Post-operative steroid treatment for eosinophilic-type sinonasal polyposis

Conclusions: The preliminary finding of significantly lower eosinophilic-type CRSwNP recurrence rates in patients with associated asthma or ASA intolerance treated post-operatively with local nasal and oral steroids warrants further investigation in larger, prospective series. Objective: A high recurrence rate after functional endoscopic sinus surgery (FESS) has been widely reported in patients with eosinophilic-type chronic rhinosinusitis with nasal polyps (CRSwNP). This study compared the influence of two post-operative medical treatments – local nasal steroids alone vs local nasal and oral steroids – on the recurrence of eosinophilic-type CRSwNP. Method: Between January 2009–December 2010, 32 patients with eosinophilic-type CRSwNP received local steroid nasal therapy after FESS (Group A); from January 2011 onwards, another 28 patients were treated post-operatively with the same nasal treatment plus two cycles a year of oral steroids (Group B). All patients in both groups had a follow-up of at least 36 months. Results: Groups A and B did not differ significantly in recurrence rate (31.25% vs 32.14%, p = 1) or disease-free interval (p = 0.91), but Group B patients who were asthmatic or ASA-intolerant had a significantly lower recurrence rate than Group A patients with asthma or ASA intolerance (p = 0.04 and p = 0.004, respectively).     

Important clinical symptoms in patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis

OBJECTIVE: To evaluate the prevalence and severity of individual Rhinosinusitis Task Force (RSTF) symptoms in patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS). METHODS: Retrospective analysis of prospectively collected data in 201 patients treated with FESS. The prevalence and severity of individual RSTF major and minor symptom scores graded on a visual analogue scale (VAS) were compared. Correlation between absolute improvement in individual symptom scores at 1-year postoperative was performed. RESULTS: One-hundred fifty-eight of 201 patients met inclusion criteria giving a response rate of 78%. The average age was 49.4 (range 18-80) with a male-to-female ratio of 1.1:1. The preoperative leading mean symptom scores were postnasal drip (5.8 +/- 0.3), nasal obstruction (5.7 +/- 0.3), and facial congestion (5.1 +/- 0.3). These symptoms were also the most prevalent with 82%, 84%, and 79% of patients reporting these symptoms, respectively. Postoperative symptom improvements were significant (P < .0001) across all RSTF domains except fever. The highest percentage improvement was seen with facial congestion (93%), nasal obstruction (92%), and postnasal drip (85%). Multivariate analysis revealed significant (P < .0001) high correlation between improvements of facial pain/pressure with facial congestion (R = 0.72), facial congestion with nasal obstruction (R = 0.65), and facial pain/pressure with headache (R = 0.72). CONCLUSION: The top three RSTF symptoms were postnasal drip, nasal obstruction, and facial congestion in terms of prevalence and severity. Symptom scores improved after FESS. Of these symptoms, the degree of improvement of facial pain/pressure, facial congestion, nasal obstruction, and headache are highly correlated.     

慢性鼻窦炎伴鼻息肉与哮喘的相关性机制及治疗策略研究进展

慢性鼻窦炎伴鼻息肉(CRSwNP)和哮喘作为上下呼吸道最具代表性的慢性炎症性疾病,二者在发病过程中常相互并存,临床诊治棘手。目前对CRSwNP和哮喘的相互作用机制尚未阐明。欧洲鼻窦炎鼻息肉诊疗指南(EPOS 2012)对治疗CRSwNP伴或不伴哮喘已给出具体的指导意见,其常规治疗包括鼻用糖皮质激素、生理盐水洗鼻等,并进一步根据CRSwNP的特点、症状严重程度等进行后续的联合治疗。据报道,鼻窦手术和药物治疗CRSwNP对合并支气管哮喘的转归有益。但CRSwNP合并哮喘患者经药物与手术治疗后的疗效判定尚缺乏足够的随机对照试验证据。     

Efficacy of posterior nasal neurectomy for allergic rhinitis combined with chronic rhinosinusitis with nasal polyps

Abstract

Background: Allergic rhinitis combined with chronic rhinosinusitis with nasal polyps (ARwCRSwNP) is very common clinically. Conventionally, the treatment for these patients is surgical method for CRSwNP followed by treatment with a nasal steroid spray or other antiallergic drugs to control AR. In recent years, some rhinologists introduced vidian neurectomy (VN) or posterior nasal neurectomy (PNN) into endoscopy to treat refractory AR and reported an encouraging outcome. Furthermore, we explore the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP.

