Increased Risk of Nasal Septal Abscess After Septoplasty in Patients with Type 2 Diabetes Mellitus

Prophylactic antibiotics in septoplasty with intranasal septal splints: A comparative analysis

OBJECTIVES

Postoperative antibiotic therapy is a common practice following septoplasty with intra-septal splints placement (ISS), even though there is a lack of evidence to support it. We sought to investigate the role of antibiotic therapy in septal surgeries with the placement of ISS.

DESIGN

A retrospective comparative study was conducted using the electronic charts of adult patients who underwent septoplasty with the placement of ISS with or without turbinate reduction. Nasal cultures were taken routinely during surgery as part of the department's protocol for monitoring infectious diseases. The ISS were also routinely examined for the presence of bacteria after their removal on the eighth day following surgery.

SETTING

A large otolaryngology department in a tertiary medical center.

PARTICIPANTS

Adult patients who underwent septoplasty in our institution.

MAIN OUTCOME MEASURES

We analyzed all post-operative infections to search for risk factors in the cohort.

RESULTS

Post-operative infection rates following septoplasty with ISS were low at 6%, which is consistent with previously published rates. Infection rates were significantly higher in patients who were not treated with antibiotics (OR = 8.2, 95%CI: 1.63-41.1; p = .01, φ = 0.04). Diabetes was associated with an increased risk of postoperative infection regardless of prophylactic antibiotic therapy (OR = 5.2, 95%CI: 1.15-23.5; p = .032, φ = .04). The detection of Klebsiella pneumonia before surgery was associated with an increased rate of postoperative infection (OR = 16.6, 95%CI: 3.02-91.54; p = .001, φ = 0.12).

CONCLUSIONS

Patients undergoing septoplasty with the placement of ISS are at increased risk of gram-negative bacterial colonisation, and development of postoperative nasal infection. A single preoperative dose of IV antibiotic therapy should be considered a potential prophylactic option for septoplasty with ISS.

Nasal septal abscess in adult patients - A single center study

PURPOSES

The purpose of this study was to present and analyze the etiologic factors, clinical manifestations, bacteriology, and treatment outcomes of nasal septal abscess in a large cohort of adult patients.

MATERIAL AND METHODS

Retrospective analysis.

RESULTS

36 adult patients, age from 19 to 85 (mean age, 51.83), with nasal septal abscesses were treated at Ear Nose Throat Hospital of Ho Chi Minh City from January 2020 to August 2022. The most common symptoms were nasal obstruction (75 %), headache/facial pain (58.33 %). Etiologic factors were found in 83.33 % of cases with the most common were diabetes mellitus (47.22 %), nose-picking (44.44 %). 75 % of cases had positive bacterial culture, of which 70.37 % were Staphylococcus aureus. Septal abscess was successfully treated in all cases using our treatment protocol, which involved an extended modified Killian's incision, irrigation with 1 % poviodine, placement of gauze in the abscess pocket, and nasal packing with Merocels.

CONCLUSIONS

Diabetes and nose-picking were the most common etiologic factors; Staphylococcus aureus was the most common organism of nasal septal abscess in our study. Our treatment protocol is safe and effective.

The Bacterial Compositions of Nasal Septal Abscess in Patients with or without Diabetes

The nasal septal abscess (NSA) is a rare but potentially fatal disease causing intracranial infection. Treatments for NSA include antibiotics, surgical incision and drainage. Diabetes mellitus (DM) is a risk factor for NSA. Therefore, we assessed the pathogenic bacterial composition of NSA in diabetic patients. We analyzed the Chang Gung Memorial Hospital database to collect 79 NSA patients who received surgical incisions and drainage from 2004 to 2015. We divided them into DM and non-DM groups for analysis. We integrated the bacteria cultured from each patient, listed the top three with the highest frequency and divided the bacterial species into facultative anaerobes or aerobes and anaerobes. The microbiological cultures revealed mono-microbial infection in most of the cases. The top three facultative anaerobes or aerobes with the highest frequency of NSA-DM were Klebsiella pneumoniae (37.5%), methicillin-sensitive Staphylococcus aureus (MSSA; 25%) and methicillin-resistant Staphylococcus aureus (MRSA; 12.5%). The top three for NSA-non-DMs were MSSA (24%), MRSA (20%) and Pseudomonas aeruginosa (16%). The top three anaerobes causing NSA were Prevotella intermedia (25%), Peptostreptococcus species (12.5%) and Propionibacterium acnes (12.5%) in DM patients. The top three in non-DM patients were P. intermedia (25%), P. acnes (16.7%) and Fusobacterium nucleatum (12.5%). When treating NSA in diabetic patients, clinicians should choose empirical antibiotics for K. pneumoniae and P. intermedia, and when treating patients with NSA-non-DM, MSSA and P. intermedia should be considered first.

