Budesonide nasal irrigation improved Lund–Kennedy endoscopic score of chronic rhinosinusitis patients after endoscopic sinus surgery

AbstractBackgroundNasal irrigation is commonly performed in patients with chronic rhinosinusitis after functional endoscopic sinus surgery. This study systematically assessed the clinical efficacy of nasal irrigation from the medical literature.MethodsThe PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched using a comprehensive strategy, limited to English-language articles, published from October 1971 to March 2017, and comprising human subjects.ResultsA total of 824 trials were identified, 5 of which, involving 331 participants, were included in this systematic review. After selection, only three trials were eligible for inclusion in a meta-analysis. Nasal irrigation using normal saline and various solutions was found to be effective in reducing symptom scores and endoscopic scores for chronic rhinosinusitis patients after functional endoscopic sinus surgery. Comparison of outcome measures, such as eosinophil count reduction, revealed that various solutions are more effective than normal saline alone; however, no statistical significance was found in terms of reduced symptom or endoscopic scores.ConclusionBased on the current limited evidence, nasal irrigation is an effective therapy for chronic rhinosinusitis patients after functional endoscopic sinus surgery. However, when comparing various solutions with normal saline, no significant difference was found in symptom scores or endoscopic scores.

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Double-blind, randomised controlled trial on the efficacy of saline nasal irrigation with sodium hyaluronate after endoscopic sinus surgery

The Journal of Laryngology & Otology ◽

10.1017/s0022215119000446 ◽

2019 ◽

Vol 133 (4) ◽

pp. 300-308 ◽

Cited By ~ 2

Author(s):

F Mozzanica ◽

A Preti ◽

R Gera ◽

C Bulgheroni ◽

A Cardella ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Sodium Hyaluronate ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Double Blind ◽

Nasal Irrigation ◽

Post Operative Period ◽

Group 2 ◽

Group 1

AbstractObjectiveThere is a growing interest in sodium hyaluronate for the clinical management of patients who undergo functional endoscopic sinus surgery for chronic rhinosinusitis, because of the mucosal regenerative properties of this macromolecule. However, its role in post-operative care is still debated. This study aimed to evaluate the effect of sodium hyaluronate administered via nasal irrigation with saline, in the post-operative period, after functional endoscopic sinus surgery.MethodsA multicentric, prospective, randomised, double-blind, parallel group study was conducted on 56 consecutive patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis without polyps. Group 1 received the standard therapy of normal saline; group 2 received saline plus sodium hyaluronate.ResultsBoth objective and subjective measurements, in terms of endoscopic appearance and patient-reported satisfaction, were significantly better in group 2 compared to group 1.ConclusionSodium hyaluronate may be a useful adjunct to nasal saline irrigation in the early post-operative period following functional endoscopic sinus surgery.

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Outcome of Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinisinusitis Not Responding to Medical Therapy

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v15i4.25086 ◽

2019 ◽

Vol 15 (4) ◽

pp. 235-238

Author(s):

Pradeep Kumar Pyakurel ◽

Deepak Paudel ◽

Shyam Thapa Chettri

Keyword(s):

Chronic Rhinosinusitis ◽

Medical Therapy ◽

Medical Management ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Safe Procedure ◽

Endoscopic Score ◽

The Mean ◽

Prospective Longitudinal

Background: chronic rhinosinusitis (CRS) is common chronic condition and is treated with antibiotics, nasal irrigation and steroids. Patients who do not respond to medical therapy are subjected to functional endoscopic sinus surgery. The objective of the study is to assess the clinical improvement after functional endoscopic sinus surgery among the patients of chronic rhinosinusitis (CRS) who failed medical management. Methods: A Prospective longitudinal study conducted within a period of 1 year. Patient with CRS who failed with medical management were subjected functional endoscopic sinus surgery (FESS). Pre –operative symptoms score and endoscopic score were assessed and compared with that of post- operative scores at the end of 6 weeks and 12 weeks. Results: Fifty-two patients who completed three months of follow up were included in the study. The mean preoperative VAS symptoms score was 5.7 and was 2.23 after FESS and difference was significant (P <0.01). There was significant improvement of the endoscopic score (ES) after FESS, the mean ES preoperatively was 4.038 and it improved to1.31 at 6 weeks and 0.75 in the 12 postoperative weeks. Post-operative adhesion was the most common complication and occurred in 15% of patients. Conclusions: FESS is a safe procedure. Patients with CRS who don’t respond to medical therapy should undergo this safe surgical procedure FESS with good outcome. Keywords: chronic rhinosinusitis; functional endoscopic sinus surgery; outcome.

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The effects of nasal lavage with betamethasone cream post-endoscopic sinus surgery: clinical trial

The Journal of Laryngology & Otology ◽

10.1017/s0022215117001827 ◽

2017 ◽

Vol 132 (2) ◽

pp. 143-149 ◽

Cited By ~ 3

Author(s):

B Dawson ◽

I Gutteridge ◽

A Cervin ◽

D Robinson

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Safety Data ◽

Serum Cortisol ◽

Urinary Free Cortisol ◽

Sinus Surgery ◽

Nasal Irrigation ◽

Free Cortisol ◽

Cortisol Levels ◽

The Impact

AbstractBackground:Steroid nasal irrigation for chronic rhinosinusitis patients following endoscopic sinus surgery reduces symptom recurrence. There are minimal safety data to recommend this treatment. This study evaluated the safety of betamethasone nasal irrigation by measuring its impact on endogenous cortisol levels.Methods:Participants performed daily betamethasone nasal irrigation for six weeks. The impact on pre- and post-intervention serum and 24-hour urinary free cortisol was assessed. Efficacy was evaluated using the 22-item Sino-Nasal Outcome Test.Results:Thirty participants completed the study (16 females and 14 males; mean age = 53.9 ± 15.6 years). Serum cortisol levels were unchanged (p = 0.28). However, 24-hour urinary free cortisol levels decreased (47.5 vs 41.5 nmol per 24 hours; p = 0.025). Sino-Nasal Outcome Test scores improved (41.13 ± 21.94 vs 23.4 ± 18.17; p < 0.001). The minimal clinical important difference was reached in 63 per cent of participants.Conclusion:Daily betamethasone nasal irrigation is an efficacious treatment modality not associated with changes in morning serum cortisol levels. The changes in 24-hour urinary free cortisol levels are considered clinically negligible. Hence, continued use of betamethasone nasal irrigation remains a viable and safe treatment option for chronic rhinosinusitis patients following functional endoscopic sinus surgery.

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What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00519-9 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Nadim Saydy ◽

Sami P. Moubayed ◽

Marie Bussières ◽

Arif Janjua ◽

Shaun Kilty ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Patient Reported Outcome ◽

Sinus Surgery ◽

Structured Interviews ◽

Subjective Data ◽

Operative Outcomes ◽

Patient Reported ◽

Definition Of Success ◽

Reported Data

Abstract Objectives Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. Methods A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. Results According to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. Conclusions According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2). Graphical abstract

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