Use of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery

Background Chronic rhinosinusitis with nasal polyps recurs frequently after functional endoscopic sinus surgery (FESS), with resultant poor quality of life with persistence of nasal obstruction, sinus aches, and discharge as well anosmia and dysgysia; revision FESS is usually the treatment of choice referred to relief patients’ suffering, yet it is not always the case, patients preference as well as fitness for general hypotensive anesthesia, patients age, cardiopulmonary status, and concurrent bronchial asthma might render unfit for an elective procedure. The aim of this study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery. Results Thirty patients suffering from recurrent sinonasal polyposis after single or multiple FESS procedures were selected; all patients were subjected to intranasal application of gelfoam soaked with triamcinolone as a conservative medical office procedure using triamcinolone-soaked absorbable gelatin foam (gelfoam) weekly for a period of 8 weeks followed by intranasal steroid nasal spray for maintenance and as anti-recurrence measure. Patients were followed up for 4 months post-intervention; Meltzer Clinical Scoring System was used to analyze the patients’ pre- and post-intervention via office endoscopy (0° 4-mm Hopkins endoscope). All patients tolerated the procedure well. The study group showed no statistical significance pre-intervention which comprised 17 (56.7%) patients with grade 4 sinonasal polyposis extent and 13 (43.3%) patients with grade 3 sinonasal polyposis extent (P=0.795), denoting no difference between patients pending treatment option. Post-treatment, both groups showed a significant reduction in the extent of polyposis (P<0.001) where post-treatment showed 21 (70%) patients with grades 0 no polyps and 9 (30%) patients with grade 1 sinonasal polyposis extent. Conclusion Triamcinolone-soaked gelfoam packing is an effective and safe method for managing recurrent sinonasal polyposis after FESS. Intervention contributed to a successful result, decreased the need for surgery in poor candidates for hypotensive anesthesia, and could be used as a sole treatment of recurrent sinonasal polypsis in elderly patients whose general condition could not tolerate invasive procedures.

Prevalence of allergic fungal sinusitis among patients with nasal polyposis

Objective: The objectives of the study were to determine the frequency of AFS among patients with nasal polyps and to compare the Lund-Mackay scores of patients with and without AFS. Methods: The study was carried out at a tertiary health care center of Karachi, Pakistan from December 2016 to November 2018, after taking ethical approval. Total of 114 patients with sinonasal polyposis undergoing surgery were included. Patients were categorized as case of AFS when histopathology showed allergic mucin with fungal hyphae and culture was positive for fungal growth. Lund-Mackay scoring based on CT PNS of each patient was done and mean scores of AFS and non AFS patients were compared. Results: Mean age of 114 participants was 37.3 ± 15.3 years. 61 (53.5%) of them were males. 27 (23.7%) patients met the AFS criteria. 19 (16.7%) patients were asthmatic and a significant relationship was found between asthma and AFS (P = 0.03). The mean Lund-Mackay score was 13.2 for non AFS and 18.8 for AFS patients (P = <0.01). Recurrence was seen in 11 (9.6%) cases. Conclusion: The frequency of AFS in patients with nasal polyps was 23.7% and the patients with AFS showed significantly higher mean Lund-Mackay score compared to non AFS patients. Continuous....

Effect of topical furosemide on sinonasal polyposis relapse after endoscopic sinus surgery

<p class="abstract"><strong>Background: </strong>Chronic rhinosinusitis with nasal polyposis (CRSwNP) relapse is commonly seen during follow up period after endoscopic sinus surgery. Some studies claim the credibility of topical furosemide in preventing the polyposis recurrence after surgery. This randomised control trial was done to check the effectiveness of topical furosemide on sinonasal polyposis relapse after the endoscopic sinus surgery.</p><p class="abstract"><strong>Methods:</strong> In the current study, 44 patients, attending ENT department, VSSIMSAR, for follow up after endoscopic sinus surgery, were evaluated clinically and endoscopically to demonstrate the prevalence and severity of polyposis relapse using Visual analogue scale (VAS) and meltzer endoscopic grading, before initiating the intervention. Patients were then randomised in two groups- one receiving topical furosemide nebulization and other intranasal normal saline spray, respectively. All patients were evaluated again at 1st, 2nd, 4th and 6th month follow-ups by VAS and MEG, setting statistical significance at p&lt;0.05.</p><p class="abstract"><strong>Results:</strong> The MEG was grade 0 in 77% (17) patients of furosemide group and 32% (7) of normal saline group (p=0.0147). Statistically significant improvement was also observed in VAS for nasal symptoms in former group (p=0.028) than latter. The rate of relapse was less (23.81%) in furosemide group as compared to normal saline group (65%) but result not statistically significant at p&lt;0.05.</p><p class="abstract"><strong>Conclusions:</strong> Topical furosemide can be used as a valid therapeutic approach for reducing the severity of sinonasal polyposis relapse after endoscopic sinus surgery with no known side effects of furosemide when administered topically.</p><p> </p>

Study of Nasal Polyps in a Tertiary Care Hospital

Nasal polyps are macroscopic oedematous lesions in the nose openings are the most common problem of the patients. Main causes of the polyps are due to inflammatory conditions and allergy. An association with asthma, aspirin sensitivity and cystic fibrosis was seen in the population. The main objectives of medical treatment of nasal polyps are to eliminate or reduce the size of the polyps thereby improving the symptoms of rhinitis and breathing. The clinical characteristics and treatment pattern among the 125 patients having nasal polyps was analyzed by a retrospective, observational study using patient’s medical records and hospital data management system. Males predominated in the present study (64.8%) and majority of the patients were in the age group of 41-60 years (44%). Most of the patients suffered from sinonasal polyposis (76.8%) with the main symptom being nasal block (88.8%). Most of the polyps were of the inflammatory origin (53.6%). Asthma and rhinitis were observed in 11% patients. Majority of the patients were treated with corticosteroids and antihistamines. Many patients required surgery for the management of nasal polyps. Nasal polyps appear to be associated with inflammatory and may be an allergic response. Most of the patients require surgery while few can be managed with anti-inflammatory and/or anti-allergic drugs.

the Frequency of Intranasal Synechiae Formation between Nasal Septum and Lateral Nasal Wall after Endoscopic Sinus Surgery Among Patients with Sinonasal Polyposis

Objectives: To determine the frequency of intranasal synechiae formation between lateral nasal wall and nasal septum after (ESS) Endoscopic Sinus Surgery among patients with Sino nasal Polyposis Methods: After obtaining approval from the ethical committee of our Hospital, a total number of 150 subjects fulfilling the study criteria were recruited in the research which was conducted in the department of Otorhinolaryngology, Services Hospital, Lahore. Demographic information (name, age, gender, contact details) was also obtained were included in this study. All the patients underwent ESS and were followed up post operatively at the end of 1st, 2nd, 3rd and 4th weeks respectively, to observe the formation of synechiae. Results: Age range in this study was between 21-40 years out of which a small number of patients were < 20 years old. Mean age of the patients was 35.30±10.54 years. Male patients were 80 (53.3%) while female patients were 70 (46.7%). Intranasal Synechiae formation was observed in 28 patients (18.7%). Conclusion: Intranasal Synechiae formation between lateral nasal wall and nasal septum was found in 18.4% of the patients after endoscopic sinus surgery. Keywords: Sino nasal polyposis, ESS, Intranasal Synechiae Formation