Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized, double blind, placebo-controlled study

Grzeskowiak, Blazej; Wierzchowska, Malgorzata; Walorek, Rafal; Seredyka-Burduk, Malgorzata; Wawrzyniak, Katarzyna; Burduk, Pawel Krzysztof

doi:10.1016/j.bjorl.2018.04.002

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Otorhinolaryngology

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • Braz. j. otorhinolaryngol. 85 (4) • Jul-Aug 2019 • https://doi.org/10.1016/j.bjorl.2018.04.002 copy

Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized, double blind, placebo-controlled study^☆ ☆ Please cite this article as: Grzeskowiak B, Wierzchowska M, Walorek R, Seredyka-Burduk M, Wawrzyniak K, Burduk PK. Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized, double blind, placebo-controlled study. Braz J Otorhinolaryngol. 2019;85:473-80.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Endoscopic sinus surgery can lead to crusting or synechiae formation, which can affect the healing process.

Objective:

The aim of our study was to compare the influence of steroid versus antibiotic versus saline solution impregnated absorbable nasal spacers on postoperative wound healing and patient satisfaction.

Methods:

Eighty patients, 33 women and 47 men, were enrolled in this study. At the end of the surgery, two pieces of 4 cm biodegradable material were applied in each ethmoid cavity. One of them was impregnated with saline solution, while the second one with steroid, or with antibiotic.

Results:

We observed statistically significant differences in the Lund-Kennedy score between the control and both treatment groups: for the Antibiotic-group on days 10 and 30 (p = 0.009; p = 0.009) and for the Steroid-group on day 90 (p = 0.008). The extended endoscopic appearance of nasal mucosa indicated statistically significant differences in crust formation on day 10 comparing the steroid and control dressing (p = 0.025), in secretion type on days 10 and 30 comparing the antibiotic and control dressing (p = 0.003; p = 0.016) and additionally for steroid and control on day 90 (p = 0.046). On Day 90 we observed statistically significant differences in the absence of mucosal edema in the S-group compared to controls (p = 0.007).

Conclusions:

The results of this study reveal the significant positive influence of steroid- and antibiotic-impregnated biodegradable nasal packing on the postoperative healing process and patient satisfaction compared to the saline soaked dressing.

PALAVRAS-CHAVE
Agentes antibacterianos; Esteroides; Cicatrização de feridas; Cirurgia endoscópica nasal; Nasopore/tampão biodegradável

		Group		Total
		Antibiotic	Steroid
Gender
Females	n	18	15	33
Females	%	45.0	37.5	41.25
Males	n	22	25	47
Males	%	55.0	62.5	58.75
Total		40	40	80
Age (years)
Mean		42.95	47.73	45.34
SD		14.422	12.447	13.435

Day	Antibiotic (n = 40)			p between groups	Steroid (n = 40)
	Drug	Control	p		Drug	Control	p
Baseline	4.00 ± 1.396	4.08 ± 1.269	0.66	0.297	3.40 ± 1.257	3.45 ± 1.197	0.623
10	0.67 ± 0.772	1.05 ± 0.826	0.009	0.633	0.68 ± 0.797	0.95 ± 0.986	0.087
30	0.64 ± 0.811	0.85 ± 0.812	0.009	0.051	1.00 ± 1.076	1.28 ± 1.169	0.096
90	0.57 ± 0.867	0.62 ± 0.953	0.527	0.321	0.58 ± 0.889	0.97 ± 1.219	0.008
180	0.54 ± 1.039	0.60 ± 1.117	0.157	0.075	0.56 ± 1.021	0.76 ± 1.458	0.084

