scholarly journals The use of intranasal glucocorticosteroids in patients with chronic rhinosinusitis in the preoperative period

2022 ◽  
pp. 51-55
Author(s):  
I. I. Chernushevich ◽  
A. N. Naumenko ◽  
A. V. Voronov ◽  
A. Y. Golubev ◽  
E. E. Kozyreva
Keyword(s):  
Blood Loss ◽  
Nasal Cavity ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Control Group ◽  
Preoperative Period ◽  
Nasal Breathing ◽  
Intraoperative Bleeding ◽  
Ostiomeatal Complex ◽  
Intraoperative Period

Introduction. Chronic rhinosinusitis is a disease that occurs everywhere, characterized by inflammation of the mucous membrane of the paranasal sinuses and nasal cavity. If it is impossible to eliminate the causes of the recurrent disease with medical therapy, the use of surgical treatment help to recover the normal functioning of the ostium, including the ostiomeatal complex to improve ventilation and drainage of the paranasal sinuses and recover nasal breathing to relieve chronic inflammation.Purpose of the study. Assessment of the degree of intraoperative bleeding in patients with chronic rhinosinusitis.Materials and methods. On the basis of the FGBU SPB Research Institute of ENT of the Ministry of Health of the Russian Federation in the period from 2020 to 2021. the study of the effect of local intranasal glucocorticosteroids (INGKS) in the intraoperative period in patients with chronic polypous rhinosinusitis was carried out. The total amount of blood loss during surgery for chronic polypous rhinosinusitis in patients who used mometasone furoate preoperatively and in patients not taking topical hormonal drugs was analyzed.Results. In the study group, the average blood loss per operation was 257 ml, in the control group – 401 ml. In patients who took intranasal glucocorticosteroids during surgery, the intensity of bleeding is less pronounced. Undoubtedly, there are many reasons that affect the intensity of bleeding in general, however, a decrease in the inflammatory response in the nasal cavity and a decrease in inflammatory metabolites have a beneficial effect on the state of the nasal mucosa.Conclusion. The use of intranasal glucocorticosteroids in the preoperative period has a positive effect on reducing the inflammatory process in the nasal cavity, which helps to reduce the intensity of intraoperative bleeding.

Application of Nasomer in surgical treatment of patients with polyposis rhinosinusitis

2018 ◽  
pp. 39-42
Author(s):  
Vladimir Bereznyuk ◽  
Alexander Chernokur ◽  
Oleg Gospod
Keyword(s):  
Nasal Cavity ◽  
Postoperative Period ◽  
Paranasal Sinuses ◽  
Standard Treatment ◽  
Surgical Intervention ◽  
Sodium Hyaluronate ◽  
Main Group ◽  
Control Group ◽  
Nasal Breathing ◽  
Minimal Invasiveness

Relevance: Modern endonasal surgery allows to remove polyps from all affected paranasal sinuses, following the principles of minimal invasiveness. Minimal traumatic of surgical intervention gives the best results, accompanied by less progression of the disease. Minimal invasiveness of surgical intervention and its obligatory combination with postoperative medical treatment are common practice in many countries. One of the drugs that actively effect the restoration of the mucous membrane of the nasal cavity and paranasal sinuses in the early postoperative period is Nazomer, which includes sodium hyaluronate and dexpanthenol in saline solution. The purpose of the study is to investigate the effectiveness of the drug Nazomer in patients with polyposis rhinosinusitis after endoscopic polyposynosotomy. Results and discussion: The main group consisted of 30 patients with polyposis rhinosinusitis, who were prescribed Nasomer in addition to standard treatment in the postoperative period. The control group included 30 patients who underwent standard treatment in the postoperative period. As criteria for clinical efficacy, data from endoscopic examination of the nasal cavity and indicators of anterior rhinomatometry, measured by the «Optimus» device, were selected. In the main group, the index of nasal breathing according to rhinomatometry was better than the results of patients in the control group on the 3rd and 5th day of the postoperative period by 26% and 24%, respectively. Conclusion: The use of the drug Nazomer in the postoperative period in patients with polyposis rhinosinusitis contributes to more active restoration of respiratory function of the nasal cavity compared with the control group, according to rhinomatometry, up to 26%. Based on the results obtained, the drug Nazomer is an effective anti-inflammatory and regenerative agent in the postoperative period in patients with polyposis rhinosinusitis.