Objective: To investigate the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP.

Methods: Eighty-five patients with ARwCRSwNP who were admitted to our hospital from November 2016 to July 2018 were enrolled in two groups. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN; group B underwent conventional FESS alone. VAS, RQLQ, SNOT-22 and postoperative nasal endoscopy were used to evaluate the improvement in symptoms and the recurrence of nasal polyps.

Results: The experimental group had better control of sneezing (p?<?.05) and rhinorrhea (p?<?.01) than the control group. For those who underwent surgery more than 6 months prior in both groups, the recurrence rate was 29.6% (8/27) in the experimental group and 44.4% (8/18) in the control group, and there was no significant difference (χ² = .483, p?=?.487).

Conclusion: FESS combined with PNN can improve the symptoms of sneezing and rhinorrhea caused by ARwCRSwNP more obviously than FESS alone, but there is no clear statistical advantage of this procedure for improving the overall symptoms and controlling the recurrence of nasal polyps.     

Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery

Fungal rhinosinusitis is an important clinical problem with diverse manifestations. Although many literatures had found low recurrence rate after surgical treatment of fungus ball rhinosinusitis, patient satisfaction and treatment outcomes (symptom-free and symptom improvement rate, etc.) for fungus ball sinusitis are not yet well established. The purpose of this study is to estimate the patient satisfaction and treatment outcome in patients with fungus ball rhinosinusitis undergoing functional endoscopic sinus surgery (FESS). Medical records of consecutive patients with diagnosed fungus ball rhinosinusitis treated by FESS between 1995 and 2005 were reviewed retrospectively. The post-operative improvement in individual symptom was assessed by chart review and telephone visiting. Ninety consecutive patients (21 men and 69 women) were eligible for the study. Six patients (7%) presented bilateral fungus ball rhinosinusitis. Multiple paranasal sinus fungus ball involvements were found in 48 patients (53%). Complete resolution of complaints with respect to nasal discharge, postnasal drip, cough with sputum, nasal bleeding, fetid odor of nose, olfactory dysfunction, nasal obstruction, headache, and facial pain or pressure were described in 74 patients (82%). The overall patient satisfaction rate was 96%. The estimated recurrence rate of fungus ball rhinosinusitis treated with FESS was 3%, with a mean follow-up of 81 months. Treatment protocol of fungus ball rhinosinusitis with FESS and without postoperative antifungal drugs is efficient because of very low recurrence rate, high patient satisfaction, and very high symptom-free rate. Furthermore, the obvious difference of symptom-free rate between fungus ball rhinosinusitis and chronic rhinosinusitis highlights the need of further studies to discover the pathophysiology of fungal sinusitis.     

