Assessment of Nasal Airflow and Pain, Safety and Cost of an Improvised Nasal Airway (Nasogastric) Tube After Endoscopic  Sinus Surgery

ABSTRACT Objective: To compare subjective nasal airflow and overall pain score (as well as safety and added cost of) using an improvised nasal airway tube (nasogastric tube) versus nasal packing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods:Design: Quasi - Experimental Prospective Cohort StudySetting: Tertiary Government Training HospitalParticipants: Twenty-six (26) consecutive patients aged 18 to 77 years old diagnosed with CRSwNP who underwent ESS were alternately assigned to an experimental group (A) of 13, where an improvised nasal airway (nasogastric) tube was placed in addition to the nasal pack or a control group (B) of 13 with nasal packing alone. Results: There was a significant difference in subjective nasal airflow between experimental (A) and control (B) groups during the immediate postoperative period where the mean subjective airflow was 8.07 and 0.00 over 10.00, respectively. No significant difference was noted between the groups in terms of age, gender, severity of polyposis and overall pain score. No complications such as bleeding, Toxic Shock Syndrome, vestibular or alar injury and septal necrosis were noted immediately post-op and after one week follow-up in both groups. An approximate cost of PhP 25 was added to group A. Conclusion: An improvised nasal airway using a nasogastric tube provides adequate airflow without additional pain in the immediate postoperative period. It is safe to use and an affordable option for patients in need of nasal airway stents residing in areas where a preformed nasal packing with incorporated tube stent is not available.

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Comparison of polyvinyl alcohol coated nasal packing with non-absorbable nasal packing

Rhinology Journal ◽

10.4193/rhino12.176 ◽

2013 ◽

Vol 51 (2) ◽

pp. 137-142

Author(s):

J.H. Seol ◽

J.M. Kim ◽

S.S. Kim ◽

B.R. Na ◽

H. Jung ◽

...

Keyword(s):

Wound Healing ◽

Polyvinyl Alcohol ◽

Endoscopic Sinus Surgery ◽

Bleeding Time ◽

Postoperative Bleeding ◽

Visual Analog Scale Score ◽

Packing Material ◽

Nasal Packing ◽

Sinus Surgery ◽

Significant Difference

Background: A number of different nasal packing materials are available for prevention of nasal bleeding after endoscopic sinus surgery. Polyvinyl alcohol (PVA) coated nasal packing is an expandable packing for use in rhinological surgery. This innovative surf- ace treatment helps to reduce the possibility of adherence to tissue and of blood clotting within the sponge. The present study investigated the effects of PVA coated packing and non-absorbable packing with respect to pain, healing site and postoperative bleeding following endoscopic sinus surgery. Methodology: Patients between 18-80 years of age undergoing sinus surgery were enrolled. Each patient`s ethmoid cavities were randomised to receive PVA coated packing material or the standard non-absorbable sinus packs. The remaining nasal packing material was removed on the 2nd day in the clinic. We determined visual analog scale score, bleeding time and wound healing status. A single rhinologist graded postoperative endoscopic appearance. Length of follow-up was 3 months. Results: Thirty three patients were recruited. There was a significant difference in the bleeding time between the two groups, but pain and wound healing were not significantly different between the two groups. Conclusion: PVA-coated nasal packing presents comparable characteristics with traditional nasal packing.

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Effect of polyvinyl acetal sponge nasal packing on post-operative care of nasal polyposis patients: a randomised, controlled, partly blinded study

The Journal of Laryngology & Otology ◽

10.1017/s0022215111003471 ◽

2012 ◽

Vol 126 (4) ◽

pp. 380-384 ◽

Cited By ~ 5

Author(s):

B Saedi ◽

M Sadeghi ◽

S Farschi

Keyword(s):

Endoscopic Sinus Surgery ◽

Nasal Polyposis ◽

Controlled Trial ◽

Nasal Packing ◽

Sinus Surgery ◽

Tertiary Referral Centre ◽

Operative Care ◽

Significant Difference ◽

Blinded Study ◽

Randomised Controlled

AbstractObjective:To compare the effects of routine nasal packing with polyvinyl acetal sponge (Merocel) versus no packing, after endoscopic sinus surgery for nasal polyposis.Subjects and methods:This clinical, randomised, controlled trial was performed in an academic tertiary referral centre between 2008 and 2011. Sixty patients with resistant nasal polyposis underwent endoscopic sinus surgery, and were then randomly divided into two groups: packed and non-packed. The amount of bleeding and pain in each group during pack removal was documented.Results:There was no significant difference between the two groups in the outcome of surgery and complications. One patient in each group needed extra packing. In the packed group, the mean ± standard deviation pain score on pack removal was 61 ± 3 (using a visual analogue scale in which 0 = no pain and 100 = worst pain imaginable).Conclusion:This study found no significant difference between polyvinyl acetal packed and non-packed groups, following endoscopic sinus surgery for nasal polyposis. This confirms the findings of similar studies, and supports the reconsideration of routine post-operative packing in selected cases.

