Analysis of Absorbable Hemostatic Packing Compared to Physiologic Hemostasis in Functional Endoscopic Sinus Surgery With or Without Septoplasty

2019 ◽  
Vol 33 (5) ◽  
pp. 531-539
Author(s):  
Brett T. Comer ◽  
Kristan P. Alfonso ◽  
Edward J. Doyle ◽  
James A. Gallogly ◽  
Matthew C. Simpson ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Selection Criteria ◽  
Randomized Study ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Significant Difference ◽  
Patient Groups ◽  
Randomized Control ◽  
To Receive ◽  
Subjective Outcomes

Background There currently are no randomized studies examining if absorbable hemostatic packing (AHP) results in better objective and subjective outcomes than physiologic healing in sinus surgery with or without septoplasty. Objective The objective of this study is to examine outcomes after functional endoscopic sinus surgery (FESS) with or without septoplasty with the use of AHP versus physiologic hemostasis and healing. Methods A prospective randomized control trial was performed at 2 tertiary academic institutions. Fifty-nine patients undergoing bilateral FESS with or without septoplasty were enrolled and randomized to receive AHP in 1 middle meatus and no packing contralaterally. Subjective outcomes (pain, bleeding, obstruction, discharge) on self-reported visual analog scale questionnaires were tabulated on postoperative days 0, 1, 7, and 14 by the patient. Endoscopic outcomes (synechiae formation, edema, infection, granulation, debridement, crusting) were measured at 1 week, 2 weeks, and 6 weeks postoperatively by their surgeon. Results No significant differences were identified in subjective or endoscopic outcomes with AHP use. Concurrent septoplasty patients with AHP experienced no sustainable difference in subjective or endoscopic outcomes compared to septoplasty control. No sustainable differences were found among the types of AHP or the 2 surgeons. Conclusion This first reported prospective randomized study of patients with nonstrict selection criteria found AHP made no significant difference on subjective and objective postoperative outcomes as compared to physiologic hemostasis. Previous AHP-specific studies have shown differences in carefully selected patient groups. Generalizing study-proved benefits of specific AHP to all AHP is shown to be not appropriate.

Outcomes of Concurrent Functional Endoscopic Sinus Surgery and Rhinoplasty: A Meta-analysis

2020 ◽  
pp. 194589242098067
Author(s):  
Benjamin F. Bitner ◽  
Karthik R. Prasad ◽  
Khodayar Goshtasbi ◽  
Brandyn S. Dunn ◽  
Edward C. Kuan
Keyword(s):  
Patient Satisfaction ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Complication Rates ◽  
Medical Problems ◽  
Random Effects Models ◽  
Ovid Medline ◽  
Significant Difference

Introduction Chronic rhinosinusitis (CRS) and functional nasal airway obstruction are common but distinct medical problems which affect quality of life. In certain instances, patients often benefit from concomitant functional septorhinoplasty, or elect for cosmetic rhinoplasty, in addition to functional endoscopic sinus surgery (FESS) and prefer combining procedures. Determining outcomes of combined surgery is important when discussing risks and benefits with patients. Methods A thorough literature search of articles published in PubMed, Ovid MEDLINE, and Cochrane databases. Patients were categorized as either having FESS or rhinoplasty alone or combined. Binary random-effects models were applied to calculate odds ratios (ORs) for outcomes including complications, recurrence, and satisfaction. Results Of the 55 screened articles, 6 were included in the analysis, and of these, 6 (405 patients), 2 (90 patients), 4 (290 patients), and 3 (190 patients) provided data for postoperative complications, recurrence of CRS symptoms, revision rates, and patient satisfaction, respectively. Major complications were observed in 11 (5.8%) total combined cases, 0 (0%) FESS cases, and 6 (3.5%) rhinoplasty cases with no statistical difference between combined cases and rhinoplasties (OR 1.37, 95% CI 0.45–4.16, p = 0.58). Recurrence of CRS symptoms was noted in 35.6% combined cases and 28.9% FESS cases (OR 1.42, 95% CI 0.55–3.64, p = 0.47). There was no observed difference in revision rates between combined and isolated rhinoplasties (OR 1.00, 95% CI 0.43–2.32, p = 1). Lastly, 91.6% of patients were satisfied with results of combined cases compared to 87.4% of patients in standalone cases (OR 1.57, 95% CI 0.61–4.03, p = 0.35). Conclusion Aggregate evidence demonstrates similar risk in complication rates in combined surgical cases compared to stand-alone rhinoplasty. There appears to be no significant difference in recurrence of symptoms, revision rates or patient satisfaction.

