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Wang M, Sun P, Zhang J, Li D, Liu Y, Xia Y, Shao L, Jia M. Intelligent and biocompatible cellulose aerogels featured with high-elastic and fast-hemostatic for epistaxis and wound healing. Int J Biol Macromol 2024; 277:134239. [PMID: 39074712 DOI: 10.1016/j.ijbiomac.2024.134239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/07/2024] [Accepted: 07/26/2024] [Indexed: 07/31/2024]
Abstract
Nasal tamponade is a commonly employed and highly effective treatment method for preventing nasal bleeding. However, the current nasal packing hemostatic materials exhibit some limitations, such as low hemostatic efficiency, the potential for causing secondary injury when removed from the nasal cavity, limited intelligence in their design, and an inability to promote the healing of nasal mucosa wounds. Herein, we report the fabrication of a smart cellulose aerogel through the covalent cross-linking of carboxymethyl cellulose (CMC) macromolecules, while incorporating one-dimensional cellulose nanofibers (CNF) and two-dimensional MXene as reinforcing network scaffolds and conductive fillers. The abundant hydrogen and ether bonds in aerogels make them possess high elasticity in both dry and wet states, which can be compressed 100 times at 90 % deformation with a stress loss of <10 % under water. The highly elastic aerogels can be filled into the narrow nasal passages, pressuring the capillaries and reducing the amount of bleeding. Moreover, the strong interface between aerogels and blood can promote red blood cell aggregation, platelet adhesion and activation, activate intrinsic coagulation pathway and accelerate blood coagulation, resulting in excellent hemostatic ability. Furthermore, the aerogels exhibit excellent hemocompatibility and cytocompatibility, making them suitable for wound healing and capable of fully healing wounds within 15 days. Notably, the presence of MXene causes the aerogels to form a conductive network when exposed to blood, enabling them to perform real-time hemostatic monitoring without removing the dressing. This innovative biomedical aerogel, prepared from natural materials, shows excellent potential for applications in rapid nasal hemostasis.
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Affiliation(s)
- Meng Wang
- State Key Laboratory of Biobased Material and Green Papermaking, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, PR China; Advanced Materials Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, PR China.
| | - Peipei Sun
- Advanced Materials Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, PR China
| | - Jing Zhang
- Advanced Materials Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, PR China
| | - Dongwei Li
- Advanced Materials Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, PR China
| | - Yuhua Liu
- Advanced Materials Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, PR China
| | - Yiran Xia
- Shandong Success Biotechnology Co., Ltd, Jinan 250353, PR China
| | - Lupeng Shao
- State Key Laboratory of Biobased Material and Green Papermaking, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, PR China
| | - Mengying Jia
- State Key Laboratory of Biobased Material and Green Papermaking, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, PR China; School of Municipal and Environmental Engineering, Shandong Jianzhu University, Jinan 250101, PR China.
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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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Tochigi K, Ebihara T, Omura K, Aoki S, Takeda T, Otori N, Tanaka Y. Nasal Packing Materials and Placement Duration on Wound Healing in Nasal Mucosa: An Animal Study. Laryngoscope 2024; 134:562-568. [PMID: 37409795 DOI: 10.1002/lary.30865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE The histological findings of wound healing depending on different nasal packing materials and replacement periods were lacking. METHODS Mucosal defects were created in the nasal septum of rabbits and covered with Spongel®, Algoderm®, or Nasopore®, which were cleaned on Day 14. To investigate the effect of replacement durations, Spongel® was removed on Days 3 and 7. All nasal septal specimens were collected on Day 28. Samples without packing material were prepared as controls. Depending on residual packing materials in the regenerated tissue, specimens were classified into the remnant and non-remnant groups, and morphology was compared using epithelium grade score and subepithelial thickness. RESULTS The epithelium grade score in the Spongel-14d group was lower than that in the other groups (p < 0.05). Subepithelial thickness was higher in the Algoderm-14d and Spongel-14d groups (p < 0.05). Epithelium grade scores were higher and subepithelial thicknesses were lower in the Spongel-3d and -7d groups than in the Spongel-14d group. Epithelium grade score was lower and subepithelial thickness was higher in the remnant group (n = 10) than in the non-remnant group (n = 15; p < 0.05). CONCLUSIONS Differences in packing materials and placement durations affected wound healing of nasal mucosa. The selection of appropriate packing materials and replacement duration was considered essential for ideal wound healing. LEVEL OF EVIDENCE NA Laryngoscope, 134:562-568, 2024.
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Affiliation(s)
- Kosuke Tochigi
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Teru Ebihara
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Omura
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Aoki
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Teppei Takeda
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiro Tanaka
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Kraimer K, Geltzeiler M. Skull Base Reconstruction by Subsite after Sinonasal Malignancy Resection. Cancers (Basel) 2024; 16:242. [PMID: 38254733 PMCID: PMC10813932 DOI: 10.3390/cancers16020242] [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: 10/24/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Reconstruction after the resection of sinonasal malignancies is complex and primarily dependent on the defect size and location. While the reconstructive paradigm for sellar mass resection is well delineated, the challenges associated with reconstruction after sinonasal malignancy resection are less well described. This narrative review will address the goals of reconstruction after both endonasal endoscopic and open sinonasal malignancy resection and reconstructive options specific to these subsites. The goals of reconstruction include repairing cerebrospinal fluid leaks, restoring sinonasal function, providing a nasal airway, and optimizing the patient's quality of life. These goals are often complicated by the anatomic nuances of each involved sinus. In this review, we will discuss the methods of reconstruction specific to each sinonasal subsite and describe the factors that guide choosing the optimal reconstructive technique.
