-ST group, which was significant lower than the 36.3±3.7 tablets used in the Post-Con group. CONCLUSION The above results indicate that insertion of a steroid-eluting, sinus-bioabsorbable device after ECRS surgery can reduce the oral steroid intake while maintaining long-term suppression of disease recurrence.
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Affiliation(s)
- Wataru Konno
- Department of Otorhinolaryngology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Tochigi 321-0293, Japan
| | - Takashi Kashiwagi
- Department of Otorhinolaryngology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Tochigi 321-0293, Japan
| | - Yasuhiro Tsunemi
- Department of Otorhinolaryngology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Tochigi 321-0293, Japan
| | - Kazuki Goto
- Department of Otorhinolaryngology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Tochigi 321-0293, Japan
| | - Shinichi Haruna
- Department of Otorhinolaryngology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Tochigi 321-0293, Japan.
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The Effect of Dexpanthenol-Vitamin A (Nazalnem) on Silastic Splints After Nasal Septal Surgery. J Craniofac Surg 2018; 28:2139-2142. [PMID: 28938325 DOI: 10.1097/scs.0000000000003983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the effect of dexpanthenol-vitamin A (Nazalnem) ointment applied to the surface of silastic splints with an airway immediately after nasal septal surgery on postoperative complaints and nasal mucosa function. MATERIALS AND METHODS The study enrolled 60 patients undergoing nasal septoplasty surgery. Group 1 (n = 30) received silastic splints with ointment containing dexpanthenol-vitamin A (Nazalnem), and Group 2 (n = 30), the control group, received silastic splints with vaseline. Of these patients, 2 patients from the Group 1 and 9 from the Group 2 were excluded.A thin layer of ointment was applied to the flat side of a silastic splint with an airway. The splints were removed on the second postoperative day. Patients were evaluated preoperatively and 1 and 2 weeks postoperatively using a visual analog scale and the Sino-Nasal Outcome test (SNOT-22). Mucociliary clearance (MCC) tests were performed at the same times. RESULTS Visual analog scale for nasal crusting, nasal congestion, and foul odor was better in Group 1 than in Group 2 both at 1 week and at 2 weeks postoperatively (P < 0.05).The SNOT scores were significantly lower in Group 1 than in Group 2 at 1 week (P < 0.01), but did not differ at 2 weeks postoperatively (P > 0.05).Postoperatively, the MCC were insignificant between the groups and within the groups at 1 and 2 weeks (P > 0.05). CONCLUSION Although Dexpanthenol-Vitamin A ointment had no direct effect on wound healing, it had significant effects on crusting, obstruction, and foul smell. However, silastic splints with dexpanthenol did not improve the MCC of the nose.
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Song SH, Lee KH. The Clinical Effects of Triamcinolone-soaked Nasal Packing on Endonasal Dacryocystorhinostomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.4.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seok Hyeon Song
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
- Myunggok Medical Research Institute, Konyang University, Daejeon, Korea
| | - Ka Hyun Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
- Myunggok Medical Research Institute, Konyang University, Daejeon, Korea
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Patel VS, Walgama E, Psaltis A, Lavigne F, Pletcher SD, Hwang PH. Biocompatibility and Pharmacokinetics of Fluticasone-Eluting Sinus Implant in a Rabbit Model. Am J Rhinol Allergy 2017; 31:382-388. [DOI: 10.2500/ajra.2017.31.4481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background A novel, bioabsorbable, fibrinogen-based implant has been developed as a mucosal dressing after endoscopic sinus surgery (ESS). This implant can be formulated with fluticasone propionate (TP) for local elution of corticosteroid to reduce postoperative inflammation and promote mucosal healing. Objective This study investigated the biocompatibility and pharmacokinetics of the implant in a rabbit model. Methods Implants with and without TP were placed on both intact and demucosalized maxillary sinuses of 33 New Zealand White rabbits. Sinuses with either intact or denuded bone without implants acted as controls. Histopathologic assessments were carried out at 5, 15, and 28 days. Concentrations of TP in the maxillary sinus mucosa, nasal cavity mucosa, and plasma were measured for up to 44 days. Results Implants placed on intact mucosa or denuded bone were grossly integrated within 15 days. Minimal foreign body reaction was seen with negligible differences for inflammation, fibrosis, or bone remodeling among controls, sinuses with the implant, or sinuses with the implant plus TP, at all time points. All samples also showed complete or near-complete percentage reepithelialization at 28 days, although the denuded bone controls demonstrated greater percentage reepithelialization at 5 days compared with denuded bone with the implant or implant plus TP (p <0.0001). The maxillary sinus mucosa demonstrated levels of TP of >140 ng/g up to 44 days. Plasma concentrations of TP were generally very low and were undetectable after day 7. Conclusions The implant and the implant plus TP seemed to be biocompatible in rabbits. The implant plus TP effectively eluted steroid locally over at least 44 days, with negligible plasma concentrations. Further studies are warranted regarding potential therapeutic applications in patients undergoing ESS for chronic rhinosinusitis.
