Efficiency of Repetitive Topical Corticosteroid Embedded Nasopore Tamponing on Wound Healing After Endoscopic Sinus Surgery

Yıl 2018, Sayı: 4, 309 - 317, 20.04.2018

Ümit Taşkın Kadir Yücebaş Şahin Öğreden Mehmet Erdil Mehmet Faruk Oktay Necip Ozan Tiryakioğlu Abdullah Yüksel Barut

Öz

Aim: We aimed to maximize the efficiency of topical
steroid use in the sinus cavity by application for an extended duration after
endoscopic sinus surgery. We also evaluated the efficiency of repetitive
application of a topical steroid through the sinus cavity directly on wound
healing and earlier postoperative complications.

Method:
Thirty-five patients who underwent bilateral endoscopic sinus surgery were
included in our study. Upon completion of the surgery, randomly, one side of
the middle meatus was packed with NasoPore, embedded with a nasal steroid
(budesonide 0.5µg/2ml), plus antibiotic cream, and the other side was packed
with NasoPore embedded with only antibiotic cream. All the patients were
scheduled for follow-up visits at 1, 2, 4, 8, and 12 weeks after surgery for
the assessment of outcome measures.

Findings:
The mean score of synechia, mucosal edema, and granulation tissue was lower in
steroid embedded group than nonembedded one, during the first three months
after surgery. However, there were no statistically significant differences
between the two groups. The mean score of edema was significantly decreased in
steroid embedded group when compared to other group.

Conclusion: We believe that the use of a steroid embedded in an
absorbable nasal packing after ESS is highly safe and effective in prevention
of early postop ESS complications, including synechia and granulation. 

Anahtar Kelimeler

Endoscopic surgical prosedure, postoperative period, wound healing

Endoskopik Sinus Cerrahisi Sonrası Tekrarlı Topikal Kortikosteroid Uygulamasının Etkinliği

Öz

Amaç: Endoskopik sinus cerrahisi (ESC) sonrası sinus
boşluğunda uzun sureli topikal steroid uygulamasının etkilerini arttırmayı
hedefledik.  Ayrıca sinus boşluğuna
tekrarlı topikal steroid uygulamasının doğrudan yara iyileşmesine ve erken
postoperative komplikasyonların önlenmesine olan etkisini değerlendirdik. 

Yöntem:
Çalışmaya bilateral endoskopik sinus cerrahisi uygulanan otuz beş hasta dahil
edildi. Cerrahi müdahalenin tamamlanması sonrası orta meatusun bir tarafına
nazal steroid içeren NasoPore (budesonide 0.5µg/2ml) ve antibiyotik krem diğer
tarafına sadece antibiyotik krem yerleştirildi. Bütün hastalar 1.,2.,4.,8., ve
12. haftalarda müdahale sonuçlarının gözlemlenmesi amacıyla muayene edildi.

Bulgular:
Operasyon sonrası ilk üç ayda steroid uygulanan grupta ortalama sineşi, mukozal
ödem ve doku granülasyonu skorları uygulanmayan gruba göre daha düşüktür. Fakat
iki grup arasında istatistiksel olarak anlamlı bir fark gözlemlenememiştir.
Ortalama ödem skoru steroid grubunda diğer gruba kıyasla önemli derecede daha
düşüktür.

Sonuç:
ESC sonrası emilebilir nazal paket aracılığıyla steroid kullanımının oldukça
güvenli olduğuna ve sineşi ve granülasyon gibi erken postoperatif ESC
komplikasyonlarının önlenmesinde etkili olduğunu düşünmekteyiz.   

Anahtar Kelimeler

Endoskopik cerrahi işlem, postoperatif dönem, yara iyileşmesi

Kaynakça

• Wee JH, Lee CH, Rhee CS, Kim JW. Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients. Eur Arch Otorhino. 2012;269(3):897–903. doi: 10.1007/s00405-011-1768-7.
• Antisdel JL, West-Denning JL, Sindwani R. Effect of microporous polysaccharide hemospheres (MPH) on bleedingafter endoscopic sinus surgery: Randomized controlled study. Otolaryngol Head Neck Surg. 2009;141(3):353–357. doi: 10.1016/j.otohns.2009.06.078.
• Singhal D, Psaltis AJ, Foreman A, Wormald PJ. The impact of biofilms on outcomes after endoscopic sinus surgery. American Journal of Rhinology & Allergy. 2010;24(3):169-174. doi: 10.2500/ajra.2010.24.3462.
• Brown CL, Graham SM. Nasal irrigations: Good or bad? Curr Opin Otolaryngol Head Neck Surg. 2004;12(1):9-13.
• Ramakrishnan VR, Suh JD. How necessary are postoperative debridements after endoscopic sinus surgery? Laryngoscope. 2011;121(1):8-9. doi: 10.1002/lary.21351.
• Li PM, Downie D, Hwang PH. Controlled steroid delivery via bioabsorbable stent: Safety and performance in a rabbit model. Am J Rhinol Allergy. 2009;23(6):591-596. doi: 10.2500/ajra.2009.23.3391.
• Cote DW, Wright ED. Triamcinolone-impregnated nasal dressing following endoscopic sinus surgery: A randomized, double-blind, placebo-controlled study. Laryngoscope. 2010;120(6):1269-1273. doi: 10.1002/lary.20905.
• Zitt M, Kosoglou T, Hubbell J. Mometasone furoate nasal spray: A review of safety and systemic effects. Drug Safety. 2007;30(4):317–326.
• Kastl KG, Betz CS, Siedek V, Leunig A. Effect of carboxymethylcellulose nasal packing on wound healing after functional endoscopic sinus surgery. Am J Rhinol Allergy. 2009;23(1):80–84.
• Welch KC, Thaler ER, Doghramji LL, Palmer JN, Chiu AG. The effects of serum and urinary cortisol levels of topical intranasal irrigations with budesonide added to saline in patients with recurrent polyposis after endoscopic sinus surgery. Am J Rhinol Allergy. 2010;24(1):26-28. doi: 10.2500/ajra.2010.24.3418.