2016 Section 5 Green Book

b. Surgery i.

Perioperative management Hauser LJ, Ir D, Kingdom TT, et al. Investigation of bacterial repopulation after sinus surgery and perioperative antibiotics. Int Forum Allergy Rhinol . 2015; 6(11):34-40. EBM level 2b..........................................................................120-126 Summary: This article examines the changes in the microbial flora after medical and surgical therapies of chronic sinusitis. It demonstrates that surgery and postoperative antibiotic treatment did not reduce bacterial burden, but instead shifted the microbial consortia. Macdonald KI, Wright ED, Sowerby LJ, et al. Squeeze bottle versus saline spray after endoscopic sinus surgery for chronic rhinosinusitis: a pilot multicentre trial. Am J Rhinol Allergy . 2015; 29(1):e13-e17. EBM level 1...........................127-131 Summary : This article compares low-volume saline to high-volume, high-pressure saline irrigation after endoscopic sinus surgery. The authors demonstrate that both methods result in improvement of sinus symptomology, but the study is not powered enough to rule out a difference in the two modalities. Complications Suzuki S, Yasunaga H, Matsui H, et al. Complication rates after functional endoscopic sinus surgery: analysis of 50,734 Japanese patients. Laryngoscope . 2015: 125(8):1785-1791. EBM level 2........................................................132-138 Summary : This article examines complication rates of endoscopic sinus surgery (ESS) in a very large cohort of patients. It demonstrates that in the modern era, complications after ESS are uncommon, but the risk of orbital injury may be higher after previous surgical intervention. Systemic (antibiotics, steroids, and biologics) Poetker DM. Oral corticosteroids in the management of chronic rhinosinusitis with and without nasal polyps: risks and benefits. Am J Rhinol Allergy . 2015; 29(5):339-342. EBM level 5........................................................................139-142 Summary : Oral corticosteroids are frequently used in the management of chronic rhinosinusitis. In this review, an overview of the existing data on the risks of oral corticosteroids is presented, along with associated medicolegal risks, and a discussion of the data supporting the use of these drugs in patients with chronic rhinosinusitis. Varvyanskaya A, Lopatin A. Efficacy of long-term low-dose macrolide therapy in preventing early recurrence of nasal polyps after endoscopic sinus surgery. Int Forum Allergy Rhinol . 2014; 4(7):533-541. EBM level 1.........................143-151 Summary : In this prospective study, patients with chronic rhinosinusitis with nasal polyps undergoing endoscopic sinus surgery were postoperatively randomized to receive clarithromycin 250 mg daily for 12 weeks, 24 weeks, or to not receive any clarithromycin. All patients were treated with mometasone nasal spray. At intervals for 24 weeks, patients were assessed with visual analog scale (VAS), SNOT-20, acoustic rhinometry, rhinomanometry, saccharin transit time, nasal endoscopy, Lund-Mackay CT score, and eosinophilic cationic protein in nasal secretions. All parameters except for VAS and acoustic rhinometry were significantly improved in the clarithromycin groups as compared to the control.

ii.

c.

Medical i.