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Affiliation(s)
| | - Mathew Geltzeiler
- Department of Otolaryngology—Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA
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Devarakonda AK, Falco JJ, Kountakis SE, Reyes C. Topical nasal medication distribution: A cadaver-based simulated quantitative method. Int Forum Allergy Rhinol 2023; 13:1539-1541. [PMID: 36409548 DOI: 10.1002/alr.23105] [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: 10/09/2022] [Accepted: 10/26/2022] [Indexed: 07/25/2023]
Affiliation(s)
- Aditya K Devarakonda
- Augusta University, Department of Otolaryngology - Head and Neck Surgery, Augusta, Georgia, USA
| | - Jeffrey J Falco
- Augusta University, Department of Otolaryngology - Head and Neck Surgery, Augusta, Georgia, USA
| | - Stilianos E Kountakis
- Augusta University, Department of Otolaryngology - Head and Neck Surgery, Augusta, Georgia, USA
| | - Camilo Reyes
- Augusta University, Department of Otolaryngology - Head and Neck Surgery, Augusta, Georgia, USA
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Cheng MZ, Saraswathula A, Qureshi HA, Mukherjee D, Rowan NR. Otolaryngology Considerations of Pituitary Surgery: What an Endocrinologist Should Know. J Endocr Soc 2023; 7:bvad058. [PMID: 37313347 PMCID: PMC10259068 DOI: 10.1210/jendso/bvad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Indexed: 06/15/2023] Open
Abstract
Endoscopic endonasal skull base surgery is the preferred surgical approach for the management of pituitary adenomas. Perioperative management of pituitary lesions requires multidisciplinary care and typically includes a dual surgeon team consisting of a neurosurgeon and an otolaryngologist. The involvement of the otolaryngologist allows for a safe surgical approach with excellent intraoperative visualization of the tumor to enable an effective resection of the tumor by the neurosurgeon. Detection and treatment of sinonasal pathology is essential prior to surgery. Patients may experience sinonasal complaints following endoscopic transsphenoidal surgery, although this is typically temporary. Sinonasal care in the postoperative period can expedite recovery to baseline. Here we discuss the perioperative factors of endoscopic pituitary surgery that endocrinologists should be aware of, ranging from preoperative patient selection and optimization to postoperative care, with a particular emphasis on anatomic and surgical factors.
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Affiliation(s)
- Michael Z Cheng
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Anirudh Saraswathula
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Hannan A Qureshi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Nicholas R Rowan
- Correspondence: Nicholas R Rowan, MD, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, 601 N Caroline St, 6th floor, Baltimore, MD 21287, USA.
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Behr W, Li H, Birk R, Nastev A, Kramer B, Klein S, Stuck BA, Birk CE. Impact of Bepanthen ® and dexpanthenol on human nasal ciliary beat frequency in vitro. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07916-y. [PMID: 36920556 DOI: 10.1007/s00405-023-07916-y] [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: 01/29/2023] [Accepted: 03/05/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Dexpanthenol-containing ointments/fluids are recommended to restore impaired nasal mucosa. To date, there are no data about the influence of dexpanthenol or formulations including dexpanthenol on ciliary beat frequency (CBF) of nasal epithelial cells. METHODS We tested the ciliary beat frequency of human nasal epithelial cells in RPMI 1640 cell solution using in vitro high-frequency video microscopy every 60 s over a period of 15 min (min). Bepanthen® solution and dexpanthenol in two clinically relevant concentrations (1.67% and 3.33%) were added to the cells. Addition of sterile water served as control group. To get a better overview, the measurements after 1 min, 5 min and 15 min were combined. RESULTS The CBF in the control group (n = 17) after 15 min was 7.3 ± 2.6 Hz. In comparison, the CBF after 15 min was 1.8 ± 1.0 Hz in the 3.33% Bepanthen® group (n = 17) and 3.2 ± 1.2 Hz in the 1.67% group, which was statistically significantly lower in both groups (p < 0.001). With regard to the dexpanthenol group (n = 17) a CBF of 6.0 ± 2.6 Hz with 3.33% and 6.1 ± 2.4 Hz with 1.67% dexpanthenol, was detected, which was again statistically significantly lower (p = 0.06) compared to the control group except CBF at 15 min with 1.57% (n = 17; p = 0.04). In general, the effect on CBF was less pronounced with dexpanthenol compared with Bepanthen® with a statistically significant difference between the two formulations. The results were verified by calculating an analysis of variance (ANOVA). CONCLUSIONS Bepanthen® as an ointment, solution or inhalation is commonly used in ENT for mucosal care. Our results have shown that both substances reduce CBF in clinically relevant concentrations, although the effect was more pronounced with Bepanthen® compared to dexpanthenol solution, which could be related to additives or change of physical properties in the solution. Further research is needed to assess potential clinical relevance.
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Affiliation(s)
- Wieland Behr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | - H Li
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldinger Straße, 35043, Marburg, Germany
| | - R Birk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldinger Straße, 35043, Marburg, Germany
| | - A Nastev
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldinger Straße, 35043, Marburg, Germany
| | - B Kramer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldinger Straße, 35043, Marburg, Germany
| | - S Klein
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldinger Straße, 35043, Marburg, Germany
| | - B A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldinger Straße, 35043, Marburg, Germany
| | - C E Birk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldinger Straße, 35043, Marburg, Germany
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Shaikh Z, Mishra A, Chadaram S, Preetam C, Biswas R, Adhikari A, Alagappan A, Parida PK, Pradhan P, Samal DK, Mahakud S, Hallur V, Nayak A, Das KK, Chakraborty S, Sharma P, Veetil AK, Karakkandy V, Mittal Y, Chithambaram KS, Swarup A, Chenniappan S, Shah A. To evaluate the efficacy of topical anti-fungal therapy in postoperative cases of COVID Associated Mucormycosis (CAM): A single-blinded randomized control trial. Am J Otolaryngol 2023; 44:103702. [PMID: 36521349 DOI: 10.1016/j.amjoto.2022.103702] [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: 07/18/2022] [Revised: 09/30/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare the efficacy of 0.1 % w/w Liposomal Amphotericin-B gel with 10 % w/w Povidone-Iodine and saline nasal douching in preventing revision surgery in patients with CAM. STUDY DESIGN Multi-arm, parallel randomized control trial. STUDY SETTING The trial was conducted in the Department of ENT, All India Institute of Medical Sciences (AIIMS) Bhubaneswar. METHODS Participants: Microbiologically and histologically proven cases of mucormycosis who underwent surgical debridement were included in the study. INTERVENTIONS Postoperatively, patients were randomized into three groups based on the type of topical intervention received, in the form of Lipid-based Amphotericin B gel, povidone‑iodine ointment or saline nasal douching. OUTCOME Requirement of revision surgery in postoperative cases of CAM. RANDOMIZATION Participants were allotted to one of the three arms by block randomization. BLINDING Single-blinded trial. RESULTS Numbers randomized: 15 participants were randomized to each group. Recruitment: Completed recruiting. Numbers analyzed: 15 participants were analyzed in each group. OUTCOMES Control arm's risk of revision surgery was 4.50 (95 % CI: 1.16-17.44) times than Lipid-based Amphotericin B gel arm and 1.50 (95 % CI: 0.71-3.16) times that of the Povidone- Iodine arm. The difference was statistically significant (p = 0.02) for Amphotericin but not for Povidone-Iodine. CONCLUSIONS Topical Amphotericin-B gel application in the postoperative cavity can decrease the need for revision surgery and help in early recovery. TRIAL REGISTRATION CTRI/2021/10/037257. Clinical Trials Registry of India.