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Affiliation(s)
- Vishal S. Patel
- Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Evan Walgama
- Department of Otolaryngology—Head and Neck Surgery, Cedars-Sinai, Los Angeles, California
| | - Alkis Psaltis
- Department of Otolaryngology—Head and Neck Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia
| | - Francois Lavigne
- Department of Otolaryngology—Head and Neck Surgery, Université de Montreal, Montreal, Quebec, Canada
| | - Steven D. Pletcher
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, California Presented at the American Rhinologic Society Spring Meeting, San Diego, CA
| | - Peter H. Hwang
- Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Yoo F, Ference EH, Kuan EC, Lee JT, Wang MB, Suh JD. Evaluation of patient nasal saline irrigation practices following endoscopic sinus surgery. Int Forum Allergy Rhinol 2017; 8:32-40. [DOI: 10.1002/alr.22034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Frederick Yoo
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Elisabeth H. Ference
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Edward C. Kuan
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Jivianne T. Lee
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Marilene B. Wang
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
| | - Jeffrey D. Suh
- Department of Head and Neck Surgery; University of California Los Angeles; Los Angeles CA
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Hwang CS, Al Sharhan SS, Kim BR, Kim SI, Kim JW, Cho HJ, Yoon JH, Kim CH. Randomized controlled trial of steroid-soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery. Laryngoscope 2017; 128:311-316. [PMID: 28940582 DOI: 10.1002/lary.26871] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the potential efficacy of steroid-soaked, absorbable calcium alginate nasal packing following endoscopic sinus surgery. STUDY DESIGN Prospective, randomized, single-blinded, placebo-controlled trial. METHODS Twenty-two patients (44 nostrils) who had chronic rhinosinusitis with polyps underwent bilateral endoscopic sinus surgery. Only those with an intersinus difference in Lund-Mackay severity score of 1 or less were included. In each patient, one randomly selected nostril was packed with calcium alginate soaked with 2 mL of triamcinolone (40 mg/mL) (triamcinolone group), whereas the contralateral nostril received an identical packing soaked in 2 mL of normal saline (saline group). Two independent investigators blinded to the packing allocation scored the surgical field using the validated Perioperative Sinus Endoscopy (POSE) scores 1, 4, and 8 weeks after surgery. RESULTS All 44 nostrils were analyzed; the Lund-Mackay scores did not differ significantly between the groups before surgery. Eight weeks after surgery, the total POSE scores were significantly lower in the triamcinolone group (P = .014). The POSE scoring parameters were then compared between groups, and the following variables were significantly different: middle turbinate synechiae with the lateral wall (P = .037), polypoid degeneration of the ethmoid cavity (P = .006), and sphenoid sinus severity (P = .036). CONCLUSIONS This study demonstrated that steroid-soaked, absorbable nasal packing can be used to enhance wound healing after endoscopic sinus surgery and to prevent polypoid changes in the nasal mucosa. LEVEL OF EVIDENCE 1b. Laryngoscope, 128:311-316, 2018.
