The efficacy of esmolol,remifentanil and nitroglycerin in controlled hypotension for functional endoscopic sinus surgery

IntroductionControlled hypotension is a reversible procedure in which the patient’s baseline mean arterial blood pressure is reduced by 30% and sustained at 60–70 mmHg during the procedure. It decreases blood loss and provides clear surgical field during the procedures.ObjectivesThe purpose of this study was to compare the efficacy of controlled hypotension agents esmolol, remifentanil, and nitroglycerin in functional endoscopic sinus surgery, in terms of hemodynamic changes and impact on the surgical efficiency.MethodsThe research was carried out as a cohort study. Patients who underwent functional endoscopic sinus surgery were randomized into 3 groups. Controlled hypotension was achieved with remifentanil (Group R), esmolol (Group E) and nitroglycerin (Group N). The efficacy of the drugs was tested by comparing the length of time with the targeted mean arterial pressure, the amount of anesthetics used, surgical field bleeding score and surgeon’s satisfaction.ResultsBetween May to December 2015, 60 patients were included and randomized equally into 3 different study groups. The median of the length of time with the targeted mean arterial pressure was shorter in the Group R when compared with Group E (p = 0.01) and Group N (p = 0.14). The amount of volatile anesthetics used was 25.0 mL (15–51), 43.0 mL (21–105) and 40.0 mL (26–97) in Groups R, E and N, respectively (p < 0.001). While there was more bleeding with nitroglycerin, surgical field bleeding scores were lower in Group R when compared with esmolol (p = 0.001) and nitroglycerin (p < 0.001). The analysis of surgeon’s satisfaction scores concluded that surgeons were more satisfied with the group R (100%), when compared with group E (60%) and group N (30%) (p < 0.001).ConclusionLess volatile agent, short time to achieve controlled hypotension, stable blood pressure, lower surgical field bleeding scores and larger length of time with the targeted mean arterial pressure were found as the advantages of Remifentanil. Less costly, efficiency of achieving the targeted median arterial pressure and less postoperative complications were the advantages of nitroglycerin. In functional endoscopic sinus surgery procedures, appropriate controlled hypotensive agents should be selected according to the patients’ characteristics and advantages/disadvantages of the drugs.     

The evolution of sinus surgery in England in the last decade – An observational study

Background and objectiveSinus surgery has seen significant changes over the years with advancements in instruments, endoscopes and imaging. This study aimed to use Hospital Episode Statistics (HES) data to review the total number of sinus related procedures performed in both adults and children across England and identify whether there were any trends across the study period. We predicted an increase in endoscopic sinus procedures with a decline in open approaches to the paranasal sinuses.MethodsData from HES was extracted for the years 2010–2019. The operative (OPCS-4) codes relevant to all sinus procedures between E12.1 and E17.9 were analysed. After examination of overall sinus related procedures, further subgroup analysis was performed with regards to open or endoscopic techniques.ResultsThe total number of sinus procedures performed between 2010 and 2019 was 89,495. There was an increase in endoscopic surgeries by 21.1% and a decrease of open surgeries 35.3% during this time. There was an overall increase in maxillary, frontal and sphenoid sinus procedures, with a decrease in ethmoid sinus and lateral rhinotomy operations. There was an increase in the proportion of endoscopic cases overall by 5.7% and for all sinuses individually.ConclusionOverall, we see an increase in sinus surgery over the last 9 years from 2010 to 2019. These findings are in keeping with our initial hypotheses. Although our data set is limited by coding, and lack of patient factors, it represents most, if not all, of the data in England over a large study period. It is therefore useful to add to previous studies when demonstrating the increasing popularity of endoscopic sinus surgery over open procedures.     