Optimization of postoperative management of patients undergoing functional endoscopic sinus surgery

2018 ◽  
pp. 26-31
Author(s):  
Sergey Bezshapochny ◽  
Andrey Loburets ◽  
Valery Loburets
Keyword(s):  
Nasal Cavity ◽  
Postoperative Period ◽  
Sodium Hyaluronate ◽  
Sinus Surgery ◽  
Control Group ◽  
Nasal Breathing ◽  
Traditional Therapy ◽  
Significant Difference ◽  
Water Salt ◽  
Experimental Group

Topicality: The result of surgical treatment depends largely on the chosen method of management of the postoperative period, the main purpose of which is to reduce the effects of surgical trauma. Despite the wide variety of drugs for local and systemic use, the question of pharmacotherapy of the operated sinus remains open to this day. The main properties that a modern drug should possess are safety and high clinical efficacy. Aim: to study the clinical efficacy of topical application of a complex preparation based on a saline solution containing sodium hyaluronate and dexpanthenol in patients with chronic sinusitis after functional endoscopic sinus surgery (FESS). Materials and Methods: Clinical and laboratory studies were conducted on 47 patients with chronic rhinosinusitis who underwent surgery using the FESS technique. Patients were divided into 2 groups according to the principle of the postoperative period. Patients of research group (n=21), except for traditional therapy, was used locally NASOMER (a preparation based on a water-salt solution containing sodium hyaluronate and dexpanthenol); to the control group (n=26) patients entered, in the postoperative period received traditional therapy. Traditional therapy included a toilet of the nasal cavity, the use of short-course topical decongestants, irrigation of the nasal cavity with water-salt solutions. Criteria of clinical effectiveness: data of endoscopy of the nasal cavity, rhinomanometry, activity of the mucociliary transport system. The effectiveness of functional research methods in the postoperative period was determined on the 7th and 14th day of treatment. Results: On the 3rd day of the study, an increase in the swelling of the nasal cavity was observed in patients of both clinical groups, correlated with difficulty in nasal breathing. On the 7th day, a decrease in edema was observed in patients of both groups, but in the experimental group, the index of nasal breathing, according to rhinomanometry, was significantly (p<0.05) different from the control group, and was respectively 1.54±0.14 and 2.04±0.19 kPa/l*s. On the 14th day of the study, no significant difference was observed between these indicators. When studying the activity of the ciliated epithelium of the mucous membrane of the nasal cavity, it was proved that patients of the experimental group on day 7 after surgery showed a statistically significant difference in this indicator compared to the control group (17.8±1.0 and 22.7±2.1 min. respectively). Conclusions: The use of NASOMER after surgical intervention in patients with chronic rhinosinusitis contributes to more effective treatment compared with traditional therapy, as evidenced by the rapid recovery of the main functional parameters according to active posterior rhinomanometry and mucociliary clearance. Based on the results of the studies performed, the use of NASOMER for pharmacotherapy in the postoperative period is recommended for patients who have undergone rhinosurgical interventions with the aim of reducing the period of postoperative rehabilitation as an effective anti-inflammatory and wound-healing agent.

scholarly journals Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoshikazu Nagase ◽  
Shinya Matsuzaki ◽  
Masayuki Endo ◽  
Takeya Hara ◽  
Aiko Okada ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Cesarean Delivery ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Multivariate Regression ◽  
Placenta Previa ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

scholarly journals Morphofunctional State of the Maxillary Sinus Mucosa in Patients After Endoscopic Infundibulotomy

2021 ◽  
Vol 1 (3) ◽  
pp. 6-10
Author(s):  
Djuraev Jamolbek Abdukakharovich ◽  
◽  
Makhsitaliev Mukhammadbobur Ibrokhimovich, Ibrokhimovich ◽  
Keyword(s):  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Chronic Rhinosinusitis ◽  
Mucous Membrane ◽  
Paranasal Sinuses ◽  
Pathological Process ◽  
Fundamental Factor ◽  
Sinus Mucosa ◽  
Morphological State

The work carried out made it possible to substantiate the need to apply a method for studying the frequency of beating of cilia of the mucous membrane of the nasal cavity and paranasal sinuses in patients with chronic rhinosinusitis when choosing treatment tactics in an ENT hospital. Analysis of the study of data on the functional and morphological state of the mucous membrane of the nasal cavity and maxillary sinus allows us to judge the severity of the pathological process before surgery, which is the fundamental factor in the algorithm for the treatment of chronic rhinosinusitis.