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Affiliation(s)
| | - Salma Saud Al Sharhan
- Department of Otorhinolaryngology, Imam Abdulrahman Bin Faisal University and King Fahd Hospital, Dammam, Saudi Arabia
| | - Bo Ra Kim
- Research Center for Human Natural Defense System, Seoul, South Korea
| | - Soo In Kim
- Research Center for Human Natural Defense System, Seoul, South Korea
| | - Jin Woong Kim
- Department of Otorhinolaryngology, Seoul, South Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Seoul, South Korea.,Research Center for Human Natural Defense System, Seoul, South Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Seoul, South Korea.,Research Center for Human Natural Defense System, Seoul, South Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Seoul, South Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
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Hauser LJ, Turner JH, Chandra RK. Trends in the Use of Stents and Drug-Eluting Stents in Sinus Surgery. Otolaryngol Clin North Am 2017; 50:565-571. [DOI: 10.1016/j.otc.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Adriaensen GFJPM, Lim KH, Fokkens WJ. Safety and efficacy of a bioabsorbable fluticasone propionate-eluting sinus dressing in postoperative management of endoscopic sinus surgery: a randomized clinical trial. Int Forum Allergy Rhinol 2017; 7:813-820. [PMID: 28558147 DOI: 10.1002/alr.21963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative wound healing after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS) is an important factor in procedural success. Local steroids and separation of opposing mucosa are commonly implemented to optimize healing. A bioabsorbable, fluticasone propionate (FP)-eluting implant, SinuBand FP, was assessed for its safety and efficacy when used in patients with CRS and nasal polyps, who were indicated for ESS including bilateral anterior and posterior ethmoidectomy. METHODS A first-in-human, randomized, partially double-blind, single-tertiary-referral-center, controlled trial enrolling 30 patients receiving 2 of 3 treatments (1 per sinus, intrapatient control): SinuBand FP, SinuBand (without FP), or standard nasal pack (Merocel®). Primary outcome measures were local safety, ocular safety (intraocular pressure [IOP], lens opacity), and 24-hour urine cortisol. Secondary measures (evaluated by independent review of postoperative video endoscopies) were ethmoid inflammation, polyp score, adhesion formation, and Lund-Kennedy score. Patient-reported outcomes of postoperative pain, nasal congestion, and nasal discharge were collected. RESULTS Of 30 enrolled patients (used for safety analysis), 27 patients completed the trial. SinuBand FP showed local safety, ocular safety, and no significant change in 24-hour urine cortisol. SinuBand FP showed a trend to do better concerning inflammation. Concerning polyp score SinuBand FP did significantly better compared to Merocel (p = 0.03). No significance compared to SinuBand without corticosteroids (p = 0.97). Adhesions were comparable across treatments. Patient reported pain was nominally lower in the SinuBand group. CONCLUSION SinuBand FP was well tolerated and showed evidence of efficacy. A larger study is needed to further evaluate and confirm the benefits of SinuBand FP.