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Affiliation(s)
- Zaid Shaikh
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Abhijeet Mishra
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Srinivas Chadaram
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Chappity Preetam
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Reetika Biswas
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Asutosh Adhikari
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Alamelu Alagappan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradipta K Parida
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradeep Pradhan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Dillip Kumar Samal
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sudipta Mahakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vinay Hallur
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anindya Nayak
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Krishna Kinkar Das
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Swagata Chakraborty
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prity Sharma
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Vinusree Karakkandy
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Yash Mittal
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Anurita Swarup
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Swathi Chenniappan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anwer Shah
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
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Numano Y, Nomura K, Hemmi T, Ikeda R, Kakuta R, Sugawara M. The Factors Related to the Time for Sinus Debridement after Functional Endoscopic Sinus Surgery - A Retrospective Study. Ann Maxillofac Surg 2023; 13:49-52. [PMID: 37711532 PMCID: PMC10499281 DOI: 10.4103/ams.ams_6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/16/2023] [Accepted: 07/03/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Post-operative care after functional endoscopic sinus surgery (FESS) is essential for managing the long-term success of chronic rhinosinusitis. Post-operative sinus debridement promotes proper wound healing, but the procedure can be accompanied by discomfort and pain. Hence, we analysed the clinical factors related to sinus debridement time after FESS. Materials and Methods We evaluated retrospectively the clinical factors affecting the time taken for post-operative sinus debridement on the first visit after the discharge. We reviewed 101 patients who underwent FESS at our hospital by the same surgeon and extracted patient information. The time for post-operative sinus debridement at the first outpatient clinic was measured. Results The days of putting the cotton ball in the operated nostril were negatively associated with sinus debridement time (coefficient - -16.4 ± 5.7 seconds/day, P = 0.005). In contrast, current or history of asthma, amount of bleeding during the surgery, number of opened sinuses by the operation or the number of eosinophils in resected tissues under a microscope at ×400 was not associated. Discussion We recommend the use of a cotton ball in the nostril after FESS because it shortens the sinus debridement time. Placing cotton balls in the nostril helps to maintain a humid wound environment and reduce crusting, leading to easier sinus debridement and better wound healing.
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Affiliation(s)
- Yuki Numano
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
| | - Tomotaka Hemmi
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University Hospital, Iwate, Japan
| | - Risako Kakuta
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Mitsuru Sugawara
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
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Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After Surgery. J Craniofac Surg 2023; 34:83-91. [PMID: 35968948 DOI: 10.1097/scs.0000000000008893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/04/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To identify key recommendations for maximizing the efficiency and efficacy of perioperative care in transsphenoidal pituitary surgery. METHODS The authors performed a comprehensive literature search of Enhanced Recovery After Surgery protocols implemented for patients undergoing transsphenoidal adenomectomy (TSA); individual recommendations were abstracted, and the evidence base thoroughly reviewed. RESULTS The authors identified 19 individual recommendations pertinent to the care of patients undergoing TSA, which were subdivided into preoperative (n=6), intraoperative (n=6), and postoperative (n=7) interventions. Key factors recommended for minimizing length of stay, preventing readmission, and improving patient outcomes included comprehensive patient education, multidisciplinary evaluation, avoidance of routine lumbar drain placement and nasal packing, and rigorous postoperative monitoring of pituitary function and salt-water imbalances. The overall level of evidence for 7/19 (37%) implemented recommendations was found to be low, suggesting a need for continued research in this patient population. CONCLUSION Several key interventions should be considered in the development of Enhanced Recovery After Surgery protocols for TSA, which may aid in further decreasing length of stay and promoting positive patient outcomes.
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Liu R, Gong Z. Effect of chitosan-based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps: A meta-analysis. Int Wound J 2022; 19:2146-2153. [PMID: 35524493 DOI: 10.1111/iwj.13820] [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: 04/02/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
A meta-analysis was performed to evaluate the effect of chitosan-based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps. A systematic literature search until March 2022 incorporated 386 subjects after endoscopic sinus surgery of nasal polyps at the beginning of the study; 187 were using chitosan-based gel dressing, and 199 were control. Statistical tools like the dichotomous method were used within a random or fixed-influence model to establish the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the influence of chitosan-based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps. Chitosan-based gel dressing had significantly lower wound infection (OR, 0.48; 95% CI, 0.25-0.92, P = 0.03), and synechia (OR, 0.25; 95% CI, 0.13-0.50, P < 0.001) compared with control in subjects with endoscopic sinus surgery of nasal polyps. However, no significant difference was found in granulations between chitosan-based gel dressing and control in subjects with endoscopic sinus surgery of nasal polyps. Chitosan-based gel dressing had significantly lower wound infection, synechia compared with control in subjects with endoscopic sinus surgery of nasal polyps, and no significant difference in granulations. Further studies are required to validate these findings.