The evolution of sinus surgery in England in the last decade – An observational study

Background and objectiveSinus surgery has seen significant changes over the years with advancements in instruments, endoscopes and imaging. This study aimed to use Hospital Episode Statistics (HES) data to review the total number of sinus related procedures performed in both adults and children across England and identify whether there were any trends across the study period. We predicted an increase in endoscopic sinus procedures with a decline in open approaches to the paranasal sinuses.MethodsData from HES was extracted for the years 2010–2019. The operative (OPCS-4) codes relevant to all sinus procedures between E12.1 and E17.9 were analysed. After examination of overall sinus related procedures, further subgroup analysis was performed with regards to open or endoscopic techniques.ResultsThe total number of sinus procedures performed between 2010 and 2019 was 89,495. There was an increase in endoscopic surgeries by 21.1% and a decrease of open surgeries 35.3% during this time. There was an overall increase in maxillary, frontal and sphenoid sinus procedures, with a decrease in ethmoid sinus and lateral rhinotomy operations. There was an increase in the proportion of endoscopic cases overall by 5.7% and for all sinuses individually.ConclusionOverall, we see an increase in sinus surgery over the last 9 years from 2010 to 2019. These findings are in keeping with our initial hypotheses. Although our data set is limited by coding, and lack of patient factors, it represents most, if not all, of the data in England over a large study period. It is therefore useful to add to previous studies when demonstrating the increasing popularity of endoscopic sinus surgery over open procedures.     

Juvenile psammomatoid ossifying fibroma in paranasal sinus and skull base

Conclusion: The endoscopic transnasal approach with IGS is a safe and effective technique, allowing completely resection of JPOF, with minimal morbidity and recurrence.

Objectives: JPOF is a benign but locally aggressive fibro-osseous lesion. This study presents a series of JPOF cases, involving anterior skull base and orbit, treated by endoscopic transnasal approach with image guidance system (IGS) to resect the mass completely.

Method: This study retrospectively reviewed the clinical presentations, surgical procedures, and complications of 11 patients with JPOF who were treated by endoscopic approach from May 2009 to April 2014. All patients were followed by endoscopic and CT scan evaluations during follow-up.

Results: All of the 11 cases were boys, with a mean age of 11.8 years (range?=?6–17 years). The size of mass in the paranasal sinus ranged from 2.5–4.6?cm in greatest dimension (mean?=?3.7?cm), and the medial orbital wall and cranial base were involved in all patients. All 11 patients received successful operation and were relieved from symptoms without mortality and major complications. During follow-up (range from 17–67 months; mean follow-up?=?25.8 months), only one patient was recurrent in local position. The skull base partial resected during surgery was found to rebuild after 1 year.     

The effect of beta-blocker premedication on the surgical field during endoscopic sinus surgery

OBJECTIVES/HYPOTHESIS: A number of previous studies have tried to assess the effects of hypotension on the surgical field during endoscopic sinus surgery. These studies have been limited by inadequate sample sizes, lack of a control group, and limited data collection. The aim of the present study was to determine whether the routine use of beta-blockers as a pre-medication could improve the operative field in endoscopic sinus surgery. STUDY DESIGN: A prospective, randomized, double-blinded, placebo-controlled trial. METHODS: Eighty patients undergoing endoscopic sinus surgery who fit the inclusion and exclusion criteria were randomly assigned to receive either a beta-blocker, Metoprolol (group 1), or a placebo tablet (group 2) 30 minutes before surgery. A standard anesthetic protocol was followed. At the commencement of surgery and at regular 15-minute intervals the surgical field, blood loss, heart rate, blood pressure, and isoflurane concentration were assessed. RESULTS: There was a significant difference in overall mean heart rate between the placebo and beta-blocker groups (P <.0001). In the entire group, surgical grade correlated with heart rate (r = 0.36, P <.05) but not with mean arterial blood pressure. Mean surgical grade was similar between the placebo and beta-blocker groups, but early in the study a significantly better surgical field was recorded in the beta-blocker group (P <.001). Surgical grade was significantly better in those with a mean heart rate of less than 60 beats per minute (P <.02). CONCLUSION: Although "optimum" conditions were present in the patients receiving beta-blocker, the authors thought that the grading system was not discriminating enough to demonstrate a significant difference between the groups. The crucial finding in the study was the correlation between heart rate and surgical grade in the entire group. During endoscopic sinus surgery surgery, anesthetic manipulations should be directed at maintaining a low heart rate.     

Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study

BACKGROUND: Bleeding is a major concern in endoscopic sinus surgery (ESS), as it may impede surgical progress and is often associated with complications. To improve the study and management of intraoperative bleeding, a standardized method of recording bleeding during ESS is needed. The aim of this study was to develop a standardized method of documenting bleeding in ESS and of grading the surgical field. METHODS: Bleeding after endoscopic sinus surgery was recorded using video-endoscopy. Standardized and non-standardized video-endoscopies of 20 patients were graded using a previously published grading scale (the Boezaart scale) in randomized order on two different occasions. Effects of standardization on intra- and interrater reliability were evaluated.Based on this experience, a new 11-point surgical field grading scale was developed and simultaneously compared with the six-point Boezaart scale via means of a DVD in three international centers. RESULTS: Inter and intrarater reliability of the Boezaart and new Wormald scales significantly improved by employing a standardized video-endoscopy technique. The Wormald scale had significantly higher interrater (0.80 vs. 0.74, P < .001) and intrarater (0.89 vs. 0.83, P < .001) reliability than the Boezaart scale. Linear regression analysis revealed the Wormald scale to be more sensitive to changes in the most common surgical fields experienced in ESS. CONCLUSION: Standardized video-endoscopy has been demonstrated to significantly improve reliability and reproducibility of results and is recommended for future work evaluating bleeding in ESS. The new Wormald grading scale has been shown to be an inexpensive, reliable, and sensitive tool to rapidly evaluate intraoperative bleeding in ESS. It overcomes several limitations of the Boezaart scale, enabling us to analyze currently employed and newly developed hemostatic methods and agents.     

Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia?

IntroductionTranexamic acid is a hemostatic agent, which inhibits fibrin degradation, which may be beneficial in controlling bleeding during surgery.ObjectivesThe purpose of this study was to provide a meta-analysis and review of the effects of tranexamic acid on hemorrhage and surgical fields and side effects on patients during endoscopic sinus surgery.MethodsTwo authors independently searched six databases (Medline, Scopus, Embase, Web of Science, Google Scholar and Cochrane library) from the start of article collection until July 2018. Postoperative complications such as intraoperative bleeding, operative time, hypotension, nausea, vomiting, and coagulation profile were included in the analysis of tranexamic acid (Treatment Group) and placebo (Control Group) during the operation.ResultsThe amount of blood loss during surgery was statistically lower in the treatment group compared to the placebo group, and the surgical field quality was statistically higher in the treatment group than in the placebo group. On the other hand, there was no significant difference in operation time, hemodynamics, or coagulation profile between groups. In addition, tranexamic acid had no significant effect on vomiting and thrombosis compared to the Control Group.ConclusionThis meta-analysis has shown that topical administration of tranexamic acid can reduce the amount of bleeding during surgery and improve the overall quality of the surgery. Hemodynamic instability during surgery, vomiting after surgery, or abnormal clotting profile were not reported. Additional studies are needed to confirm the results of this study because there are fewer studies.     

Doyle silicone splint insertion: endoscopy-assisted versus nasal speculum assisted