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Affiliation(s)
- Gwijde F J P M Adriaensen
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Keng-Hua Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Sabarinath V, Harish MR, Divakaran S. Triamcinolone Impregnated Nasal Pack in Endoscopic Sinus Surgery: Our Experience. Indian J Otolaryngol Head Neck Surg 2017; 69:88-92. [PMID: 28239586 PMCID: PMC5305642 DOI: 10.1007/s12070-016-1041-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022] Open
Abstract
The selection of an effective packing method to prevent postoperative complications and recurrence following Endoscopic Sinus Surgery remains ambiguous at present. This study was conducted to evaluate the efficacy of Triamcinolone impregnated nasal pack in Endoscopic Sinus Surgery, in the prevention of postoperative crusting, edema, infection and recurrence. This study was an interventional randomized placebo-controlled study, conducted at a tertiary care centre in South India between February 2015 and May 2016, after getting approval from Institute Ethical Committee. 75 patients with bilateral chronic rhinosinusitis undergoing Endoscopic Sinus Surgery were selected for the study. After surgery, each patient was randomized to receive Polyvinyl Acetal (Merocel) nasal pack soaked with Triamcinolone to one side, while the contralateral side was packed with Merocel soaked with saline. Incidence of postoperative crusting, edema, polypoidal change and mucosal discharge was evaluated using the Endoscopic Staging System at 1st and 2nd weeks and at 1st and 3rd months of surgery. A significant reduction in mucosal edema was observed in the test group at all stages of follow up (p values <0.05). Incidence of crusting was found to be significantly lower in the test group (p values <0.05) except at 3 months (p value >0.05). However, there was no significant difference in the occurrence of polypoidal change and mucosal discharge between the groups. Triamcinolone impregnated nasal pack is an effective method to reduce the incidence of early postoperative complications following Endoscopic Sinus Surgery.
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Affiliation(s)
- V. Sabarinath
- Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry India
| | - M. R. Harish
- Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry India
| | - Shilpa Divakaran
- Pondicherry Institute of Medical Sciences, Kalapet, Puducherry India
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Bury S, Singh A. Evaluation of a steroid releasing sinus implant for the treatment of patients undergoing frontal sinus surgery for chronic rhinosinusitis. Expert Rev Med Devices 2017; 14:93-101. [PMID: 28092201 DOI: 10.1080/17434440.2017.1281740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Management of the frontal sinus places great demands on the otolaryngologist. Given that the fronto-ethmoidal region is susceptible to recurrent inflammation, scarring, and stenosis, maintaining long-term patency of the frontal sinus is a difficult challenge. Oral and topical anti-inflammatory therapy, post-operative stenting, and 'home-brew' drug elution have been used for the treatment of the frontal sinus with mixed success. Recently an implant has been approved for post-operative placement into the frontal recess. This implant provides reliable and consistent steroid drug elution to address inflammation of the frontal recess secondary to chronic sinusitis. Areas covered: This review discusses the development and application of steroid eluting implants in the postoperative care of patients with chronic frontal sinusitis. All randomized controlled trials evaluating steroid eluting implants are discussed. Relevant supporting material discussing background, economics, safety are included. Expert commentary: Steroid eluting implants fulfill a unique niche in the treatment following frontal sinus surgery. They are shown to decrease the need for post-operative interventions and improve outcomes in patients with chronic sinusitis. There is significant potential for growth in the use of steroid eluting implants.
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Affiliation(s)
- Sean Bury
- a Division of Otolaryngology , George Washington University , Washington , DC , USA
| | - Ameet Singh
- a Division of Otolaryngology , George Washington University , Washington , DC , USA
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Jung YH, Lee KH. Effects of Triamcinolone-soaked Packing for Endonasal Revision in Patients with Failed Endoscopic Dacryocystorhinostomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.5.586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Young Hoon Jung
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Ka Hyun Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
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41
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Michael P, Farid M, Kwok M, O'Leary S. Routine nasal packing versus no nasal packing following functional endoscopic sinus surgery. Hippokratia 2016. [DOI: 10.1002/14651858.cd011587.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Philip Michael
- Royal Victorian Eye and Ear Hospital/University of Melbourne; Department of Otolaryngology; 32 Gisborne Street Melbourne Australia 3122
| | | | - Matthew Kwok
- Western Hospital; Department of Otolaryngology; Melbourne Australia
| | - Stephen O'Leary
- Royal Victorian Eye and Ear Hospital/University of Melbourne; Department of Otolaryngology; 32 Gisborne Street Melbourne Australia 3122
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Varshney R, Lee JT. Current trends in topical therapies for chronic rhinosinusitis: update and literature review. Expert Opin Drug Deliv 2016; 14:257-271. [PMID: 27500891 DOI: 10.1080/17425247.2016.1214563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) affects millions of patients worldwide. The disease is multifactorial with influences including anatomic factors, immunological disturbances, and altered sinonasal microbiome. Although oral medications are effective in controlling some symptoms, they are associated with side effects and long-term use is not ideal. Thus, topical therapies have emerged as an alternative delivery method for localized, high-concentration medication with less side effects. Areas covered: This is a review of the various topical therapies available or under investigation for the management of CRS. Common medications such as saline, steroids, and antimicrobials will be discussed. Furthermore, additives including manuka honey, xylitol, surfactant, N-chlorotaurine, Dead Sea salt, and sodium hyaluronate will be addressed. Innovations in topical therapies, such as drug-eluting biomaterials and photodynamic therapy, will also be reviewed. Expert opinion: Although topical therapies provide a high dose of active substance at the site of disease, their efficacy in CRS is not clear. Topical saline and intranasal steroids appear to consistently demonstrate therapeutic benefits. However, other topical medications require further investigation to determine long-term clinical efficacy and safety. A better understanding of their effects on the sinonasal mucociliary system is needed before they become the standard of care in CRS.