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Comparison of Absorbable Packing versus No Packing in Wound Healing after Endoscopic Sinus Surgery: A Systematic Review and Pooled Analysis

ORL ◽

10.1159/000514793 ◽

2021 ◽

pp. 1-8

Author(s):

Zhenxiao Huang ◽

Bing Zhou

Keyword(s):

Systematic Review ◽

Wound Healing ◽

Endoscopic Sinus Surgery ◽

Adhesion Formation ◽

Pooled Analysis ◽

Nasal Packing ◽

Sinus Surgery ◽

Cochrane Library ◽

Significant Difference ◽

Mucosal Edema

Introduction: Nasal packing after endoscopic sinus surgery (ESS) is controversial. The aim of this systematic review was to compare absorbable packing versus no packing in wound healing after ESS for the treatment of chronic rhinosinusitis. Data Source: English electronic databases, including Cochrane Library, EMBASE, MEDLINE, and PubMed, were searched, and only randomized controlled trials were included. Methods: The outcome measures were the presence of synechiae/adhesion formation, mucosal edema, crusting, granulation formation, and infection. The McNemar’s test was used for pooled analysis. Results: Four studies with 148 participants were included. The pooled analysis showed that absorbable packing may offer benefit in reducing adhesion at 6–8 weeks (odds ratio [OR]: 0.3864; 95% confidence interval [CI]: 0.2136–0.7235) and 12 weeks (OR: 0.2396, 95% CI: 0.08267–0.7709) postoperatively compared with no packing. There was no significant difference between the packed and the unpacked side at 2, 6–8, and 12 weeks after ESS in terms of presence of crusting, edema, and granulation formation. Conclusion: There is insufficient evidence to suggest that absorbable packing after ESS does not increase mucosal edema, granulation formation, and infection. However, the absorbable packing may be more effective than no packing for the prevention of mucosal adhesion after ESS. The use of absorbable nasal packing after ESS is recommended when used to reduce postoperative mucosal adhesion. More research in this area is clearly needed.

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Comparison of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

Romanian Journal of Rhinology ◽

10.2478/rjr-2019-0011 ◽

2019 ◽

Vol 9 (34) ◽

pp. 91-95

Author(s):

Ramiya Ramachandran Kaipuzha ◽

Nirmal Coumare Venkataramanujam ◽

Padmanabhan Karthikeyan ◽

Davis Thomas Pulimoottil

Keyword(s):

Endoscopic Sinus Surgery ◽

Mucosal Injury ◽

Sinus Surgery ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Mean Time ◽

Sinonasal Polyposis

AbstractOBJECTIVE. To study and compare the benefits of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery in terms of subjective and objective improvement in symptoms of nasal polyposis.MATERIAL AND METHODS. This study involved 60 patients with bilateral sinonasal polyposis scheduled to undergo Endoscopic Sinus Surgery. The patients were randomized into two groups: Group A -Conventional endoscopic sinus surgery and Group B -Microdebrider-assisted endoscopic sinus surgery.RESULTS. There was a significant difference in the mean VAS at 3 months postoperatively in Group B, but no significant difference at 6 months postoperatively following either of the two methods. The mean time for surgery (p<0.01) and the mean intraoperative blood loss (p<0.01) were significantly lower in Group B.CONCLUSION. A well-trained surgeon with proper anatomical knowledge, good instruments, hypotensive anaesthesia, minimal mucosal injury and regular proper follow-up will have similar postoperative results with both methods.

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Postoperative airway management after nasal endoscopic sinus surgery: A comparison of traditional nasal packing with nasal airway

Anesthesia Essays and Researches ◽

10.4103/0259-1162.114017 ◽

2013 ◽

Vol 7 (1) ◽

pp. 116 ◽

Cited By ~ 1

Author(s):

SukhminderJit Singh Bajwa ◽

Jasbir Kaur ◽

SS Parmar ◽

Amarjit Singh ◽

Sunder Singh

Keyword(s):

Airway Management ◽

Endoscopic Sinus Surgery ◽

Nasal Packing ◽

Sinus Surgery ◽

Nasal Airway

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A double-blind randomised controlled trial of gloved versus ungloved merocel middle meatal spacers for endoscopic sinus surgery