The effects of debridement after endoscopic sinus surgery

OBJECTIVES/HYPOTHESIS: The aim of this randomized, partly blinded, controlled clinical trial was to evaluate the effects of debridement 6 and 12 days after endoscopic sinus surgery. METHODS: Sixty patients (male/female = 26/34; mean age, 43.5 years; age range, 23-73 years) with chronic or acute recurrent rhinosinusitis were included. The patients were randomized to postoperative debridement or not. Primary outcome variables were adhesions between the middle turbinate and the lateral nasal wall 10 to 14 weeks after surgery judged by blinded evaluation of endoscopic video recordings. Secondary outcome variables were crusts in the nasal cavity 12 days after surgery and pain caused by debridement. RESULTS: We found a significant reduction in adhesions in the group that underwent debridement (P < .001). At 12 weeks, bilateral adhesions were observed in nine control patients but in only one debridement patient. Unilateral adhesions were found in 11 control patients and in nine debridement patients. Twelve days after surgery, we found significantly less severe crusts in the debridement group (P < .01). Patients with severe crusts in the middle meatus 12 days after surgery had more adhesions 12 weeks postoperatively. The debridement group used more analgesics the days after the first debridement (3.7 days [standard deviation 2.3] vs. 2.3 days [standard deviation 2.6] in the control group, P < .041). CONCLUSIONS: Crusts in the middle meatus after sinus surgery is associated with postoperative adhesions. Debridement of the nasal cavity reduces crusts and postoperative adhesions significantly compared with saline irrigation only. However, the procedure induces more postoperative nasal pain.     

Selective irrigation of the sinuses in the management of chronic rhinosinusitis refractory to medical therapy: a promising start

BACKGROUND: Although endoscopic sinus surgery has been widely used for the treatment of chronic rhinosinusitis, some patients fail to derive clinical benefit from this procedure. We evaluated the efficacy of a treatment regimen consisting of selective irrigation of diseased sinus mucosa with topical antibiotics and steroids in conjunction with oral antibiotics and steroids. METHODS: Twenty patients suffering from chronic rhinosinusitis and resistant to medical treatment (mean duration 3.4 years) underwent intubations of the affected maxillary and/or ethmoid sinuses for irrigation for a duration of 21 to 30 days. A computed tomographic (CT) scan of the paranasal sinus was taken both pre- and post-treatment and staged according to the Lund-MacKay system. Clinical symptoms were scored for rhinorrhea, facial pain, nasal congestion, and smell at least 2 months prior to treatment and approximately 18 months after the follow-up. RESULTS: The clinical experience with the technique of intubation and irrigation was well tolerated by all patients. We found an improvement in all symptom scores, including rhinorrhea, nasal congestion, smell (n = 20; p < .001), and facial pain (n = 20; p < .01). Similar improvements were seen on the CT scans, with reduced staging from 14.6 +/- 1.1 to 5.6 +/- 1.1 (p < .001). Only three patients did not respond to selective irrigation of the sinuses and needed further surgery. CONCLUSION: These results suggest that sinus irrigation could provide a reasonable and effective alternative to ethmoidectomy with drainage procedures and offer promise for the treatment of patients with chronic rhinosinusitis who are resistant to medical treatment.     

Effects of nonabsorbable packing in middle meatus after sinus surgery

OBJECTIVES/HYPOTHESIS: The aim of this study was to evaluate the effects of a nonabsorbable packing (NAP) in the middle meatus (MM) for 5 days after sinus surgery. STUDY DESIGN: A randomized, partly blinded, controlled clinical trial. METHODS: Sixty-one patients (M/F = 30/31, mean age 42, range 18-72) with chronic or acute recurrent rhinosinusitis were included. Fifty-nine underwent surgery. Thirty-one had NAP in the MM for 5 days, and 28 served as controls with daily saline irrigations postoperatively. Primary outcome variables were nasal congestion, nasal pain, and headache the first 2 weeks rated on visual analogue scales (VAS; 0-100) and the amount of postoperative bleeding recorded on an ordinal scale (1-4). Secondary outcome variable was the extent of adhesions in MM 10 to 14 weeks after surgery judged by blinded evaluation of endoscopic video recordings. RESULTS: Fifty-eight patients completed a diary. No significant differences in primary outcome variables between the groups were found. Nasal congestion decreased most the first 5 to 7 days postoperatively. Removal of the NAP caused little pain (mean 23 on VAS). Temporary bleeding occurred in three patients. Bilateral adhesions were observed in 10 control patients but in none with NAP. Unilateral adhesions were found in nine control patients and in seven with NAP (exact P < .001). CONCLUSIONS: NAP in the MM for 5 days significantly reduced the extent of adhesions in MM compared with saline irrigation alone. NAP did not cause additional discomfort.     