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Affiliation(s)
- Ruyang Liu
- E.N.T. Department, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Zheng Gong
- E.N.T. Department, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
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12
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Gordon A, Benedict P, Marcus S, Kingery M, Lebowitz RA, Lieberman SM. Postoperative antibiotic use in patients with unilateral purulent chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2021; 6:641-645. [PMID: 34401484 PMCID: PMC8356854 DOI: 10.1002/lio2.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/08/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe our experience with the use of postoperative antibiotics in the management of unilateral chronic rhinosinusitis (CRS) patients with active infection at the time of surgery, and to evaluate the need for routine postoperative antibiotic administration in this population. METHODS This retrospective chart review analyzed the medical records of all patients who underwent endoscopic sinus surgery for unilateral purulent CRS between November 2013 and September 2019 at a tertiary care center and who were not prescribed routine postoperative antibiotics. Duration of time until normalization of sinus cavities and whether antibiotics were ultimately prescribed for persistent infectious signs and symptoms were recorded. Patient characteristics and findings were analyzed to determine if any of the evaluated parameters were associated with the need for postoperative antibiotics. RESULTS Sixty-nine patients were included in the study. Thirty-three (47.8%) did not require antibiotics during the postoperative period. The average time to sinus normalization was 8.1 weeks (range 1-24 weeks) for patients who received antibiotics and 5.7 weeks (range 1-16 weeks) for those who did not receive antibiotics (P = .066). No evaluated variables were associated with antibiotic use on univariate or multivariate analysis. CONCLUSION Postoperative antibiotics were not necessary to normalize infected sinus cavities for nearly half of patients with unilateral purulent CRS in this series. Further studies are needed to better delineate which patients would derive benefit from postoperative antibiotics. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Alex Gordon
- NYU Langone Medical Center, Department of Otolaryngology‐Head and Neck SurgeryNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Peter Benedict
- NYU Langone Medical Center, Department of Otolaryngology‐Head and Neck SurgeryNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Sonya Marcus
- Stony Brook Medicine, Department of SurgeryDivision of Otolaryngology‐Head and Neck SurgeryStony BrookNew YorkUSA
| | - Matthew Kingery
- NYU Langone Medical Center, Department of Otolaryngology‐Head and Neck SurgeryNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Richard A. Lebowitz
- NYU Langone Medical Center, Department of Otolaryngology‐Head and Neck SurgeryNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Seth M. Lieberman
- NYU Langone Medical Center, Department of Otolaryngology‐Head and Neck SurgeryNew York University Grossman School of MedicineNew YorkNew YorkUSA
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13
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Tsai T, Shih LC, Lee IT, Ng TY, Wang JY, Hsu CL, Bau DAT, Tai CJ. Older Age Is Associated With Better Compliance With Follow-up in Taiwan After Functional Endoscopic Sinus Surgery. In Vivo 2021; 34:2571-2576. [PMID: 32871786 DOI: 10.21873/invivo.12074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM Functional endoscopic sinus surgery (FESS) is frequently conducted for restoring sinus ventilation and function. Postoperative care is critical for success. However, loss to follow-up is disturbing. The specific aim of this study was to identify critical factors contributing to loss of patients to follow-up and how to improve it. PATIENTS AND METHODS A total of 221 patients with chronic rhinosinusitis undergoing FESS were enrolled. Patients were divided into three groups according to their follow-up after surgery: Less than 1 month (short-term), 1-3 months (medium-term) and more than 3 months (long-term). The gender, age, smoking status, comorbidities, laterality, Lund-Mackay score, 22-question Sinonasal Outcome Test, nasal obstruction Visual Analogue Scale and mucociliary clearance were evaluated for their contribution to better compliance in follow-up. RESULTS The results revealed that older patients had better compliance in follow-up compared with younger ones (p=0.0093). Other factors were not contributory (p>0.05). CONCLUSION In contrast to the US, older patients in Taiwan have better compliance in postoperative follow-up, while younger ones require more education on the importance of follow-up.
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Affiliation(s)
- Tammy Tsai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Liang-Chun Shih
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C
| | - Ivan T Lee
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Teik-Ying Ng
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C.,School of Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, R.O.C
| | - Che-Lun Hsu
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - DA-Tian Bau
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C. .,Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, R.O.C.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, R.O.C
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C. .,School of Medicine, China Medical University, Taichung, Taiwan, R.O.C.,Department of Health Services Administration, China Medical University, Taichung, Taiwan, R.O.C
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14
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Kühnel TS, Hosemann WG, Weber R. [Postoperative treatment following paranasal sinus surgery]. HNO 2021; 69:517-528. [PMID: 33942126 DOI: 10.1007/s00106-021-01057-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Postoperative care is a crucial aspect for the success of paranasal sinus interventions. Basic procedures include saline nasal wash, which should be started on the first postoperative day, topical steroids, and antibiotics in cases of infection. Medical treatment involves aspiration of secretion in the inferior meatus during the first week. Removal of scabs in the surgical field should be carried out under endoscopic control beginning at the second week. Intervals are scheduled individually. Occlusion of the nose for the time of epithelium regeneration provides a moist space in the ethmoid, which improves wound healing.