IntroductionSeptoplasty and endoscopic sinus surgery are very often concurrently performed operations in otolaryngology practice. The most common complication of endoscopic sinus surgery is lateralization of the middle turbinate. In our practice intranasal stenting is done routinely with Doyle silicone splints.ObjectiveRetrospectively, we aimed to review the postoperative period and to document efficacy of endoscopy-assisted Doyle silicone splint application on prevention of middle turbinate lateralization.MethodsPatients who had failed medical therapy and who underwent elective primary endoscopic sinus surgery for chronic rhinosinusitis with septal deviation requiring septoplasty were included to the study. Doyle silicone splints were inserted to all patients at the end of the operation with nasal speculum or with endoscopic assistance. Groups were compared for position of the middle turbinate at the end of the postoperative first month regarding lateralization and for pain score recorded on the second postoperative day.ResultsIn the Doyle silicone splints applied with nasal speculum group, there were 46 patients with a total of 80 operated sides. In the endoscopy assisted group, there were 54 patients with a total of 88 operated sides. At the 1 month follow-up, the mean of middle turbinate position scores was 1.62 in the speculum-assisted group and 1.80 in the endoscopy-assisted group, the difference between two groups was found to be statistically significant. Mean of postoperative second day pain scores were worse in patients with the Doyle silicone splints applied with endoscopic assistance. This difference was found statistically significant.ConclusionIn our study, after concomitant endoscopic sinus surgery and septoplasty, less middle turbinate lateralization was observed when the Doyle silicone splints were inserted with endoscopic guidance. The surgical techniques or methods of sinus packing as well as nasal packing may have an impact on middle turbinate lateralization after concurrent septoplasty and endoscopic sinus surgery.     

轮廓化后半周膜鼻泪管在治疗上颌窦良性病变中的意义

目的 探讨轮廓化后半周膜鼻泪管在治疗上颌窦病变的临床应用效果以及手术方法和适应证。方法 30例上颌窦良性病变患者均行鼻科常规术前检查及鼻窦影像学检查。患者均采用轮廓化后半周膜鼻泪管手术，该术式通过去除鼻泪管骨管后半周骨质及依附其上的黏膜组织，从而扩大上颌窦自然开口，保留鼻泪管膜部，进入窦腔，去除病变。结果 所有患者术中彻底清除病变，完整保护鼻泪管膜部，术后恢复良好，窦腔上皮化良好，病变均无复发，无鼻周局部麻木、鼻翼塌陷、溢泪等并发症。结论 轮廓化后半周膜鼻泪管手术通过保留鼻泪管膜部，可扩大手术视野，增大手术操作空间，从而减小手术损伤，避免并发症，对于处理上颌窦的良性病变有巨大优势，并可最大限度保留鼻腔、上颌窦的生理功能，防止窦口狭窄，是值得推广的手术方式。     

Impact of the Endoscopic Sinus Surgical Simulator on Operating Room Performance

Objectives/Hypothesis The aim of this study is to evaluate an endoscopic sinus surgical simulator (ESS) as a training device and to introduce a methodology to assess its impact on actual operating room performance. Study Design Prospective evaluation of the endoscopic sinus surgical simulator as a trainer. Methods Ten junior and senior ear, nose and throat residents served as subjects, some of whom had prior training with the simulator. The evaluation team collected several measures, which were analyzed for a statistical correlation, including simulator scores, operating room performance rating, ratings of videotaped operating room procedures, and surgical competency rating. Results These findings suggest the ESS simulator positively affects initial operating room performance across all measures as judged by senior surgeons rating anonymous videotapes of those procedures. The two simulation‐trained residents were rated consistently better than the other two residents across all measures. These differences approached statistical significance for two items: anterior ethmoidectomy (P = .06;P <.05) and surgical confidence (P = .09;P <.05). In addition, the 3 subjects with the highest overall scores on the competency evaluation also had 3 of the 4 highest cumulative simulation times. Conclusions The endoscopic sinus surgical simulator is a valid training device and appears to positively impact operating room performance among junior otolaryngology residents.     

