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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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Traumastem Powder in Treatment of Non-Traumatic Anterior Epistaxis in Emergency Department; a Randomized Clinical Trial. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2020; 8:e78. [PMID: 33134974 PMCID: PMC7588002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Various studies are being conducted because of the value of finding an appropriate medication to control bleeding in patients with epistaxis faster and more conveniently. This study aimed to compare the effect of Traumastem powder with routine tampons in treatment of non-traumatic epistaxis. METHODS This randomized clinical trial enrolled patients with epistaxis presenting to the emergency departments of two hospitals affiliated to Tabriz University of Medical sciences. Patients were divided into two groups using randomization software (intervention group: 107 patients, control group: 96 patients). Primary outcome variables included bleeding control time and patient satisfaction. Secondary outcome variable was recurrence of bleeding within the first 24 hours after treatment. Visual assessment scoring system was used to assess patient satisfaction. RESULTS Epistaxis was controlled in less than 5 minutes in 85 (79.4%) patients in the intervention group and 85 (88.5%) patients in the control group (P=0.058). Patient satisfaction in the intervention group was higher than that of the control group (P<0.05). In the intervention group, 10 patients experienced recurrence of epistaxis within 24 hours of treatment, while 9 patients in the control group experienced recurrence (P= 0.591). CONCLUSION Based on the findings, bleeding control time was similar in the two groups, but patient satisfaction was higher in Traumastem group. It is concluded that Traumastem can conveniently control anterior epistaxis, but it is not successful in cases with severe bleeding.
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Jeong H, Choi B, Lee J, Kim KS, Min SJ, Kim JK. Prevalence and characteristics of S-point bleeding compared to non S-point bleeding in severe epistaxis. Braz J Otorhinolaryngol 2020; 87:462-468. [PMID: 33012702 PMCID: PMC9422729 DOI: 10.1016/j.bjorl.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/17/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Stamm's S-point is gaining importance as a bleeding focus in severe epistaxis. However, prevalence and features of S-point bleeding compared to non S-point bleeding have not been studied. Objective To investigate the characteristics of patients with S-point bleeding among those with severe epistaxis and to compare the factors involved in the treatment of epistaxis. Methods We retrospectively analyzed medical records of 268 patients admitted to the otorhinolaryngology department of Konkuk University Hospital and Chung-Ang University Hospital with epistaxis of which the bleeding focus clarified. Patients with anterior nasal bleeding (n = 129) were excluded. The study was conducted at the department of otorhinolaryngology from January 2008 to August 2019. Collected data included patients’ demographic information, bleeding focus, body mass index underlying medical and sinonasal diseases, laboratory test results (initial hemoglobin, platelet count, and triglyceride level), use of anticoagulants, direction of epistaxis, initial and final treatments, and need for blood transfusion. Results The prevalence of S-point bleeding was 28.8% of non-anterior bleeding cases. Mean body mass index score was lower in the S-point group (23.41 ± 3.71) compared to the non S-point group (24.93 ± 3.97) (p = 0.039). Underweight patients tended to show a greater incidence of S-point bleeding (15.0%) than non S-point bleeding (2.0%) (p = 0.010). Incidence of anemia was higher in the S-point group (67.5%) than in the non S-point group (36.4%). Anemia (Odds ratio [OR]: 3.635; 95% confidence interval [CI]: 1.669-7.914, p = 0.001) and underweight (body mass index < 18.5, OR: 8.559, CI: 1.648-44.445, p = 0.011) were significantly associated with S-point bleeding. Conclusion Prevalence of S-point bleeding was significant, underlining the importance of examining the S-point in patients with severe epistaxis. Patients with S-point bleeding had lower body mass index scores and a higher incidence of anemia than those with non S-point bleeding.
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Affiliation(s)
- Hamin Jeong
- Konkuk University Medical Center, Konkuk University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - BoYoon Choi
- Konkuk University Medical Center, Konkuk University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Jiyeon Lee
- Konkuk University Medical Center, Konkuk University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Kyung Soo Kim
- Chung-Ang University, College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Sung Jin Min
- Chung-Ang University, College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Jin Kook Kim
- Konkuk University Medical Center, Konkuk University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea.
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Nithianandan H, Thavorn K, Banaz F, Macdonald K, Lasso A, Kilty SJ. Determining the hospital cost of anterior epistaxis treatment modalities at a Canadian tertiary care centre. World J Otorhinolaryngol Head Neck Surg 2020; 5:193-199. [PMID: 32083246 PMCID: PMC7015865 DOI: 10.1016/j.wjorl.2019.11.001] [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: 06/03/2019] [Revised: 07/31/2019] [Accepted: 11/27/2019] [Indexed: 11/05/2022] Open
Abstract
Objective To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada. Material and methods A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014. A consecutive sample of adult patients with a diagnosis of anterior epistaxis was included. Anterior epistaxis was managed via one of: Nasal clip, Merocel®, Silver Nitrate cautery, Vaseline packing, other treatment or no treatment. Both the direct and indirect hospital costs ($CDN) for anterior epistaxis treatment were calculated from the hospital's perspective. Generalized linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding factors. Results Three hundred and fifty-three patients (49% female) with a mean age of (69.9 ± 18.5) years were included in the analysis. The median (interquartile ranges) costs of treatment ranged from C$227.83 (C$167.96, C$328.69) for observation to C$763.98 (C$632.25,C$830.23) for Merocel®. The overall median total hospital costs incurred across all modalities was C$566.24 (C$459.61, C$753.46) for the management of anterior epistaxis. Silver Nitrate, nasal clip, and observation were statistically associated with a lower cost when compared to Merocel® (P < 0.001) even after potential confounding factors were controlled. Conclusions Our results show wide difference in the hospital cost of epistaxis across treatment modalities. These cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.
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Affiliation(s)
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, Ontario, Canada
| | - Fatmahalzahra Banaz
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa, Ottawa, Ontario, Canada
| | - Kristian Macdonald
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea Lasso
- Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Shaun J Kilty
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa, Ottawa, Ontario, Canada.,Dr. S. Kilty Medicine Prof. Corp., Ottawa, ON, Canada
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Sözen T, Önay Ö, Ceylan MS. Comparing efficacy of Surgicel ® application with nasal packing in epistaxis. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2019. [DOI: 10.25000/acem.489634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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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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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