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Affiliation(s)
- Thomas S Kühnel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Werner G Hosemann
- Fachbereich HNO, Helios Hanseklinikum Stralsund, Große Parower Straße 47, 18435, Stralsund, Deutschland
| | - Rainer Weber
- HNO-Klinik, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Deutschland
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15
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Omani MA, Crepy-Ameil M, Grinholtz-Haddad J, Zaer S, Benkhatar H. Development of a New Device for Postoperative Self-Irrigation of the Maxillary and Frontal Sinus. EAR, NOSE & THROAT JOURNAL 2021; 102:239-243. [PMID: 33645265 DOI: 10.1177/0145561320983942] [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: 11/17/2022] Open
Abstract
OBJECTIVES Nasal saline irrigation is the corner stone of postoperative care after functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS). However, intrasinus penetration of the saline solution can be challenging and may require difficult head position, particularly for the frontal sinus. Our aim was to evaluate a novel device for direct intrasinus self-irrigation, usable at home for both maxillary and frontal sinus. METHODS Thirty devices were implemented in 23 patients: in the maxillary sinus for 18 patients and in the frontal sinus for 5 patients. The device was removed after 7 days on average (5-10 days), and nasal saline irrigation was carried on with a squeeze bottle for 6 weeks. Retrospective evaluation of the device included: device-related complication, patient satisfaction, and ostial or middle turbinate synechiae at 3 months. RESULTS No device-related complication (obstruction, displacement, infection, bleeding) occurred. Twenty-one (91.3%) patients were satisfied with the device. Two patients required the help of a nurse for irrigation. No ostial of middle turbinate synechiae was visualized at 3 months. This new endonasal device enables direct intrasinus self-irrigation after FESS for CRS. CONCLUSION This preliminary study showed that this device is safe and easy to use. However, further investigations are required to assess its potential role to reduce the risk of synechiae and revision surgery.
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Affiliation(s)
- Mohammad Al Omani
- 26938Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Marie Crepy-Ameil
- 26938Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Julia Grinholtz-Haddad
- 26938Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Saïd Zaer
- 26938Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Hakim Benkhatar
- 26938Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
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16
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Gao Z, Matin F, Weber C, John S, Lenarz T, Scheper V. High Variability of Postsurgical Anatomy Supports the Need for Individualized Drug-Eluting Implants to Treat Chronic Rhinosinusitis. Life (Basel) 2020; 10:life10120353. [PMID: 33348668 PMCID: PMC7766873 DOI: 10.3390/life10120353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 01/21/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a common disease in the general population that is increasing in incidence and prevalence, severely affecting patients’ quality of life. Medical treatment for CRS includes self-management techniques, topical and oral medical treatments, and functional endoscopic sinus surgery (FESS). FESS is a standard procedure to restore sinus ventilation and drainage by physically enlarging the inflamed sinus passageways. Nasal drug-releasing stents are implanted to keep the surgically expanded aperture to the sinus frontalis open. The outcome of such an intervention is highly variable. We defined the anatomical structures which should be removed, along with ‘no-go areas’ which need to be preserved during FESS. Based on these definitions, we used cone beam computed tomography (CBCT) images to measure the dimensions of the frontal neo-ostium in 22 patients. We demonstrate anatomical variability in the volume and diameter of the frontal sinus recess after surgery. This variability could be the cause of therapy failure of drug-eluting implants after FESS in some patients. Implants individually made to fit a given patient’s postsurgical anatomy may improve the therapeutic outcome.
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Affiliation(s)
- Ziwen Gao
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, 30625 Hannover, Germany; (Z.G.); (F.M.); (C.W.); (T.L.)
- Cluster of Excellence ‘Hearing4all’ EXC 1077/1, 30625 Hannover, Germany
| | - Farnaz Matin
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, 30625 Hannover, Germany; (Z.G.); (F.M.); (C.W.); (T.L.)
| | - Constantin Weber
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, 30625 Hannover, Germany; (Z.G.); (F.M.); (C.W.); (T.L.)
| | | | - Thomas Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, 30625 Hannover, Germany; (Z.G.); (F.M.); (C.W.); (T.L.)
- Cluster of Excellence ‘Hearing4all’ EXC 1077/1, 30625 Hannover, Germany
| | - Verena Scheper
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, 30625 Hannover, Germany; (Z.G.); (F.M.); (C.W.); (T.L.)
- Cluster of Excellence ‘Hearing4all’ EXC 1077/1, 30625 Hannover, Germany
- Correspondence:
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17
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Javanbakht M, Saleh H, Hemami MR, Branagan-Harris M, Boiano M. A Corticosteroid-Eluting Sinus Implant Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A UK-Based Cost-Effectiveness Analysis. PHARMACOECONOMICS - OPEN 2020; 4:679-686. [PMID: 32048233 PMCID: PMC7688856 DOI: 10.1007/s41669-020-00198-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is one of the commonest chronic health problems among adults in the UK. Around 15% of CRS patients undergo functional endoscopic sinus surgery (FESS) annually after failing medical treatment. However, as incomplete resolution of symptoms or complications post-operatively is common, the post-operative management is considered to be as important as the surgery itself. A bioabsorbable corticosteroid-eluting sinus implant (CESI) (Propel®, mometasone furoate 370 µg) has been used as an alternative post-FESS treatment. OBJECTIVE The objective of this study was to assess the cost effectiveness of the corticosteroid-eluting implant versus non-corticosteroid-eluting spacer following FESS for treatment of patients with CRS. METHODS A decision tree model was developed to estimate the cost and effectiveness in each strategy. Costs and effects were estimated from a UK National Health Service (NHS) and personal social services perspective over a 6-month time horizon. Model pathways and parameters were informed by existing clinical guidelines and literature and sensitivity analyses were conducted to explore uncertainties in base-case assumptions. RESULTS Over a 6-month time horizon, inserting CESI at the end of FESS is less costly (£4646 vs. £4655 per patient) and is the more effective intervention [total quality-adjusted life-years (QALYs) over 6 months 0.443 vs. 0.444] than non-corticosteroid-eluting spacers; hence, it is a dominant strategy. The probabilistic analysis results indicate that CESI following FESS has a 62% probability of being cost effective at the £20,000/per QALY willingness-to-pay threshold and 56% probability of being a cost-saving intervention. CONCLUSIONS The use of CESI after FESS results in fewer post-operative complications than non-corticosteroid-eluting implants and may be a cost-saving technology over a 6-month time horizon. Although the cost of initial treatment with the CESI is greater, cost savings are made due to a reduction in the number of complications experienced.