The efficacy of cotton ball packing after endoscopic sinus surgery: A prospective,randomized, controlled trial

ObjectiveThe blocking of airflow into sinonasal cavity may decrease postoperative crusting and the development of adhesions. The purpose of this study was to investigate the efficacy of cotton ball packing in patients following endoscopic sinus surgery (ESS).MethodsThirty nine patients with chronic rhinosinusitis requiring the same extent of ESS were included. As a part of postoperative care, the patients were instructed to perform a nasal saline irrigation and apply a nasal spray in each nostril, and then informed to put a cotton ball in a one side of nostril, and the other side was kept to be empty as a control. Patients’ subjective symptoms, patients’ pain while receiving sinonasal cavity debridement, time required to perform debridement, and postoperative wound healing were evaluated.ResultsAlthough cotton ball packing resulted in less discomfort for postnasal drip, rhinorrhea, headache, and facial pain than no packing, there were no statistically significant differences between the groups. The cotton ball packing was associated with significantly less pain on while performing postoperative debridement, therefore less time was needed to perform debridement. The cotton ball packing appears to improve wound healing within the sinus cavities up to 1 month postoperatively.ConclusionThe use of the cotton ball packing after ESS results in significantly less formation of crusts and adhesions, leading to decreasing pain and time during postoperative debridement and promoting faster wound healing.     

FESS术后加用香菊胶囊与康复新液治疗慢性鼻窦炎伴有鼻息肉的对比研究

目的 评价对比慢性鼻窦炎伴有鼻息肉患者功能性鼻内镜手术后,分别加用香菊胶囊口服治疗与康复新液冲洗术腔治疗的有效性及安全性.方法 选取择期行FESS治疗的90例CRSwNP患者,使用简单随机数字表法将其随机分成康复新组(n=30)、香菊组(n=30)、对照组(n=30).所有患者均接受FESS及相同的术后常规处理.对照组...     

Comparison of effects of baby shampoo vs. saline irrigation on endoscopic sinus surgery outcomes and quality of life

ObjectiveNasal irrigation is an important step of functional endoscopic sinus surgery (FESS) postoperative care. This study was performed to compare the effects of diluted baby shampoo (BS) and normal saline solution (NSS) irrigation on patients’ quality of life (QoL) and surgical outcomes after FESS.MethodsThis study included 77 patients who underwent FESS to treat chronic rhinosinusitis with nasal polyps. Lund–Mackay score, Lund–Kennedy endoscopic score (LKES), synechia score and QoL (using the Sinonasal Outcome Test (SNOT-22)) were evaluated.ResultsLKES was significantly better in the BS group (p=0.001), especially in terms of nasal discharge and crust formation (p=0.024 and p=0.030, respectively) at 1 month postoperatively. However, no significant difference was found at 3, 6 or 12 months postoperatively (p=0.833, p=0.263, and p=0.346, respectively). The reduction of SNOT-22 score (between preoperative assessment and 1 month postoperatively) was significantly better in the BS than in the NSS group (p=0.025). However, no statistically significant differences were found between groups at 3, 6, or 12 months postoperatively (p=0.312, p=0.280, and p=0.285, respectively). In the evaluation of SNOT-22 subdomains, changes in psychological, rhinological and extranasal rhinological subdomains were significantly better in the BS group at 1 month postoperatively (p=0.019, p=0.010 and p=0.002, respectively).ConclusionCompared to irrigation with NSS, BS usage following FESS led to reductions of crusting, nasal discharge and synechia formation; moreover, it was associated with improved SNOT-22 scores, especially in psychological, rhinological and extranasal rhinological subdomains.     

慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后症状与病理学指标相关分析

目的：评估病理学指标对预测慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后疗效的价值。方法：通过对53例接受鼻内镜手术1年以上的慢性鼻-鼻窦炎伴鼻息肉患者的临床症状问卷调查,阅读这些患者的手术标本病理切片,统计相关病理指标,统计学分析慢性鼻-鼻窦炎伴鼻息肉患者接受鼻内镜术后的主要症状及其与病理学指标之间的联系。结果：慢性鼻-鼻窦炎伴鼻息肉患者接受鼻内镜手术后最主要的症状有鼻塞、流脓涕、流清涕或打喷嚏,其中杯状细胞与打喷嚏、流脓涕症状,病理性腺体形成与头昏症状,组织水肿程度与后鼻滴漏症状相关（P〈0.05）。结论：病理学指标有助于预测慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后疗效。     

The importance of follow-up examinations in chronic rhinosinusitis with nasal polyposis

PurposeClinical examinations following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) are critical for physicians to assess results of the intervention and to early identify recurrences. However, no clear consensus on the frequency and timing of clinical examinations following surgery exists. The aim of this study was to analyze CRSwNP recurrences after FESS with a specific focus on the adherence to follow-up examinations.Materials and methodsSixty patients who underwent FESS for CRSwNP were enrolled. Clinical parameters were recorded. Adherence to follow-up examinations with nasal fiber optic endoscopy and regular administration of nasal steroids were analyzed.ResultsAdherence to periodic clinical examinations and regular treatment with nasal steroids was 25 %. CRSwNP recurrence was observed in 56.7 % of cases at the last follow-up examination. No statistically significant difference concerning nasal symptoms was observed between patients with and without current recurrence (p > 0.05). Subjects who underwent regular examinations and prompt treatment of small recurrences had a lower probability of relapse at their last examination (7.7 % versus 38.2 %, respectively; p < 0.001). Polyp grade > 2 in patients with or without adherence were seen in 15.4 % and 42.9 % of cases, respectively (p < 0.05).ConclusionsAdherence to follow-up examinations with nasal optic fiber endoscopy is crucial to early identify recurrence after surgery and promptly treat it with medical therapy.     

Effect of hypochlorous acid nasal spray as an adjuvant therapy after functional endoscopic sinus surgery

ObjectivesTo evaluate the efficacy of hypochlorous acid (HOCl) nasal spray as an adjuvant therapy after functional endoscopic sinus surgery (FESS).Material and methodsPatients with chronic rhinosinusitis who had received FESS for treatment were recruited and assigned to one of two groups at random at one month post-surgery. In the HOCl group, patients received 0.02% HOCl nasal spray three times a day for two months. In the control group, normal saline (NS) nasal irrigation was given. Before FESS and before and after nasal spray or irrigation, patients completed the Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22). In addition, patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial cultures obtained from their middle meatus.ResultsSeventy-eight patients completed the study. Among them, 41 received HOCl nasal spray, and 37 received NS irrigation. Endoscopic score significantly decreased after 2-month HOCl nasal spray (p = 0.036). TWSNOT-22 score also decreased, although insignificantly (p = 0.285). In contrast, TWSNOT-22 score significantly decreased after NS nasal irrigation (p = 0.017), but endoscopic score did not significantly decrease (p = 0.142).ConclusionsOur results showed that HOCl nasal spray had a similar effect to that of NS nasal irrigation in post-FESS care. It can be an alternative of NS nasal irrigation for its convenient application.     

Olfactory function in patients with chronic rhinosinusitis before and after functional endoscopic sinus surgery