Clinical analysis of delayed epistaxis following endoscopic sinus surgery

ObjectiveTo investigate the clinical characteristics and treatment methods associated with delayed epistaxis following endoscopic sinus surgery.MethodsThe clinical data of 46 patients with delayed epistaxis following endoscopic sinus surgery were retrospectively analyzed. To explore the clinical features, pathogenesis, and treatment plan for delayed epistaxis, the postoperative bleeding time, bleeding inducements, systemic complications, surgical approach, the hemorrhage locations and responsible vessels, and treatment methods were analyzed.ResultsThe average bleeding time was 16.34 ± 9.05 days after the operation, and 76.6% of the cases occurred 6–20 days after the operation. Sphenopalatal artery hemorrhage accounted for 69.6% (32/46), the most common of which was a posterior nasal septal artery hemorrhage (17/32). A total of 45 patients received endoscopic low-temperature plasma hemostasis following ineffective nasal packing, and no rebleeding in the ipsilateral nasal cavity was observed during the postoperative follow-up for 3 to 6 months.ConclusionsThe peak of hemorrhaging in delayed epistaxis following endoscopic sinus surgery occurred at 6–20 days post-operatively. Bleeding of the posterior nasal septal artery from the sphenopalatine artery was the most common. Surgical methods were closely related to delayed postoperative hemorrhage. Treatment with low temperature plasma hemostasis under nasal endoscope was found to be effective.     

Influencia de la premedicación con esteroides sistémicos en el sangrado y visualización del campo quirúrgico durante la cirugía endoscópica nasosinusal

IntroductionChronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisting for at least 12 weeks. The success of endoscopic sinus surgery (ESS) depends on minimising oedema and intraoperative bleeding. For this purpose, some surgeons advocate the use of preoperative systemic steroids (SS).Our aim was to assess if the administration of preoperative SS in patients with CRS with or without nasal polyps (NP) facilitates the surgical procedure.MethodsNon-randomized clinical trial in CRS patients with or without NP. Patients in the ESS group received oral meprednisone preoperatively, whereas the control group did not. The visibility of the surgical field, intraoperative bleeding and surgery duration were recorded.ResultsEach group (SS group and control group) included 27 patients. The administration of SS reduced the values of all the parameters in patients without NP, with no significant differences. In patients with NP, only operative bleeding was reduced significantly.ConclusionsEven though all the parameters decreased with the preoperative administration of SS, only operative bleeding was significantly reduced in patients with CRS with NP.     

An evaluation of effect of pterygopalatine fossa injection with local anesthetic and adrenalin in the control of nasal bleeding during endoscopic sinus surgery

BACKGROUND: The aim of this study was to determine the effect of pterygopalatine fossa infiltration with lidocaine and adrenalin on bleeding in the surgical field during endoscopic sinus surgery. METHODS: A prospective blind randomized controlled trial was performed. Fifty-five patients were randomized to receive a unilateral transoral infiltration of the pterygopalatine fossa with 2 mL of 2% lidocaine and 1:80,000 adrenalin. The operating surgeon was blinded as to which side had been infiltrated at the start of surgery. The surgical field was graded on a previously validated surgical field grading scale every 15 minutes with the side being operated on alternated every 30 minutes. The pulse, mean arterial blood pressure, and end-tidal CO2 concentration were monitored with each surgical field observation. RESULTS: At each individual time point from 30 minutes to 3.5 hours there was a significant difference in surgical grade between injected and noninjected sides in favor of the injected side (p = 0.01). The difference between surgical grades averaged across all time points was slight but significant. The injected side had an overall mean of 2.59 (SE, 0.22) compared with 2.99 (SE, 0.23) for the noninjected side. Heart rate also was found to correlate independently to surgical grade. CONCLUSION: Injection of the pterygopalatine fossa resulted in an improved surgical field during endoscopic sinus surgery.     

Comparison of direct monocular endoscopic,two- and three-dimensional display systems on surgical task performance in functional endoscopic sinus surgery

Surgeons performing functional endoscopic sinus surgery (FESS) traditionally rely on direct endoscopic viewing through a single monocular Hopkins rod lens telescope. While the majority of surgeons have found this satisfactory, most other endoscopic surgical specialities have moved to 2-D video endoscopy, where a monoscopic image is presented on a television monitor. This study set out to determine whether 2-D or 3-D display systems had any advantage over direct endoscopy in FESS. Ten otolaryngology trainees performed a series of standardized procedures on a FESS model using direct endoscopic vision, 2-D and 3-D. A performance score was obtained by dividing the execution time by the number of tasks achieved. There was a significant difference in both surgical and diagnostic task performance with 2-D (mean scores 56.8 and 41.1) performing better than direct endoscopy (mean scores 94.1 and 74.1) (P < 0.05). Tasks were also performed significantly better with 3-D compared with 2-D (P < 0.05).     