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Affiliation(s)
- Mehdi Javanbakht
- Optimax Access UK Ltd, University of Southampton Science Park, Chilworth, Hampshire, UK.
- Device Access UK Ltd, University of Southampton Science Park, Chilworth, Hampshire, UK.
| | - Hesham Saleh
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Margaret Boiano
- Device Access UK Ltd, University of Southampton Science Park, Chilworth, Hampshire, UK
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18
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Moiseeva YP, Piskunov GZ. [Dynamic monitoring of patients with chronic rhinosinusitis with nasal polyps]. Vestn Otorinolaringol 2020; 85:58-62. [PMID: 32476393 DOI: 10.17116/otorino20208502158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In connection with the prevalence and tendency to relapse, chronic rhinosinusitis with nasal polyps is an urgent problem not only for otorhinolaryngologists, but also for specialists whose therapeutic activity is somehow related to the respiratory system. Based on clinical observations, 5 phenotypes of this pathology were identified, each of which requires an individual approach to treatment and prevention. As a rule, the first stage is functional endoscopic rhinosinus surgery, the volume of which is determined depending on the phenotype. But even with a carefully performed operation, the result of surgical treatment may be unsatisfactory if there was no adequate care in the early inpatient and outpatient periods. This paper highlights the features of dynamic monitoring of patients with different phenotypes of chronic rhinosinusitis with nasal polyps.
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Affiliation(s)
- Yu P Moiseeva
- Russian Medical Academy for Continuing Professional Education of the Ministry of Health of Russia, Department of Otorhinolaryngology, Moscow, Russia
| | - G Z Piskunov
- Russian Medical Academy for Continuing Professional Education of the Ministry of Health of Russia, Department of Otorhinolaryngology, Moscow, Russia
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19
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Pendolino AL, Koumpa FS, Zhang H, Leong SC, Andrews PJ. Draf III frontal sinus surgery for the treatment of Pott's puffy tumour in adults: our case series and a review of frontal sinus anatomy risk factors. Eur Arch Otorhinolaryngol 2020; 277:2271-2278. [PMID: 32346755 PMCID: PMC7335370 DOI: 10.1007/s00405-020-05980-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 11/22/2022]
Abstract
Purpose We present our case series of four adult patients with Pott’s puffy tumour (PPT), successfully treated with Draf III over a mean period of 11 months. A critical review of the literature is also provided. Methods A retrospective review of patients undergoing Draf III for PPT from January 2018 to January 2019 was performed. Results Four consecutive male patients ranging from 26 to 62 years, with a mean age of 49.5 ± 16.3 years, undergoing Draf III for Pott’s puffy tumour were included. Two patients had a Kuhn type IV frontal cell narrowing the frontonasal pathway and presented without previous sinus surgery, whereas the other two had previous sinus surgery. The success rate of the operation was 100% with an average length of follow-up of 11 months (range 5–18). Conclusion In our experience, the Draf III procedure is a highly effective treatment of PPT. In particular, we have demonstrated it to be very effective in accessing highly positioned Kuhn type IV cells.
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Affiliation(s)
- Alfonso Luca Pendolino
- Department of ENT, Royal National Ent and Eastman Dental Hospitals, 47-49 Huntley St Bloomsbury, London, WC1E 6DG, UK. .,Ear Institute, UCL, London, UK.
| | - Foteini Stefania Koumpa
- Department of ENT, Royal National Ent and Eastman Dental Hospitals, 47-49 Huntley St Bloomsbury, London, WC1E 6DG, UK
| | - Henry Zhang
- Department of ENT, Royal National Ent and Eastman Dental Hospitals, 47-49 Huntley St Bloomsbury, London, WC1E 6DG, UK
| | - Samuel C Leong
- Skull Base Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Peter J Andrews
- Department of ENT, Royal National Ent and Eastman Dental Hospitals, 47-49 Huntley St Bloomsbury, London, WC1E 6DG, UK.,Ear Institute, UCL, London, UK
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20
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Hussaini AS, Clark CM, DeKlotz TR. Perioperative Considerations in Endoscopic Skull Base Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020; 8:129-135. [PMID: 32421026 PMCID: PMC7223122 DOI: 10.1007/s40136-020-00278-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose of the Review Present an overview of perioperative considerations specific to endoscopic skull base surgery necessary to maximize successful outcomes. Recent Findings The majority of perioperative considerations for endoscopic skull base surgery lack strong supporting evidence and frequently have varied use or implementation amongst institutions. A notable exception comes from a recent randomized controlled trial demonstrating the benefit of lumbar drainage in high-risk cerebrospinal fluid leaks. Summary Skull base surgeons must consider a multitude of perioperative factors. While many components of perioperative management are extrapolated from related fields such as endoscopic sinus surgery or open cranial base surgery, additional high-quality studies are needed to delineate best practices specific to endoscopic skull base surgery.