Rhinology Journal ◽

10.4193/rhino11.215 ◽

2012 ◽

Vol 50 (3) ◽

pp. 306-310

Author(s):

E. Akbari ◽

C.M. Philpott ◽

A.J. Ostry ◽

A. Clark ◽

A.R. Javer

Keyword(s):

Endoscopic Sinus Surgery ◽

Controlled Trial ◽

Visual Analogue Score ◽

Mucosal Healing ◽

Nasal Packing ◽

Sinus Surgery ◽

Mucosal Inflammation ◽

Lateral Side ◽

Double Blind ◽

Significant Difference

Background: Middle meatal spacers are commonly used following endoscopic sinus surgery to prevent post-operative bleeding and lateralization of the middle turbinates. The effects of nasal packing on post-operative sinonasal mucosal healing remain unknown in humans. Objective: This study aims to compare the histopathalogical effects of Merocel and Merocel covered with a finger glove on mucosal healing, and patients` discomfort immediately post-operatively after endoscopic sinus surgery and at removal of the nasal packing. Methods: Thirty-seven patients with chronic rhinosinusitis undergoing bilateral endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive Merocel middle meatal spacer (MMMS) in one nostril and finger glove Merocel middle meatal spacer (FGMMS) in the contra lateral side. Patients were seen on post-operative day 6, and completed a visual analogue score reporting the post-operative discomfort from nasal packing on each side. Following the removal of nasal packing, patients indicated which side caused more discomfort on removal. Biopsies were taken from the middle turbinates and sent to a blinded pathologist who scored the level of mucosal inflammation from 0 - 4. Results: There was no statistically significant difference between MMMS and FGMMS in regards to their effect on sinonasal mucosal inflammation and discomfort post-operatively. A statistically significant difference was noted with respect to discomfort at removal with the uncovered Merocel more likely to cause discomfort when compared to the Merocel covered in a glove finger. Conclusion: MMMS and FGMMS are equivalent in the amount of sinonasal mucosal inflammation and discomfort post endoscopic sinus surgery. However, the main advantage of the FGMMS was a significant reduction in pain on removal when compared with the MMMS.

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Comparison of dexmedetomidine versus propofol-based anaesthesia for controlled hypotension in functional endoscopic sinus surgery

Southern African Journal of Anaesthesia and Analgesia ◽

10.36303/sajaa.2019.25.2.2051 ◽

2019 ◽

pp. 37-40

Author(s):

DK Bharathwaj ◽

SS Kamath

Keyword(s):

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Controlled Hypotension ◽

Significant Difference ◽

Group A ◽

Group B

Background: Increased intraoperative bleeding during functional endoscopic sinus surgery (FESS) affects operative field visibility, which increases both duration of surgery and frequency of complications. Controlled hypotension is an anaesthetic technique in which there is deliberate reduction of systemic blood pressure during anaesthesia. The aim of the study was to compare the efficacy of dexmedetomidine against propofol infusion when used for controlled hypotension during FESS. Methods: A randomised, prospective, and single-blinded study was carried out, which included 80 patients of either sex of ASA grade І & ІІ who underwent elective FESS. Patients were randomly assigned to two groups: Group A (dexmedetomidine), Group B (propofol). Intraoperative mean arterial pressure (MAP), heart rate (HR), surgical grade of bleeding (based on the Fromme– Boezzart scale), and amount of bleeding were recorded. Results: Groups were well matched for their demographic data. There was a statistically significant difference (p < 0.05) between Group A and Group B in heart rate, mean arterial pressure (MAP) and mean total blood loss, with Group A being effectively in controlled on all three parameters during FESS. However, there was no significant difference (p > 0.05) in terms of surgical grade of bleeding between Group A and Group B. Conclusions: Both dexmedetomidine and propofol infusion are efficacious to facilitate controlled hypotension and haemodynamic stability intraoperatively.

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The management of postoperative airway after nasal endoscopic sinus surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204405 ◽

2020 ◽

Vol 6 (11) ◽

pp. 1956

Author(s):

Ashish Sharma ◽

Nagababu Pyadala

Keyword(s):

Endoscopic Sinus Surgery ◽

Nasal Packing ◽

Sinus Surgery ◽

Internal Diameter ◽

Nasal Airway ◽

Nasal Surgery ◽

Respiratory Parameters ◽

Group 3 ◽

Group 2 ◽

Group 1

Background: Nasal surgery followed by nasal packing can be vulnerable due to airway complications like, respiratory blockage and dyspnea. Thus the present study aimed to compare the nasal packing with nasal airway after the nasal surgery for the airway management.Methods: A total of 120 patients for fibreoptic endoscopic sinus surgery were included in this study. All subjects were equally divided in to 3 groups; group 1, 40 patients with traditional bilateral nasal packing; group 2, 40 patients with 5 mm internal diameter uncuffed ETT in to one of the nostrils and bilaterally in group 3 40 patients. During postoperative period all data were recorded and analyzed by using statistical analysis software 20.0.Results: In case of group 1 patients cardio-respiratory parameters reported significant variation. Pain and bleeding during removal of nasal airway and discomfort showed significant results among group 1 patients than in group 2 and group 3 patients.Conclusions: This study showed that the new intervention to manage the airway obstruction has benefits as compared to traditional nasal packing with ease of suctioning, oxygen supplementation.