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Affiliation(s)
- Rickul Varshney
- a Orange County Sinus Institute , Southern California Permanente Medical Group , Irvine , CA , USA
| | - Jivianne T Lee
- a Orange County Sinus Institute , Southern California Permanente Medical Group , Irvine , CA , USA.,b Department of Head & Neck Surgery , David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
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Effects of triamcinolone-impregnated nasal dressing on subjective and objective outcomes following endoscopic sinus surgery. Eur Arch Otorhinolaryngol 2016; 273:4351-4357. [PMID: 27363407 DOI: 10.1007/s00405-016-4185-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
The aim of this study was to compare the effects of triamcinolone (TA)- and saline-soaked biodegradable nasal dressing on subjective symptoms, wound healing and improvement of olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) after undergoing endoscopic sinus surgery (ESS). The study was a prospective, randomized, double-blinded, placebo-controlled study. A total of 80 patients undergoing bilateral ESS for CRSwNP were enrolled and randomly assigned to two groups. Nasal dressing was impregnated with normal saline in the control group, while patients received triamcinolone-impregnated dressing in the TA group. Sino-Nasal Outcome Test 20 (SNOT-20) and Korean Version of the Sniffin' Stick (KVSS) II test were used to assess the patients' condition preoperatively and at postoperative 1 and 3 months. Lund-Kennedy (L-K) and perioperative sinus endoscopy (POSE) scores were assessed on postoperative months 1, 2, and 3. There were significant differences between the control group and the TA group in terms of postoperative L-K scores and POSE scores at 1 and 2 months. The postoperative endoscopic scores were significantly decreased in the TA group compared to the control at 1 month. Olfactory functions were significantly improved at postoperative 3 months (p = 0.0099) compared to the preoperative score in the TA group. Significant improvement in the olfactory functions among anosmic and hyposmic patients at postoperative 1 month (p = 0.0475) and 3 months (p = 0.0019) compared to their preoperative olfactory function score was observed only in the TA group. TA-impregnated dressing had a significant advantage over saline-soaked dressing with regard to postoperative wound healing and improvement of olfactory function.