Prophylactic i.v. Antibiotics in Functional Endoscopic Sinus Surgery: Trends and Attitudes of the American Rhinologic Society Membership

2009 ◽  
Vol 23 (4) ◽  
pp. 448-450 ◽  
Author(s):  
Rakesh K. Chandra ◽  
David B. Conley ◽  
Robert C. Kern
Keyword(s):  
Antibiotic Prophylaxis ◽  
Endoscopic Sinus Surgery ◽  
Pay For Performance ◽  
Neck Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Full Time ◽  
Performance Quality ◽  
Significant Difference ◽  
Or Practice

Background Use of antibiotic prophylaxis in otolaryngology–head and neck surgery is a practice that exhibits significant variation among practitioners, and trends vary by subspecialties within the field. The objective of this study was to assess these habits among otolaryngologists with special interest or experience in functional endoscopic sinus surgery (FESS). Methods Attendees of the 2008 Annual Meeting of the American Rhinologic Society were surveyed regarding practice patterns and attitudes concerning the use of prophylactic i.v. antibiotics in FESS. Results Surveys were returned from 49 attendees, and within this sample, i.v. antibiotic prophylaxis was used by 28 (57%) and was not in 21 (43%). Among those who used prophylaxis, only 2/28 (7%) did so because they felt there was strong evidence to support such a practice, while 26/28 (93%) used prophylactic antibiotics despite the opinion that there is no solid evidence in support of this. The most common antibiotic chosen empirically was a cephalosporin (25/28; 89%). There was no significant difference between those who did and did not use prophylactic i.v. antibiotics with regard to number of years in practice or practice situation (full-time academic, academic affiliated private, solo private, and group private). Conclusion Opinion of the respondents suggests there is no solid empiric evidence supporting the use of prophylactic i.v. antibiotics in FESS. Nonetheless, this practice is more common than not. Possible explanations for these observations are explored in the context of new pay for performance quality measures.

Radical versus Functional Endoscopic Sinus Surgery for Osteitis in Chronic Rhinosinusitis

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Mingjie Wang ◽  
Bing Zhou ◽  
Yunchuan Li ◽  
Shunjiu Cui ◽  
Qian Huang
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Blood Eosinophil ◽  
Peripheral Blood Eosinophil ◽  
Prick Test ◽  
Preoperative Symptom ◽  
Significant Difference ◽  
One Year

Introduction: Osteitis in chronic rhinosinusitis (CRS) is a predictive factor of disease severity and an important potential reason for disease recalcitrance. Other than medical treatment, transnasal endoscopic surgery could be another choice to deal with osteitis in CRS. Objective: In this study, 2 different surgical outcomes and influence in patients with osteitis in CRS were discussed. Methods: A retrospective analysis of 51 cases was carried out. Osteitis in CRS was confirmed by sinus computed tomography (CT). According to surgical management, patients were divided into the radical endoscopic sinus surgery (RESS) group (n = 24) and functional endoscopic sinus surgery (FESS) group (n = 27). Baseline measures and postoperative outcomes were evaluated by symptom visual analog scale (VAS), peripheral blood eosinophil percentage, serum total IgE, skin prick test, endoscopy Lund-Kennedy score, CT scan Lund-Mackay score, and global osteitis scoring scale (GOSS) in 2 groups. Results and Conclusions: There was no significant difference between the 2 groups in age, gender, and complicated with allergic rhinitis and asthma. The preoperative symptom VAS score and endoscopy Lund-Kennedy score were higher in the RESS group than in the FESS group, and the Lund-Mackay score and GOSS score were similar in the 2 groups. One year after surgery, symptom VAS scores, endoscopy Lund-Kennedy score, and Lund-Mackay score were significantly lower in the 2 groups. The endoscopy Lund-Kennedy score and Lund-Mackay score were lower in the RESS group than in the FESS group 1 year after surgery. RESS was more effective in reducing inflammatory load of sinuses in patients with osteitis in CRS.

scholarly journals ROLE OF SEPTOPLASTY AND FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN THE TREATMENT OF RHINOGENIC HEADACHE

2021 ◽  
Vol VOLUME 9 (ISSUE 1) ◽  
pp. 6-12
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Nasal Endoscopy ◽  
P Value ◽  
Age Group ◽  
Significant Difference ◽  
Key Factor ◽  
A Prospective Study

INTRODUCTION: Rhinogenic headaches are basically described as headache or facial pain caused by rhinological source. The presence of nasal symptoms & it’s temporal relationship with headache is the key factor that can guide the diagnosis and patient management. AIMS: This study aims to evaluate the efficacy of Septoplasty with Functional endoscopic sinus surgery (F.E.S.S) in the management of Rhinogenic headache. MATERIALS & METHODS: It was a Prospective study conducted in M.G.M Medical College & associated M.Y group of hospitals from March 2019 to March 2020. 64 patients of age group 18 years to 60 years having chronic rhinosinusitis with headache included in the study. After detailed history and thorough examination, nasal endoscopy and CT Paranasal sinus was done. Patients not responding to conservative management were selected for undergoing functional endoscopic sinus surgery. RESULTS: A total of 64 patients were included in the study,34 male & 30 female with the mean age group of 31.4 & 30.1 years respectively. Out of 64 patients,67% were completely free from headache,15% were significantly improved,7% had mild relief & 11% did not show any benefit in headache from surgery. Postoperatively, there was statistically significant difference was found patient’s symptomatology (i.e. p value =0.0165). CONCLUSION: To make the diagnosis both anatomical & infective factors needed to be considered. Correction of obvious anatomic abnormalities in carefully selected patients can significantly improve several important clinical outcomes from abolishing headache completely to decreasing its intensity and frequency of episodes. KEY-WORDS: Rhinogenic headaches, Septoplasty, Chronic rhinosinusitis, F.E.S.S, Nasal endoscopy

scholarly journals Prospective, randomised controlled trial comparing intense endoscopic cleaning versus minimal intervention in the early post-operative period following functional endoscopic sinus surgery

