xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

629

Orlandi et al.

Strong Recommendation for topical corticosteroids

GI upset, colitis, anaphylaxis, bacterial resistance. Moderate to high Balance of benefit and harm Option for oral antibiotics Increased pain, possible rhinitis medicamentosa potential for creating synechia or granulation. Moderate to high, depending on material Balance of benefit and harm. Potential small benefit of absorbable vs nonabsorbable packing. Moderate to high, depending on material and medication. Balance of benefit and cost. Recommendation for steroid-eluting spacer or stent corticosteroids Recommendation against topical decongestants Option for packing or spacer Possible systemic absorption, pain, inconvenience.

postoperative debridement

Mitomycin C

Recommendation for use of nasal saline irrigation

Recommendation for

TABLE XII-25 Summary of recommendations for postoperative care following sinus surgery Intervention Grade Benefit Harm (see Table II-1) Cost Benefit-Harm Assessment Policy Level Saline irrigations B Well-tolerated. Improved symptoms and endoscopic appearance Local irritation, ear symptoms Minimal Preponderance of benefit overharm Sinus cavity debridements B Improved symptoms and endoscopic appearance. Reduced risk of synechia and turbinate lateralization Inconvenience, pain, epistaxis, syncope, and mucosal injury. In-office procedure with cost Preponderance of benefit overharm Topical corticosteroids A Improved symptoms and endoscopic appearance. Reduced recurrence rate of polyps Epistaxis, headache Moderate Preponderance of benefit overharm Oral antibiotics B Improved symptoms and endoscopic appearance. Reduced crusting. Topical decongestants Minimal Preponderance of harm over benefit Packing/spacers without medication Pain, inconvenience, N/A Potential reduced mucosal swelling and bleeding.

Moderate to high. Balance of benefit and harm Recommendation against

Insomnia, mood changes, hyperglycemia, gastritis, increased intraocular pressure, avascular necrosis Minimal Balance of benefit and harm Option for systemic Off-label use, systemic absorption, local toxicity

A Reduction in inflammation, polyps, adhesions.

formation, improvement in maxillary ostium patency

B Improved symptoms and endoscopic appearance.

Reduced risk of synechia

and turbinate lateralization

C Improvement in endoscopic appearance, reduction in polyp recurrence.

Mitomycin C B Reduction in synechia

spacers/stents

corticosteroids

Drug-eluting

Systemic