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Affiliation(s)
- Adnan S Hussaini
- Department of Otolaryngology, Head and Neck Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd. NW, Gorman Building, 1st Floor, Washington, DC, 20007 USA
| | - Christine M Clark
- Department of Otolaryngology, Head and Neck Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd. NW, Gorman Building, 1st Floor, Washington, DC, 20007 USA
| | - Timothy R DeKlotz
- Department of Otolaryngology, Head and Neck Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd. NW, Gorman Building, 1st Floor, Washington, DC, 20007 USA
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21
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Winebrake JP, Mahrous A, Kacker A, Tabaee A, Levinger JI, Pearlman AN, Stewart MG, Lelli GJ. Postoperative Bioresorbable Chitosan-Based Dressing for Endoscopic Middle Meatal Dacryocystorhinostomy With Balloon Dilation. EAR, NOSE & THROAT JOURNAL 2019; 100:425-429. [PMID: 31558059 DOI: 10.1177/0145561319866822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the improvement in epiphora and need for surgical revision in patients with acquired nasolacrimal duct obstruction following balloon-assisted, middle meatal endoscopic dacryocystorhinostomy with chitosan-based dressing versus bioresorbable polyurethane packing versus no packing. PATIENTS AND METHODS This was a retrospective study of consecutive adult patients seen from 2015 to 2018 with follow-up evaluation of epiphora at least 3 months after balloon-assisted, middle meatal endoscopic dacryocystorhinostomy. Patients with a history of prior punctoplasty, septoplasty, sinus surgery, or dacryocystorhinostomy of any kind were excluded. Those meeting criteria were stratified by postoperative hemostatic intervention: no packing, bioresorbable packing, and chitosan-based dressing (groups 1, 2, and 3, respectively). Procedural outcomes were graded as successes or failures based on subjective report and anatomical findings at most recent visit within an 18-month postoperative window. Instances of recommendation for revision surgery were also recorded. RESULTS Forty-three cases (36 patients) met the abovementioned criteria. Groups 1, 2, and 3 comprised 12, 17, and 14 cases each, respectively. Average patient age was 55.3 years old, and average duration of follow-up was 6.7 months. Significant variation in outcomes was detected across the 3 groups (P = .0495), particularly between groups 1 and 3 (P = .033). Use of chitosan-based dressing trended toward reduced rates of recommendation for surgical revision (P = .203, P = .113). CONCLUSIONS Use of chitosan-based dressing after endoscopic dacryocystorhinostomy was associated with improved subjective and anatomical outcomes. It may also contribute to less frequent need for revision surgery. Further study in a larger prospective trial is recommended.
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Affiliation(s)
- James P Winebrake
- Department of Ophthalmology, 12295Weill Cornell Medicine, New York, NY, USA
| | - Abdallah Mahrous
- Department of Ophthalmology, 12295Weill Cornell Medicine, New York, NY, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, 12295Weill Cornell Medicine, New York, NY, USA
| | - Abtin Tabaee
- Department of Otolaryngology, 12295Weill Cornell Medicine, New York, NY, USA
| | - Joshua I Levinger
- Department of Otolaryngology, 12295Weill Cornell Medicine, New York, NY, USA
| | - Aaron N Pearlman
- Department of Otolaryngology, 12295Weill Cornell Medicine, New York, NY, USA
| | - Michael G Stewart
- Department of Otolaryngology, 12295Weill Cornell Medicine, New York, NY, USA
| | - Gary J Lelli
- Department of Ophthalmology, 12295Weill Cornell Medicine, New York, NY, USA
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22
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Kim KS, Yu SC, Han JW, Shim SM, Kwak S, Kim YM, Kim SS. Effect of fentanyl nasal packing treatment on patients with acute postoperative pain after closed reduction of nasal bone fracture: a randomized double-blind controlled trial. J Plast Surg Hand Surg 2019; 53:167-172. [PMID: 30734629 DOI: 10.1080/2000656x.2019.1566738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Nasal bone fracture reduction surgery is normally followed by nasal packing to control bleeding. Yet, patients suffer from pain and require further analgesic treatments following nasal packing and removal. This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial. METHODS Sixty-five patients that have undergone closed nasal bone fracture reduction surgery were included in this study. Thirty-two patients were treated postoperatively with 50 mcg fentanyl-soaked Merocel®, a biodegradable synthetic polyurethane foams packing, and the other 33 patients were treated with saline-soaked packings. To analyze the relative nasal pain control effect of fentanyl, Numeric Rating Scale, patient satisfaction and Ramsay Sedation Scale were used. Patients were closely monitored to record relevant cardiopulmonary indicators and degree of adverse symptoms such as headache or sore throat. RESULTS Fentanyl group had a significantly lower Numeric Rating Scale and higher patient satisfaction for most of the time periods after operation (p < .05). Symptoms of headache and sore throat were also significantly reduced. Ramsay Sedation Scale scores improved compared to the control group (p < .05). No significant differences in cardiopulmonary relevant indicators between the two experimental groups were observed (p > .05). CONCLUSION Fentanyl-soaked packing significantly decreased postoperative pain with no observable adverse effects. Our results demonstrate that topical fentanyl application to nasal packing is an effective method of postoperative pain control after closed nasal bone fracture reduction surgery.
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Affiliation(s)
- Kwan-Sub Kim
- a Department of Anesthesiology and Pain Medicine, Dongkang Medical Center , Ulsan , South Korea
| | - Sung Chul Yu
- b Department of Plastic Surgery, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea
| | - Jung-Woo Han
- c Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea
| | - Sung-Min Shim
- c Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea
| | - Soohyun Kwak
- d Department of Rehabilitation Medicine, Semin hospital , Seoul , Korea
| | - Yong-Min Kim
- e The Hong Kong University of Science and Technology , Clear Water Bay , Hong Kong
| | - Seong-Su Kim
- c Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea
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23
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Liu J, Zeng Q, Ke X, Yang Y, Hu G, Zhang X. Influence of chitosan-based dressing on prevention of synechia and wound healing after endoscopic sinus surgery: A meta-analysis. Am J Rhinol Allergy 2018; 31:401-405. [PMID: 29122085 DOI: 10.2500/ajra.2017.31.4469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Endoscopic sinus surgery (ESS) has had many complications, e.g., synechia formation. This meta-analysis investigated the effect of a novel chitosan-based dressing on prevention of synechia and wound healing after ESS. METHODS We systematically searched various medical literature data bases and included the randomized controlled trials (RCT) regarding the effect of novel chitosan-based dressing on ESS. The study outcomes included synechia, granulations, hemostasis, crusting scores, and infection. RESULTS Six RCTs, which involved 337 patients, were included in the meta-analysis. Compared with control intervention after ESS, chitosan-based gel dressing substantially inhibited synechia (risk ratio [RR] 0.28 [95% confidence interval {CI}, 0.15-0.54]; p = 0.0001), improved granulations (RR 1.47 [95% CI, 1.07-2.03]; p = 0.02), and hemostasis (RR 1.47 [95% CI, 1.07-2.03]; p = 0.02) but demonstrated no effect on crusting scores (standard mean difference -0.41 [95% CI, -1.06 to 0.23]; p = 0.21) and infection (RR 0.88 [95% CI, 0.51-1.52]; p = 0.64). CONCLUSION Compared with control intervention, chitosan-based dressing was associated with significantly reduced synechia and with increased granulations and hemostasis but showed no influence on crusting and infection after ESS.