Endoscopic management of frontal sinus CSF leaks

IntroductionEndoscopic management of frontal sinus cerebrospinal fluid leaks has become the gold standard of treatment, with high success rates and low morbidity. The aim of this study is to review our experience in managing this challenging condition.ObjectiveTo review our experience in treating frontal sinus cerebrospinal fluid leaks through an endonasal endoscopic approach.MethodsA retrospective evaluation of patients undergoing endoscopic surgery for frontal sinus cerebrospinal fluid leaks was performed. Demographics, defect location and etiology, surgical and reconstructive technique, complications, and postoperative followup were examined.ResultsTwenty-two patients with a mean age of 40.4 years were treated surgically by the senior author between 2015 and 2019. Cerebrospinal fluid leak was either traumatic (17) or spontaneous (5). Successful first-attempt endoscopic repair was accomplished in all cases. A combined endoscopic-trephination approach was necessary in 5 patients (22.8%). No serious complications were reported, and frontal sinus drainage pathway was patent in all our cases. Revision surgery was necessary in only 2 patients for synechia formation. The mean patient followup was 22.7 months (range: 7 ? 41 months).ConclusionProgress in the field of endoscopic surgery has shifted the paradigm, establishing endoscopic repair of frontal sinus leaks as the standard of care. A few remaining limits of this approach could be addressed by combining endoscopy with frontal trephination.     

Total intravenous versus inhaled anesthesia in transsphenoidal tumor surgery

Purpose

Visualization of the surgical field is essential for patient safety during endoscopic transsphenoidal tumor surgery. In this retrospective chart review and data analysis of patients undergoing endoscopic transsphenoidal resection of pituitary tumors under general anesthesia we sought to determine if total intravenous anesthesia with propofol and remifentanil leads to decreased bleeding, surgical duration, time to extubation and/or length of stay in the recovery room compared to inhaled anesthesia with sevoflurane or desflurane.

Comparison of natural ostiodilatation and endoscopic sinus surgery in the same patient with chronic sinusitis

IntroductionChronic rhinosinusitis is a broad clinical syndrome characterized by mucosal inflammation of the nose and paranasal sinuses. In order for the paranasal sinuses to maintain their physiological functions; the ostiomeatal complex drainage pathways must be open. Surgical procedures are an important treatment option in patients who do not respond adequately to medical treatment. Although the methods and instruments used in functional endoscopic sinus surgery have continued to improve in recent years, the scar tissue formed during operation disrupts the drainage of the sinuses and reduces postoperative success. The natural ostiodilatation method, which is performed by balloon sinoplasty method, has become more and more popular in recent years.ObjectivesTo compare the technique of balloon sinoplasty with the classical functional endoscopic sinus surgery method by considering the severity of chronic sinusitis on the same patient.MethodsTotal of 61 chronic sinusitis patients was included in the study. Paranasal sinus tomography of the patients was taken and according to the Lund–Mackay scoring, chronic sinusitis levels were determined. Cases were divided into two groups: Group 1 (severe chronic sinusitis group) and Group 2 (mild chronic sinusitis).ResultsThere was no statistically significant difference in the results of comparison of sinuses which underwent balloon sinoplasty and classical functional endoscopic sinus surgery in Group 2 after Lund–Mackay scores. However in Group 1, the results of the comparison of postoperative Lund–Mackay scores of the balloon sinoplasty and the classical endoscopic operation were statistically significantly lower than those of the face half operated with the classical functional endoscopic sinus surgery.ConclusionThe success of balloon sinoplasty in patients with mild sinusitis is the same as in classic functional endoscopic sinus surgery. However, as the severity of sinusitis increases, the efficacy of balloon sinoplasty decreases.     