Preoperative Management of Chronic Rhinosinusitis Prior to Office Balloon Sinus Dilation: A 2011–2014 MarketScan® Analysis

2019 ◽  
Vol 33 (4) ◽  
pp. 347-353 ◽  
Author(s):  
David W. Jang ◽  
Cecily Abraham ◽  
Derek D. Cyr ◽  
Kristine Schulz ◽  
Ralph Abi Hachem ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Practice Patterns ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Administrative Database ◽  
Control Group ◽  
Topical Steroids ◽  
Preoperative Period ◽  
Office Visits ◽  
Preoperative Management

Background In-office balloon sinus dilation (BSD) has recently gained popularity as a surgical treatment option for chronic rhinosinusitis (CRS). However, utilization, indications, and practice patterns surrounding in-office BSD remain unclear. Objective The purpose of this study was to use a large national administrative database to assess preoperative management of CRS prior to in-office BSD. Methods Patients undergoing standalone in-office BSD from 2011 to 2014 were identified on MarketScan and compared to a control group undergoing functional endoscopic sinus surgery (FESS). Visits to the otolaryngologist, number of computed tomography (CT) scans, number of antibiotic and steroid prescriptions, and duration of time from first visit to procedure were compared. Results When compared to the FESS group, the in-office BSD group overall had fewer office visits (2.0 vs 2.2), CT scans (1.0 vs 1.1), prescriptions for antibiotics (2.0 vs 2.2), prescriptions for systemic steroids (1.5 vs 1.8), and topical steroids (1.4 vs 1.5) in the preoperative period. They also had a shorter mean duration of time between first visit and CT scan (17.5 vs 21.4 days) as well as between first visit and procedure (55.0 vs 67.8 days). All of these findings were statistically significant. Conclusion In-office BSD for CRS was overall associated with less intense management in the preoperative period when compared to FESS. Such differences may reflect ongoing shifts in practice patterns and need to be further investigated.

Current approaches to the treatment of rhinosinusitis

2021 ◽  
pp. 6-15
Author(s):  
Oksana. A. Gizinger ◽  
Natalia V. Kornova ◽  
Artem S. Beloshangin
Keyword(s):  
Nasal Cavity ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Viral Infections ◽  
Recovery Period ◽  
Relative Number ◽  
Polymyxin B ◽  
Quantitative Composition ◽  
Upper Respiratory Tract ◽  
Phenylephrine Hydrochloride

Relevance: despite the available methods and medicines, rhinosinusitis occupies a leading place in the structure of diseases of the upper respiratory tract. Rhinosinusitis can be a consequence of respiratory viral infections, can be an independent nosological unit. In recent years, there has been a protracted course of rhinosinusitis with a long recovery period with chronic inflammation in the paranasal sinuses and nasal cavity. Purpose of the study: to analyze the validity and effectiveness of therapeutic approaches to the treatment of chronic rhinosinusitis using the Polydexa with phenylephrinum nasal spray with phenylephrine Materials and мethods: The study included 121 patients — 61 (50.41 %) women and 60 (49.59 %) men aged 25 to 50 years, a history of chronic rhinosinusitis in the stage of clinical exacerbation at the time of the study. All patients underwent: otorhinolaryngological examination, general clinical and radiological (radiography or computed / magnetic resonance imaging of the paranasal sinuses). Cytological examination of the detachable nasal cavity was carried out to study the calculation of the relative number of neutrophilic granulocytes, macrophages, epithelial cells, lymphocytes. Microbiological examination of the detachable nasal cavity and paranasal sinuses included the study of the qualitative and quantitative composition of pathogenic and opportunistic organisms on the surface of the nasal mucosa. Results: in patients with chronic rhinosinusitis in the stage of clinical exacerbation, an increase in the relative content of inflammatory elements was revealed in the nasal secretion against the background of the prevailing content of pathogenic staphylococci and streptococci. The use of topical preparations containing antibacterial components of a broad antimicrobial spectrum of action, dexamethasone, phenylephrine hydrochloride helps to relieve inflammation on the surface of the mucous membranes of the nasal cavity and paranasal sinuses. Conclusions: a method of treating chronic rhinosinusitis in the stage of clinical exacerbation using a combined preparation for topical application containing neomycin sulfate, polymyxin B sulfate, dexamethasone sodium metasulfobenzoate, phenylephrine hydrochloride has a pronounced anti-inflammatory, decongestant, antibacterial effect