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A double-blind randomised controlled trial of gloved versus ungloved merocel middle meatal spacers for endoscopic sinus surgery

Rhinology Journal ◽

10.4193/rhino10.215 ◽

2012 ◽

Vol 50 (3) ◽

pp. 306-310

Author(s):

E. Akbari ◽

C.M. Philpott ◽

A.J. Ostry ◽

A. Clark ◽

A.R. Javer

Keyword(s):

Endoscopic Sinus Surgery ◽

Controlled Trial ◽

Visual Analogue Score ◽

Mucosal Healing ◽

Nasal Packing ◽

Sinus Surgery ◽

Mucosal Inflammation ◽

Lateral Side ◽

Double Blind ◽

Significant Difference

BACKGROUND: Middle meatal spacers are commonly used following endoscopic sinus surgery to prevent post-operative bleeding and lateralization of the middle turbinates. The effects of nasal packing on post-operative sinonasal mucosal healing remain unknown in humans. OBJECTIVE: This study aims to compare the histopathalogical effects of Merocel and Merocel covered with a finger glove on mucosal healing, and patients` discomfort immediately post-operatively after endoscopic sinus surgery and at removal of the nasal packing. METHODS: Thirty-seven patients with chronic rhinosinusitis undergoing bilateral endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive Merocel middle meatal spacer (MMMS) in one nostril and finger glove Merocel middle meatal spacer (FGMMS) in the contra lateral side. Patients were seen on post-operative day 6, and completed a visual analogue score reporting the post-operative discomfort from nasal packing on each side. Following the removal of nasal packing, patients indicated which side caused more discomfort on removal. Biopsies were taken from the middle turbinates and sent to a blinded pathologist who scored the level of mucosal inflammation from 0 - 4. RESULTS: There was no statistically significant difference between MMMS and FGMMS in regards to their effect on sinonasal mucosal inflammation and discomfort post-operatively. A statistically significant difference was noted with respect to discomfort at removal with the uncovered Merocel more likely to cause discomfort when compared to the Merocel covered in a glove finger. CONCLUSION: MMMS and FGMMS are equivalent in the amount of sinonasal mucosal inflammation and discomfort post endoscopic sinus surgery. However, the main advantage of the FGMMS was a significant reduction in pain on removal when compared with the MMMS.

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EFFICACY OF FUNCTIONAL ENDOSCOPIC SINUS SURGERY(FESS) IN TREATMENT OF POST NASAL DRIP (PND) AS AN ANCILLARY PROCEDURE: A COMPARATIVE STUDY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.7945 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S573-76

Author(s):

Saleem Asif Niazi ◽

Shahzad Maqbool ◽

Zafar Ullah Khan ◽

Abdul Hakim ◽

Muhammad Umair Aasim ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Predominant Symptom ◽

Postnasal Drip ◽

Significant Difference ◽

Quasi Experimental ◽

Group A ◽

Group B

Objective: To assess efficacy of functional endoscopic sinus surgery (FESS) in treatment of postnasal drip (PND) as an ancillary procedure to Septoplasty with Turbinoplasty. Study Design: Quasi experimental study. Methodology: Sample size was n-200, Patients were placed in two groups Group A (n-126) had septoplasty with turbineplasty. Group B (n-74) included patients with Septoplasty and Turbinoplasty combined with functional endoscopic sinus surgery. Post operative results regarding postnasal drip were compared amongst the Two groups. Results: Data was analysed in SPSS-17, Septoplasty along with turbinectomy was performed in n-126 patients (group A). And septoplasty, turbinectomy along with functional endoscopic sinus surgery was performed in n-74 patients (group B). Post nasal drip was significantly reduced in group B at 3 months follow up (p<0.046). More significant difference was noted at 6 months follow up (p<0.003). Conclusion: Patients having Chronic rhinosinusitis with postnasal drip as predominant symptom, should undergo functional endoscopic sinus surgery as an ancillary procedure to conventional nasal surgery.

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