Administering of pregabalin and acetaminophen on management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery

Background: Management of postoperative pain is a common problem in endoscopic sinus surgery. The objective of this study is the evaluation of pregabalin and acetaminophen effects on the management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery (FESS).

Materials and methods: In this clinical trial, double-blinded study, 70 patients with nasal polyposis who have indication of FESS were enrolled to this study. After operation, patients were divided randomly into pregabalin and acetaminophen therapy groups. The pregabalin group (n?=?35) was treated under pregabalin 50?mg TDS and the acetaminophen group (n?=?35) was treated under tablet acetaminophen 500?mg/6?h. Each group was administered for 3 d. The visual analogue scale (VAS) was measured in onset, 12, 24, 48 and 72?h after surgery. All data were entered into SPSS software (SPSS Inc., Chicago, IL) and appropriate statistical tests were assessed to every relation.

Results: In this study, there was no significant difference between two groups according to VAS in onset (p?=?.37); however, VAS in 12, 24, 48 and 72?h after operation was significantly lower in the pregabalin group compared with the acetaminophen group (p?p?Conclusions: Pregabalin has more effect, safely and usefully than acetaminophen on the management of postoperative pain in the patients with nasal polyposis undergoing functional endoscopic sinus surgery.     

Is Nasal Packing Necessary Following Endoscopic Sinus Surgery?

OBJECTIVES/HYPOTHESIS: To determine the necessity of nasal packing or hemostatic agents or both following endoscopic sinus surgery. STUDY DESIGN: Retrospective review of cases in a tertiary care sinus practice at an academic medical center. METHODS: Records of 165 patients undergoing 169 endoscopic sinus surgeries were reviewed to determine the presence of adjunctive nasal procedures, the use of nasal packing or hemostatic agents or both, blood loss during surgery, and the incidence of bleeding complications following surgery. RESULTS: The median estimated blood loss during surgery was 50.0 mL (range, 5-1000 mL). In four surgeries (2.4%) hemostatic agents were placed in the nose at the conclusion of surgery, 19 (11.2%) had packing, and 147 (87.0%) had no material left in the nose. No patients had bleeding complications postoperatively. There was a significant decrease in the use of packing or hemostatic agents or both over time. CONCLUSION: Placement of nasal packing or other hemostatic agents or both within the nasal cavity is not necessary in the majority of endoscopic sinus surgeries. The risks, costs, and discomforts associated with these interventions can often be avoided.     

Endoscopic sinus surgery with and without computer assisted navigation: A retrospective study

ObjectiveIn the last years endoscopic sinus surgery (ESS) is improved with the introduction of computer assisted navigation (CAN). In this retrospective study we evaluated the usefulness of CAN in endoscopic sinus surgery and studied its advantages over conventional endoscopic sinus surgery.MethodsWe retrospectively reviewed the records of 96 patients with chronic rhinosinusitis (CRS). 48 patients undergoing endoscopic sinus surgery with surgical navigation (A group) and other 48 without navigation (B group). Data about percentage of complications, olfactory function (Visual Analogue Scale), Sino-nasal Outcomes Test (SNOT-22), Rhinosinusitis Quality of Life (RhinoQoL), recurrence (CT Lund–Mackay score), total nasal resistance (rhinomanometry) and duration of the intervention were collected and analyzed.ResultsA group evidenced a decrease of recurrence rate (p = 0.009), a reduction of total nasal resistance (p = 0.007), of frontal recess stenosis (p = 0.04) and of nasal symptomatology (p = 0.008). QoL had a better improvement in group A. Rate of other complications and olfactory function did not show statistically significant differences between the two groups. The average calibration time was approximately 11 min in the A group. Total time of surgical procedure does not evidenced statistically significant difference between the two groups (p > 0.05) but if it is considered only the time of the surgical intervention, the difference of duration is significant reduced statistically (p < 0.05) in CAN surgery.ConclusionComputer assisted navigation in ESS can be useful for the most experienced surgeons, especially in the frontal recess surgery, decreasing the recurrence rate and reducing the total nasal resistance.