Innovative Approach to Surgical Treatment for Locally Advanced Cancer of Paranasal Sinus and Nasal Cavity

2021 ◽  
Vol 76 (3) ◽  
pp. 317-323
Author(s):  
Oleg I. Kit ◽  
Igor V. Reshetov ◽  
Marina A. Engibaryan
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Nasal Cavity ◽  
Paranasal Sinus ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
Arterial Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Control Group

Background. Despite the rapid oncology development, the problem of surgical treatment for locally advanced tumors of the paranasal sinus and nasal cavity is still relevant. The search and development of ways to improve the surgical approach, including modern endovascular methods, appears necessary. Aims development and evaluation of the effectiveness of an innovative approach to the surgical treatment of malignant tumors of the nasal cavity and paranasal sinus with superselective intra-arterial embolization as a preparatory stage. Materials and methods. The study is based on the treatment outcomes of 52 patients with cancer of the nasal cavity and paranasal sinus. The main group included 21 patients receiving treatment with our developed approach including preoperative superselective intra-arterial embolization as a preparatory stage for surgical treatment. The control group included 31 patients receiving standard surgical treatment with traditional ligation of the external carotid artery at the first stage. Estimation of the amount of intraoperative blood loss with gravimetric analysis was considered the primary endpoint of the study. Post-embolization syndrome manifestations were analyzed by evaluating the pain intensity with a visual analogue scale and thermometry. Results. Intraoperative blood loss in patients of the main group varied from 100 to 400 ml, being on average 231.9100.58 ml. In the control group, the blood loss varied from 300 ml to 1000 ml, on average 630.97190.23. The data analysis proved demonstratively the effectiveness of the developed approach to surgical treatment of locally advanced tumors of the nasal cavity and paranasal sinus, since it statistically significantly reduced the amount of intoperative blood loss (p 0.005). Conclusions. Our developed approach to the treatment for malignant tumors of the paranasal sinus and nasal cavity optimized the results of surgical treatment and statistically significantly reduced the amount of intoperative blood loss, compared to the traditional ligation of the external carotid artery, from 630.97190.23 to 231.9100.58 ml (p 0.005), with minimal manifestations of post-embolization syndrome.

scholarly journals Topical Steroids in Rhinosinusitis and Intraoperative Bleeding: More Harm Than Good?

2019 ◽  
Vol 99 (6) ◽  
pp. 388-394
Author(s):  
Giancarlo Tirelli ◽  
Umberto Lucangelo ◽  
Giovanni Sartori ◽  
Maria Cristina Da Mosto ◽  
Paolo Boscolo-Rizzo ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operation Time ◽  
Treated Group ◽  
Sinus Surgery ◽  
Control Group ◽  
Topical Steroids ◽  
Intraoperative Bleeding ◽  
Fibrous Stroma ◽  
Preoperative Administration ◽  
Snot 22