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Massey CJ, Suh JD, Tessema B, Gray ST, Singh A. Biomaterials in Rhinology. Otolaryngol Head Neck Surg 2016; 154:606-17. [DOI: 10.1177/0194599815627782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 12/30/2015] [Indexed: 11/15/2022]
Abstract
Introduction Many different kinds of rhinologic biomaterials, both nonabsorbable and absorbable, have been developed over the years to improve outcomes following endoscopic sinus surgery (ESS) for patients with chronic rhinosinusitis. In particular, these products have been designed to prevent postoperative bleeding, optimize the wound healing process, and reduce inflammation. This review evaluates the most recent evidence on biomaterials used in rhinology, focusing on these outcomes after ESS. Data Sources MEDLINE, Scopus, Google Scholar, and Clinicaltrials.gov. Review Methods A primary literature search based on the listed databases was performed with combinatorial search terms. Studies were considered for review if they met a set of inclusion and exclusion criteria. Conclusions Some products have performed better than others in clinical trials, although significant heterogeneity among studies does not allow for selection of a clearly superior biomaterial. While nonabsorbable biomaterials are still effective in achieving certain outcomes, newer, absorbable substances may be just as effective and avoid the morbidity associated with nasal packing removal. Steroid-eluting biomaterials have shown promising early results in reducing inflammation and promoting wound healing. Implications for Practice Certain absorbable biomaterials, such as chitosan gel and fibrin glue, have performed well with respect to postoperative hemostasis and wound healing, although they do not address mucosal inflammation. Steroid delivery systems may play an increasingly important role in reducing disease recurrence after ESS, although more studies are needed to assess long-term outcomes.
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Affiliation(s)
- Conner J. Massey
- Division of Otolaryngology, George Washington University, Washington, DC, USA
| | - Jeffrey D. Suh
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Belachew Tessema
- Division of Otolaryngology–Head and Neck Surgery, Connecticut Sinus Center, University of Connecticut, Farmington, Connecticut, USA
| | - Stacey T. Gray
- Department of Otology and Laryngology, Harvard Medical School, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ameet Singh
- Division of Otolaryngology, George Washington University, Washington, DC, USA
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Effect of a Chitosan-Based Biodegradable Middle Meatal Dressing after Endoscopic Sinus Surgery: A Prospective Randomized Comparative Study. SINUSITIS 2015. [DOI: 10.3390/sinusitis1010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lee SH. Mechanisms of Glucocorticoid Action in Chronic Rhinosinusitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 7:534-7. [PMID: 26333699 PMCID: PMC4605925 DOI: 10.4168/aair.2015.7.6.534] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/20/2015] [Accepted: 03/30/2015] [Indexed: 01/27/2023]
Abstract
The innate immune system and its complex interplay with the adaptive immune system are increasingly being recognized as important factors in the pathogenesis of chronic rhinosinusitis (CRS). Adaptive immune components, including resident and inflammatory cells, and their associated mediators, have been the subject of most research in CRS. For this reason, theories of CRS pathogenesis have involved the concept that inflammation, rather than infection, is the dominant etiologic factor in CRS. Therefore, glucocorticoids are increasingly used to treat CRS. This review will outline our current knowledge of action mode of glucocorticoids in CRS.
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Affiliation(s)
- Sang Hag Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea.
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Antisdel JL, Meyer A, Comer B, Jang D, Gurrola J, Khabbaz E, Christopher K, Kountakis S. Product comparison model in otolaryngology: Equivalency analysis of absorbable hemostatic agents after endoscopic sinus surgery. Laryngoscope 2015; 126 Suppl 2:S5-13. [PMID: 26509639 DOI: 10.1002/lary.25678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evidence-based medicine in otolaryngology literature continues to be lacking, especially with regard to new products brought to market. The marketing of products often includes statements of benefit that have limited objective support in research or literature. To address this, and to adequately determine product equivalency/superiority, careful evaluation must be made. In order to establish standards for this process in rhinology products, we directly compare three different absorbable hemostatic agents in patients with chronic rhinosinusitis (CRS) after undergoing endoscopic sinus surgery (ESS), using both objective and subjective outcomes. STUDY DESIGN Double-blinded prospective (level 1) comparison and equivalency analysis of three plant-based absorbable hemostatic agents (carboxymethylcellulose [CMC] gel, mucopolysaccharide hemospheres (MPH), and potato starch wafer) in patients undergoing bilateral ESS. METHODS Patients with medically refractory CRS who underwent bilateral ESS were recruited and prospectively