BACKGROUND: The olfactory loss in patients with chronic rhinosinusitis has been measured by different methods. However, the results have been variable and it is not clear whether functional endoscopic sinus surgery (FESS) significantly improves olfactory function. This study was performed to evaluate the influences of FESS on olfactory function in patients with chronic rhinosinusitis using three different types of olfactory tests. METHODS: Seventy patients with chronic rhinosinusitis were administered the University of Pennsylvania Smell Identification Test (UPSIT), a single staircase phenyl ethyl alcohol odor detection threshold test (STT), and a short-term odor memory/discrimination test a day before and 6 months after FESS. A questionnaire inquiring about the patients' self-perception of olfactory function was administered also. Independent ratings of the severity of chronic rhinosinusitis before FESS were established from CT scans. RESULTS: Fifty-two (74.3%) of the patients reported that their olfactory function was impaired before surgery, and 68.6% of the patients reported impaired olfactory function after surgery, a difference that was not significant. No meaningful changes in any of the olfactory test scores were noted 6 or more months after FESS. Preoperatively, small correlations between CT scores and the symptom scores (r = 0.278; p = 0.024), threshold scores (r = -0.27; p = 0.031), and UPSIT scores (r = -0.36; p = 0.003) were observed. CONCLUSION: In patients with severe rhinosinusitis, FESS had little impact on the ability to smell, regardless of the method for assessing smell function. Subtle associations between olfactory function and the severity of chronic rhinosinusitis determined by CT were observed, however, preoperatively. The olfactory test measures were correlated with one another both pre- and postoperatively.     

Subjective improvement of olfactory function after endoscopic sinus surgery for chronic rhinosinusitis

OBJECTIVE: The purpose of this study was to determine the effect of functional endoscopic sinus surgery (FESS) on subjective olfactory dysfunction in patients with chronic rhinosinusitis.Materials and methods Prospective collection of data on consecutive patients undergoing FESS after failing prolonged medical therapy for chronic rhinosinusitis at a tertiary institution. Patients were asked to grade their olfactory dysfunction from 0 to 10, with 0 representing normal function and 10 complete anosmia. In addition, data such as computed tomography scores, presence or absence of nasal polyps, and the presence or absence of asthma were recorded and analyzed. Patients were followed up to 1 year after surgery. RESULTS: Data were collected on 178 patients who had sinus surgery over a 2-year period. The average olfactory dysfunction score before surgery was 4.9. This improved to 0.9 at 1 year after surgery (P =.00). Higher computed tomography scores as per Lund and MacKay correlated with higher olfactory dysfunction scores (r = 0.62, P <.01) and greater improvement after surgery (r = 0.82, P <.01). Asthmatics and patients with polyps had higher subjective olfactory dysfunction scores than nonasthmatics and patients without polyps (6.8 and 7.2 v 4.4 and 4.1, respectively). All groups had subjective improvement at 1 year (2.3 and 1.5 v 0.6 and 0.7, respectively; P =.00). CONCLUSION: Patients with subjective olfactory dysfunction despite appropriate medical management for rhinosinusitis benefit from FESS.     

Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients

After functional endoscopic sinus surgery (FESS), nasal packing may be necessary and a packing material which has benefits in both cost and efficacy would be required. This study aimed to determine the efficacy of Gelfoam packing on hemostasis and wound healing after FESS. Patients who underwent bilateral FESS due to chronic bilateral rhinosinusitis were enrolled. Randomly, one side was selected for Gelfoam packing and the other side for no packing. Subjective symptoms and objective findings such as synechia, granulation, pus discharge, edema, stenosis, and crust were evaluated. A total of 21 patients (17 men and 4 women; mean age 39.7 years ranging from 12 to 75 years) were included. There were no statistical significant differences between two groups regarding both subjective symptoms and objective findings during 4 months after surgery. Three patients had postoperative bleeding in the no packing side. Gelfoam packing may be recommendable in terms of efficacy and cost-benefit after FESS.     

Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient

BACKGROUND: Symptoms of postnasal drainage and thickened mucus are commonly seen in patients with chronic rhinosinusitis (CRS) recalcitrant to sinus surgery and conventional medical therapies. Chemical surfactants can act as a mucolytic by reducing water surface tension and have the potential to serve as an antimicrobial agent. Baby shampoo is an inexpensive, commercially available solution containing multiple chemical surfactants. This is an in vitro study of its antimicrobial effects on Pseudomonas biofilms with translation to a clinical study for use as an adjuvant nasal wash in patients with CRS who remain symptomatic despite adequate sinus surgery and conventional medical therapies. METHODS: In vitro testing was performed to determine the optimal concentration of baby shampoo that disrupted preformed bacterial biofilms and inhibited biofilm formation. This concentration was then used in a prospective study of symptomatic post-functional endoscopic sinus surgery (FESS) patients who irrigated twice a day for 4 weeks. Validated outcome forms and objective smell testing was performed before and after therapy. RESULTS: One percent baby shampoo in normal saline was the optimal concentration for inhibition of Pseudomonas biofilm formation. Baby shampoo had no effect on the eradication of preformed Pseudomonas biofilms. Eighteen patients with CRS with an average of 2.8 surgeries were studied after irrigating with 1% baby shampoo solution. Two patients discontinued use because of minor nasal and skin irritations; 46.6% of patients experienced an overall improvement in their subjective symptoms, and 60% of patients noted improvement in specific symptoms of thickened mucus and postnasal drainage. CONCLUSION: Baby shampoo nasal irrigation has promise as an inexpensive, tolerable adjuvant to conventional medical therapies for symptomatic patients after FESS. Its greatest benefit may be in improving symptoms of thickened nasal discharge and postnasal drainage.     

中药鼻腔冲洗治疗慢性鼻窦炎术后有效性和安全性的Meta分析

目的 系统评价近10年中药鼻腔冲洗治疗慢性鼻窦炎术后的临床疗效和安全性。 方法 以中药冲洗、慢性鼻窦炎以及随机对照试验等为检索主题,检索近10年各大中英文数据库:Pubmed、Web of science、The Cochrane Library、Embase和中国知网、万方数据库、维普、中国生物医学数据库等关于以中药冲洗鼻腔为干预措施治疗慢性鼻窦炎术后的随机对照试验,严格按照纳入及排除标准对文献进行筛选,并进行质量评估,使用R软件进行分析。结果纳入47个随机对照实验,分3个研究组参与Meta分析。 结果 中药鼻腔冲洗组的总有效率、治愈率较生理盐水冲洗组、空白组的更高;在症状评分上,中药冲洗组的VAS评分优于其余对照组,中药冲洗组较西药冲洗组、空白对照组能更好地降低鼻塞、嗅觉减退的症状评分,中药冲洗组较盐水冲洗组、空白对照组能更好地降低流涕症状评分,中药冲洗组较盐水冲洗组、西药冲洗组、空白对照组在降低头面胀痛症状评分上差异无统计学意义;在客观评价上,中药冲洗组在促进术后术腔上皮化、Lund-Kennedy内镜评分、鼻黏膜纤毛传输速率上均优于对照组。11篇文献进行了安全性报道,均未发生不良反应事件。 结论 中药鼻腔冲洗治疗慢性鼻窦炎术后疗效显著,优于等渗生理盐水冲洗、抗生素、激素溶液冲洗等,具有进一步临床推广价值。     

Partial middle turbinectomy during endoscopic sinus surgery for extended sinonasal polyposis: short- and mid-term outcomes

Conclusions. The 23 patients with extensive sinonasal polyposis who had undergone partial resection of the middle turbinate during functional endoscopic sinus surgery (FESS) showed no differences in nasal airway resistance and in postoperative complication rate (1-year follow-up period) in comparison with the 25 patients who had FESS with middle turbinate preservation. Objective. The aim of the study was to investigate the outcomes of partial middle turbinectomy during FESS in patients with sinonasal polyposis. Patients and methods. A retrospective analysis of 48 consecutive patients who had undergone surgery for extended sinonasal polyposis was performed. Twenty-three patients underwent FESS with middle turbinate head resection; 25 patients underwent FESS with preservation of middle turbinate. We endoscopically scored polyposis extension and evaluated nasal airflow resistance (NAR) preoperatively and postoperatively. Results. We found an improvement of endoscopic score (high to low grade of polyposis extension) and a statistically significant reduction of NAR after both surgical techniques. There was no statistically significant difference in the mean NAR values before and after the two techniques.