2011 ◽  
Vol 125 (6) ◽  
pp. 585-589 ◽  
Author(s):  
J M Fishman ◽  
S Sood ◽  
M Chaudhari ◽  
P Martinez-Devesa ◽  
L Orr ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Outcome Measure ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Minimal Intervention ◽  
Post Operative Period ◽  
Significant Difference ◽  
Randomised Controlled

AbstractObjective:There is currently no standardised management protocol following functional endoscopic sinus surgery. This study assessed frequent endoscopic cleaning versus minimal intervention in the early post-operative period following such surgery.Study design:Prospective, randomised controlled, single-blinded, within-subject trial involving 24 patients with bilateral chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery.Main outcome measure:The primary outcome measure was ethmoid cavity healing, based on endoscopic appearance, graded using a modified Lund–MacKay endoscopic score.Secondary outcome measure:Lund–MacKay symptom score before and after surgery.Results:There was no overall statistically significant difference between the two groups (p = 0.37). Subgroup analysis revealed a significant effect of regular suction clearance on adhesions at three months (p = 0.048), but not on oedema, polyps, granulation, discharge or crusting.Conclusion:There is no evidence from this study to support frequent endoscopic cleaning in the early post-operative period after functional endoscopic sinus surgery. Less intensive post-operative management is recommended, resulting in decreased patient morbidity and fewer post-operative follow-up appointments.

Effect of passive smoking on ciliary regeneration of nasal mucosa after functional endoscopic sinus surgery in children

2008 ◽  
Vol 123 (1) ◽  
pp. 75-79 ◽  
Author(s):  
A Atef ◽  
I Abo Zeid ◽  
M Qotb ◽  
E Gad El Rab
Keyword(s):  
Passive Smoking ◽  
Endoscopic Sinus Surgery ◽  
Chronic Sinusitis ◽  
Negative Impact ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Age Group ◽  
Paediatric Age ◽  
Patient Groups ◽  
Objective Methodology

AbstractHypothesis and background:Passive smoking in the paediatric age group is associated with an increased frequency of a number of childhood respiratory disorders. However, its effect on ciliary regeneration after functional endoscopic sinus surgery for chronic sinusitis has not previously been reported.Material and methods:We conducted a prospective, nonrandomised cohort study on 38 paediatric patients with chronic sinusitis. We compared two patient groups – passive smokers and those not subjected to passive smoking – as regards ciliary regeneration after functional endoscopic sinus surgery, using objective methodology.Results and conclusion:We found passive smoking to have a negative impact on sinus cilia regeneration following functional endoscopic sinus surgery.

Polyurethane Versus Chitosan-Based Polymers Nasal Packs After Functional Endoscopic Sinus Surgery: A Prospective Randomized Double-Blinded Study

2021 ◽  
pp. 194589242098364
Author(s):  
Ahmed Gamal Khafagy ◽  
Ahmed Mahmoud Maarouf
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Middle Turbinate ◽  
Mucosal Healing ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Middle Meatus ◽  
Packing Materials ◽  
Nasal Pack ◽  
Significant Difference ◽  
Double Blinded

Background Different packing materials are applied to the nose at the end of surgery to maintain drainage and sinus ventilation of the paranasal sinuses and avoid some complications such as bleeding, infection, crustations, adhesions in the middle meatus and lateralization of the middle turbinate. Objective The study aims to compare the clinical outcomes of two absorbable packing materials, the synthetic polyurethane, and the naturally occurring Chitosan-based polymers (CBP) nasal packs, after functional endoscopic sinus surgery. Methods Fifty patients with bilateral chronic rhinosinusitis with nasal polypi were operated with 100 surgical cavities. At the end of the surgery, one side was randomly packed with synthetic polyurethane and the opposite side with CBP nasal pack. Measure their outcomes at week 1, 2, 4, 8 and 12 as the presence of remnants materials in the middle meatus, crustations, adhesions, bleeding, granulations, infection, and general satisfaction of patients. Results CBP nasal pack shows a statistically significant advantage only in the first two weeks as regard remnants material, crusting and bleeding. All over the 12 weeks, there was no statistically significant difference between the two types of packs as regard granulations, adhesions and infection. In the first month, eight patients of the CBP group experienced bad smell and two patients had watery rhinorrhea as adverse reaction without a statistically significant difference. Patients were generally satisfied without a statistically significant difference between the two types of packs. Conclusion Synthetic polyurethane and Chitosan-based polymers nasal packs are safe and efficient regarding; the mucosal healing, bleeding control, and the overall satisfaction of patients. The CBP showed a higher statistically significant advantage in the first two weeks only regarding the amount of the retained material, crusting as well as bleeding. Patients packed with CBP experienced fish-like smelly odor and watery rhinorrhea but there is no statistically significant difference.

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