followed. At the conclusion of ESS, one of three different hemostatic agents was applied to each nasal passage. Subjective patient data was obtained using rated symptoms compared between the two sides (nasal obstruction, bleeding, pain, and nasal discharge) at baseline and on postoperative days 1, 7, and 14. Objective data was obtained by blinded endoscopic scoring to rate mucosal edema, inflammation, granulation, crusting, infection, and synechiae formation on postoperative weeks 1, 3, and 6. RESULTS Forty-eight patients who underwent ESS for CRS were included. There is no statistical difference in subjective scores for any of the variables measured, although (MPH) nearly reached statistical significance at postoperative day 7 for increased pain (P = 0.06) and obstruction (P = 0.22). Objective measures showed equivalency between all products, except the CMC gel approached significance at week 3 for increased crusting (P = 0.10), granulation (P = 0.24), and debridement (P = 0.07). At 6 weeks, increased debridement (P = 0.14) also approached significance. CONCLUSION Careful and deliberate consideration should be taken when choosing products to assist our surgical endeavors. Subjectively, patients treated with MPH showed near-significant increases in pain and obstruction. In objective measures, CMC gel nearly reaches significance for more postoperative debridement, with increased crusting and inflammation. Product choice could consider these factors, although it remains at the discretion of the surgeon. This model of comparison allows careful product comparison and should be applied to other hemostatics, as well as other materials in use in otolaryngology. LEVEL OF EVIDENCE 1b. Laryngoscope, 126:S5-S13, 2016.
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Affiliation(s)
- Jastin L Antisdel
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri
| | - Annika Meyer
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri
| | - Brett Comer
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - David Jang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Duke University, Durham, North Carolina
| | - Jose Gurrola
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - Eyad Khabbaz
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kara Christopher
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri
| | - Stilianos Kountakis
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, U.S.A
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Chen PG, Wormald PJ, Payne SC, Gross WE, Gross CW. A golden experience: Fifty years of experience managing the frontal sinus. Laryngoscope 2015; 126:802-7. [PMID: 26393824 DOI: 10.1002/lary.25648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The frontal sinus is one of the most anatomically complex and inaccessible of the paranasal sinuses. As a result, surgeons have continually tried to improve surgical management of the frontal sinus. The senior author (c.w.g.) shares 50 years of experience managing the frontal sinus. DATA SOURCES PubMed literature search. REVIEW METHODS Review of the literature regarding landmark innovations in frontal sinus surgery. RESULTS Open approaches established that the frontal sinus is accessible, and in certain circumstances, such as with large osteoma or papilloma, are still required. The endoscope changed the surgical landscape and allowed for greater finesse and decreased morbidity. Sinus balloon dilation is the newest change in frontal sinus management and shows promise in properly selected cases. CONCLUSION Surgery of the frontal sinus continues to evolve and improve. Although there are new techniques, the older techniques are still pertinent.
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Affiliation(s)
- Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio (p.g.c.), San Antonio, Texas
| | - Peter-John Wormald
- Department of Otolaryngology-Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Spencer C Payne
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - William E Gross
- Murfreesboro Clinic Otolaryngology, Murfreesboro, Tennessee, U.S.A.; and
| | - Charles W Gross
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
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Matheny KE. Bioabsorbable steroid-releasing sinus implants in the frontal and maxillary sinuses: 2-year follow-up. ALLERGY & RHINOLOGY 2015; 6:118-21. [PMID: 26302732 PMCID: PMC4541632 DOI: 10.2500/ar.2015.6.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively. Outcomes have not yet been studied when these implants are utilized in other paranasal sinuses after ESS. Objective: To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS. Methods: 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations. In July, 2012, during revision left frontal sinusotomy and right maxillary antrostomy (the fifth ESS), two bioabsorbable steroid-releasing implants were placed in the left frontal recess and the right maxillary sinus respectively and followed clinically, endoscopically, and radiographically for two years. Results: Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis. Conclusions: The steroid-releasing implants during the critical phase of wound-healing appear to have allowed the patient, now over two years postoperatively, to achieve a healthier state and to allow more successful management than the preceding 15–20 years.
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