Unusual Causes of Nasal Septal Abscess Including a COVID-19 Swab Test After Nasal Surgery

A nasal septal abscess is a rare lesion that usually results from a nasal septal hematoma after nasal trauma or surgery, although it can occur unexpectedly. Nasal septal abscesses should be prevented and treated immediately. The authors describe 2 unusual cases: 1 caused by sudden loosening of the quilting suture of the nasal septum and the other by a nasopharyngeal swab test for coronavirus disease-2019. The authors also provide an intraoperative video and a literature review.

Nasal septal abscess following septoplasty in a patient with type 2 diabetes mellitus

A man in his 50s with type 2 diabetes mellitus (T2DM) presented with a nasal septal abscess 3 weeks following septoplasty. Diabetes mellitus has been reported in association with nasal septal abscess, thought to be due to a relative immunodeficient state. We present an unusual, delayed presentation of nasal septal abscess following septoplasty and performed a literature review. Nasal septal abscess is rare. It is associated with significant complications if not diagnosed and management expediently. The association between T2DM and nasal septal abscess following septoplasty emphasises the importance of good perioperative blood sugar control and postoperative nasal care and raises the question of empirical antibiotics in this group.

Analysis of patient- and procedure-related risk factors for nasal septal perforations following septoplasty

OBJECTIVES

To assess the possible relationship between various predictive factors (patient or surgery related) and the development of nasal septal perforations (NSP) with the help of a large study group.

METHODS

One hundred and forty-three patients were included in the study. The presence of the following factors was evaluated and compared between the NSP and healthy group: types of surgeries, presence of unilateral or bilateral mucosal tears, concomitant inferior turbinate interventions, smoking, accompanying diabetes mellitus (DM) or allergic rhinitis (AR), types of nasal packings, duration of the surgery (minutes), and the experience of the surgeon (senior/junior). Nasal septal deviations were grouped into two: simple cartilage crests at the septum base and other-more complicated-deviations.

RESULTS

NSP was detected in six (4.2%) patients after a mean follow-up of 9.3 ± 3.7 (min: 6 max: 14) months. None of these patients suffered from (AR) or DM. Four of these patients had unilateral and one patient had bilateral mucosal tears during the surgeries. None of the above-mentioned factors-including mucosal tears, type of the deviation or experience of the surgeon-had a significant effect on NSP.

CONCLUSION

Untreated bilateral corresponding mucosal tears are the main cause of NSP. When immediately repaired, unilateral or bilateral tears do not affect the development of NSP significantly. Patient-related factors such as age, DM, smoking, AR, and procedure-related factors such as duration, the complexity of the septal deviation, type of the nasal packing, and experience of the surgeon also do not have a significant effect on NSP.

A Case Report of Spontaneous Nasal Septal Abscess in a Child

We describe a case of spontaneous nasal septal abscess (NSA) in a 9-year-old child. We also reviewed the literatures in recent years and summarized the characteristics of NSA, such as gender, age, inducement, pathogenic bacteria, treatment, and prognosis. We found that this boy reported by us has the most extensive abscess. May be the delay of treatment was related to the recent fluctuation of COVID-19 epidemic in China. Fortunately, with the help of surgery and anti-infection treatment, the boy was discharged from the hospital without septal perforation or saddle nose.