Group	Parameter	Scale	Packing type	10 day (Mean ± SD)	30 day (Mean ± SD)	3 month (Mean ± SD)	6 month (Mean ± SD)
Antibiotic	Bleeding	0-2	Drug	0.00	0.03 ± 0.160	0.00	0.00
			Control	0.00	0.00 ± 0.000	0.00	0.00
			p	1.000	0.317	1.000	1.000
	Secretion	0-3	Drug	0.41 ± 0.549	0.33 ± 0.478	0.14 ± 0.347	0.17 ± 0.382
			Control	0.72 ± 0.686	0.59 ± 0.595	0.22 ± 0.417	0.14 ± 0.355
			p	0.003	0.016	0.257	0.317
	Oedema	0-3	Drug	0.41 ± 0.498	0.33 ± 0.577	0.46 ± 0.730	0.49 ± 0.981
			Control	0.46 ± 0.505	0.36 ± 0.486	0.46 ± 0.767	0.60 ± 1.035
			p	0.527	0.683	1.000	0.102
	Crusting	0-1	Drug	0.82 ± 0.389	0.18 ± 0.389	0.00	0.00
			Control	0.85 ± 0.366	0.21 ± 0.409	0.00	0.00
			p	0.317	1.000	1.000	1.000
	Synechiae		Drug	0.00	0.05 ± 0.223	0.03 ± 0.164	0.14 ± 0.355
			Control	0.00	0.02 ± 0.160	0.00	0.17 ± 0.382
			p	1.000	1.000	0.317	0.655
Steroid	Bleeding	0-2	Drug	0.03 ± 0.158	0.00	0.00	0.00
			Control	0.05 ± 0.221	0.00	0.00	0.00
			p	0.317	1.000	1.000	1.000
	Secretion	0-3	Drug	0.55 ± 0.552	0.62 ± 0.781	0.21 ± 0.413	0.26 ± 0.511
			Control	0.65 ± 0.622	0.54 ± 0.642	0.32 ± 0.525	0.24 ± 0.496
			p	0.286	0.724	0.046	0.655
	Oedema	0-3	Drug	0.25 ± 0.439	0.46 ± 0.682	0.37 ± 0.633	0.32 ± 0.727
			Control	0.40 ± 0.496	0.67 ± 0.737	0.68 ± 0.775	0.44 ± 0.849
			p	0.083	0.149	0.007	0.157
	Crusting	0-1	Drug	0.60 ± 0.496	0.28 ± 0.456	0.00	0.00
			Control	0.73 ± 0.452	0.31 ± 0.468	0.00	0.00
			p	0.025	1.000	1.000	1.000
	Synechiae		Drug	0.00	0.13 ± 0.409	0.13 ± 0.343	0.21 ± 0.479
			Control	0.00	0.18 ± 0.451	0.16 ± 0.370	0.24 ± 0.554
			p	1.000	0.617	0.564	0.705

Group	Symptom	Packing type	Day
			2		10		30		90		180
			Mean ± SD	p	Mean ± SD	p	Mean ± SD	p	Mean ± SD	p	Mean ± SD	p
Antibiotic	Facial pressure	Drug	1.65 ± 2.020	0.050	0.51 ± 1.189	0.011	0.38 ± 0.963	0.066	0.24 ± 0.760	0.048	0.54 ± 1.597	0.317
	Facial pressure	Control	1.88 ± 2.300	0.050	0.90 ± 1.569	0.011	0.90 ± 1.774	0.066	0.57 ± 1.042	0.048	0.57 ± 1.632	0.317
	Nasal occlusion	Drug	3.45 ± 2.012	0.200	1.67 ± 1.722	0.356	0.95 ± 1.905	0.032	0.32 ± 0.784	0.000	0.54 ± 1.400	0.041
	Nasal occlusion	Control	1.40 ± 2.036	0.200	1.92 ± 1.723	0.356	1.46 ± 1.862	0.032	1.00 ± 1.269	0.000	0.83 ± 1.807	0.041
	Smell	Drug	2.60 ± 3.103	0.007	5.28 ± 3.077	0.008	7.00 ± 3.656	0.039	8.08 ± 3.303	0.102	8.34 ± 3.378	0.317
	Smell	Control	0.48 ± 1.012	0.007	4.92 ± 3.157	0.008	6.69 ± 3.599	0.039	7.95 ± 3.33	0.102	8.32 ± 3.411	0.317
Steroid	Facial pressure	Drug	1.25 ± 1.532	0.028	1.33 ± 2.043	0.329	1.00 ± 1.622	0.822	0.47 ± 1.179	0.102	0.29 ± 0.906	0.317
	Facial pressure	Control	1.73 ± 2.207	0.028	1.53 ± 2.160	0.329	1.00 ± 1.338	0.822	0.66 ± 1.512	0.102	0.35 ± 1.070	0.317
	Nasal occlusion	Drug	3.13 ± 2.430	0.221	1.33 ± 1.730	0.098	1.15 ± 1.927	0.596	0.62 ± 1.010	0.033	0.38 ± 1.704	1.000
	Nasal occlusion	Control	3.43 ± 2.630	0.221	1.80 ± 1.829	0.098	1.31 ± 1.908	0.596	1.16 ± 1.653	0.033	0.38 ± 0.954	1.000
	Smell	Drug	3.85 ± 3.958	0.258	6.50 ± 3.404	0.246	7.56 ± 3.033	0.593	8.55 ± 2.806	0.785	9.47 ± 1.461	0.317

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:pburduk@wp.pl (P.K. Burduk).