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Affiliation(s)
- Jie Liu
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
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Kim KS, Yeo NK, Kim SS, Park WS, Kwak SH, Cho SH, Sung GW, Kim HS, Yi SW, Cho HJ. Effect of Fentanyl Nasal Packing Treatment on Patients With Acute Postoperative Pain After Nasal Operation: A Randomized Double-Blind Controlled Trial. Ann Otol Rhinol Laryngol 2018. [PMID: 29519133 DOI: 10.1177/0003489418759113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Nasal packing is an option for bleeding control after endoscopic sinus surgery and septoplasty. Although new packing materials have been developed, patients still suffer from pain and require additional analgesics treatments. In this study, a prospective, randomized, and double-blind controlled trial was designed to evaluate the effect of fentanyl-soaked packing on pain after endoscopic sinus surgery and septoplasty. METHODS One hundred fifty-two patients who underwent nasal surgeries due to chronic rhinosinusitis or nasal septal deviation were enrolled in this study. At the end of operation, 50 mcg fentanyl-soaked biodegradable synthetic polyurethane foams packing Nasopore or Merocel were applied to a group of 79 patients, and saline-soaked ones were applied to another group of 73 patients. To evaluate the influence of fentanyl on postoperative nasal pain, patients' conditions were assessed via means of Numeric Rating Scale, patient satisfaction, and Ramsay Sedation Scale. In addition, symptoms of headache or sore throat and any signs of cardiopulmonary-relevant indicators were monitored. RESULTS The fentanyl group had significantly decreased Numeric Rating Scale and increased patient satisfaction in every operation type for the majority of postoperative time periods ( P < .05) with reduced postoperative headache and sore throat compared to the control group. The fentanyl group showed a higher score on Ramsay Sedation Scale than the control group ( P < .05 in group including endoscopic sinus surgery). There were no significant differences in cardiopulmonary-relevant indicators between the 2 groups ( P > .05). CONCLUSION Fentanyl group showed significantly reduced postoperative pain without serious adverse effects. We suggest that topical fentanyl application to nasal packs can be a useful method to reduce pain during the early postoperative period after endoscopic sinus surgery and septoplasty.
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Affiliation(s)
- Kwan-Sub Kim
- 1 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Nam-Kyung Yeo
- 2 Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Seong-Su Kim
- 1 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Woong-Sub Park
- 3 Department of Preventive Medicine & Public Health, College of Medicine, Catholic Kwandong University, Gangneung, Korea
| | - Su-Hyun Kwak
- 4 Department of Rehabilitation Medicine, Chungdam Hospital, Seoul, Korea
| | - Sang-Hyeon Cho
- 1 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Gyu-Wan Sung
- 1 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hae-Sook Kim
- 5 Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang-Wook Yi
- 6 Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hae Jun Cho
- 7 Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Providence, Rhode Island, USA
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Dkhar LK, Bartley J, White D, Seyfoddin A. Intranasal drug delivery devices and interventions associated with post-operative endoscopic sinus surgery. Pharm Dev Technol 2017; 23:282-294. [DOI: 10.1080/10837450.2017.1389956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Lari K. Dkhar
- Drug Delivery Research Group, School of Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jim Bartley
- Bio Design Lab, School of Engineering, Auckland University of Technology, Auckland, New Zealand
- Counties Manukau District Health Board, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - David White
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Ali Seyfoddin
- Drug Delivery Research Group, School of Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Bio Design Lab, School of Engineering, Auckland University of Technology, Auckland, New Zealand
- School of Interprofessional Health Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Zhou JC, Zhang JJ, Zhang W, Ke ZY, Zhang B. Efficacy of chitosan dressing on endoscopic sinus surgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2017; 274:3269-3274. [PMID: 28456847 DOI: 10.1007/s00405-017-4584-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/20/2017] [Indexed: 11/30/2022]
Abstract
Chitosan dressing might be promising to promote the recovery following endoscopic sinus surgery (ESS). However, the results remain controversial. We conducted a systematic review and meta-analysis to explore the influence of chitosan dressing on ESS. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of chitosan dressing on endoscopic sinus surgery were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were synechia and hemostasis. Meta-analysis was performed using random-effect model. Four RCTs involving 268 patients were included in the meta-analysis. Overall following ESS, compared with control intervention, chitosan dressing significantly reduced synechia (RR = 0.25; 95% CI 0.13-0.49; P < 0.0001) and promoted hemostasis (RR = 1.70; 95% CI 1.37-2.11; P < 0.00001), but showed no impact on granulations (RR = 1.18; 95% CI 0.72-1.95; P = 0.52), mucosal edema (RR = 0.88; 95% CI 0.60-1.29; P = 0.51), crusting (RR = 0.85; 95% CI 0.48-1.53; P = 0.60), and infection (RR = 0.88; 95% CI 0.51-1.52; P = 0.64). Compared to control intervention, chitosan dressing could significantly decrease edema and improve hemostasis, but had no effect on granulations, mucosal edema, crusting and infection.
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Affiliation(s)
- Jing-Chun Zhou
- Department of Otorhinolaryngology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China.
| | - Jing-Jing Zhang
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Wei Zhang
- Department of Otorhinolaryngology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Zhao-Yang Ke
- Department of Otorhinolaryngology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Bo Zhang
- Department of Otorhinolaryngology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
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