xRead - Nasal Obstruction (September 2024) Full Articles

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International consensus statement on rhinosinusitis

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TABLE XII-26 Evidence for postoperative care following sinus surgery, published since ICAR-RS-2016 Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Chen 2255 2018 1 SRandMA 3 RCTs comparing nasal irrigation (n = 226) with normal saline and various solutions (hypertonic saline, Ringer’s lactate, electrolyzed acid water, Amphotericin B) SNOT-20 or SNOT-22. Endoscopic score. Several others, not pooled. Unable to identify a solution which had improved outcomes compared with normal saline. Heterogeneity of treatments and outcomes made pooled analysis difficult. Tzelnick 2256 2018 1 Cochrane review 4RCTs (n = 152) comparing debridement with no debridement. Disease-specific HRQol. Disease severity. Adverse events. Lund-Kennedy endoscopic score. Adhesion rate. Revision surgery rate. Overall low-quality evidence with risk of bias. The evidence suggests a significant reduction in risk of adhesion at 3 months. Other outcomes did not demonstrate significant differences. Yoon 2257 2018 1 SRandMA 12RCTs (n = 360) addressing nasal steroid irrigation vs saline irrigation Symptom and HRQoL scores. Endoscopy scores. Adverse events.

No significant differences in postop symptom scores.

Significant improvement with steroid irrigation in postop endoscopy scores for pooled group (CRSsNP and CRSwNP).

Lower polyp recurrence rate with steroids in patients with CRSwNP.

No increased rate of postop infection in steroid group.

Huang 2248 2015 1 Cochrane review; 21 trials reviewed, none met all inclusion criteria Steroid eluting stents vs plain stents N/A No recommendation can be made based on lack of high-quality evidence.

Steroids showed statistically and clinically significant improvements in symptoms and endoscopic score when steroids were used; comparative studies of steroids vs saline

irrigation showed no additional benefit from steroids. No adverse effects noted. Pundir 1956 2016 1 SRandMA 18RCTs (n = 1309) addressing topical nasal steroids, which included some studies of intra-operative steroid use. Multiple symptom scores. HRQol scores. Endoscopic scores.

Different delivery methods were included.

12 RCTs addressed postop symptom scores; 8 RCTs addressed postop endoscopic scores; 4 studies

addressed postop infection rate