The aim of this study was to assess whether the chronic preoperative administration of intranasal corticosteroids (INCs) in chronic rhinosinusitis with/without nasal polyposis (CRSwNP/CRSsNP, respectively) could significantly influence bleeding during functional endoscopic sinus surgery (FESS). We prospectively enrolled 109 patients (56 CRSwNP and 53 CRSsNP) candidate for FESS who underwent clinical evaluation and anamnestic data collection. They were allocated to 2 groups depending on whether or not they were chronic INC users, as declared at their first medical evaluation: chronic “INC users” represented the treated group, while “INC nonusers” formed the control group. Lund-Mackay and American Society of Anesthesiology (ASA) scores, blood loss expressed both in milliliters and using the Boezaart scale, operation time in minutes, pre- and postoperative 22-item Sino Nasal Outcome Scores (SNOT-22) were collected. Each sample underwent histopathological evaluation. The results showed that anamnestic information, Lund-Mackay, and SNOT-22 scores were similar between the 2 groups ( P > .05). The average blood loss expressed in milliliters and operative time were slightly, but not significantly, higher in the INC user group, while the Boezaart scores proved significantly higher in the INC users ( P = .038). No differences emerged between CRSwNP and CRSsNP within each group in terms of bleeding. The pathologist described common features in the majority (78%) of INC group samples: ectatic venules embedded in a fibrous stroma and hypertrophy of the arterial muscular layer. In our experience, despite the presence of NP, chronic preoperative administration of INCs was associated with increased intraoperative bleeding according the Boezaart scale although objective recordings of blood loss were not statistically different between the INC users and nonusers.

scholarly journals The use of nasal decongestants to correction the respiratory and olfactory function of the nose

2019 ◽  
pp. 60-65 ◽  
Author(s):  
S. V. Morozova ◽  
L. A. Toporkova
Keyword(s):  
Nasal Cavity ◽  
Nasal Obstruction ◽  
Paranasal Sinuses ◽  
Nasal Congestion ◽  
Olfactory Function ◽  
Nasal Discharge ◽  
Nasal Breathing ◽  
Nasal Decongestants ◽  
Osteomeatal Complex ◽  
Tube Dysfunction

One of the main functions of the nose is respiratory and olfactory. Difficulty in nasal breathing, nasal congestion, nasal discharge can complicate the respiratory and olfactory functions of the nose or make them impossible. Most often the cause is swelling of the mucous. Nasal obstruction and rhinorrhea are the most common symptoms in diseases of the nasal cavity and paranasal sinuses. Of great importance is the use of local vasoconstrictors to eliminate swelling in the nasal cavity and prevent complications associated with auditory tube dysfunction. It is proved that the use of nasal decongestants helps to reduce swelling in the nasal cavity and in the osteomeatal complex. Otrivin Moisturizing formula, Otrivin Menthol, Otrivin Complex and Otrivin Sea are effective and well tolerated means to eliminate swelling in the nasal cavity and reduce nasal discharge and rehabilitation of olfactory function.

scholarly journals Dynamics of Recovery of Functions of the Nasal Cavity in Patients with Aspirin-Intolerant Polypous Rhinosinusitis in the Postoperative Period

2016 ◽  
Vol 22 (2) ◽  
pp. 201621
Author(s):  
Ivanna Koshel
Keyword(s):  
Nasal Cavity ◽  
Postoperative Period ◽  
Recovery Process ◽  
Main Group ◽  
Control Group ◽  
Nasal Breathing ◽  
Rapid Improvement ◽  
Postoperative Rehabilitation ◽  
Physiological Functions ◽  
Surgical Interventions

Surgical interventions in the nasal cavity are accompanied by reactive phenomena in the postoperative period. On their background the process of physiological regeneration is disorganized resulting in impaired physiological functions of the nasal cavity.The objective of the research was to study the recovery process of the main physiological functions of the nasal cavity in patients with aspirin-intolerant polypous rhinosinusitis in the postoperative period.Materials and methods. 80 patients with aspirin-intolerant polypous rhinosinusitis at the age of 24-57 years were operated on.All the patients were divided into 2 groups: the control group included 30 patients; the main group comprised 50 patients.Patients of the control group received nasal cavity cleaning, nasal mucosa anemisation, irrigation therapy since the first day of the postoperative period.Patients of the main group received an herbal drug BNO-101 additionally. The effectiveness was assessed on the 3rd, 7th and 10th days of treatment.Results. The postoperative rehabilitation with the inclusion of botanical preparation BNO-101 provided a significant improvement of nasal breathing, mucociliary transport rate and indicators of nasal peak flowmetry compared to the control group. Despite subjective improvement of nasal breathing the indicators of the peak expiratory flow rate in the main group were 34.2% lower than the norm while in the control group they were 54.7% lower than normal ones thereby justifying further treatment.Conclusions. The postoperative rehabilitation of patients with aspirin-intolerant polypous rhinosinusitis provided more rapid improvement of the main functions of the nasal cavity compared to the control group.

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