We are unable to reach any conclusions as to whether isolated nasal polypectomy or more extensive sinus surgery is a superior surgical treatment modality for chronic rhinosinusitis with nasal polyps. There is a need for high-quality randomised controlled trials to assess whether additional sinus surgery confers any benefit when compared to nasal polypectomy performed in isolation.
Our study suggests much of the laryngeal cancer information available online is of suboptimal quality and written at a level too difficult for the average adult to read comfortably.
The aims of this study were to identify differences in post-operative nausea and vomiting (PONV) and throat pain between throat packed and non-packed patient groups in nasal surgery. This was a prospective, double blind, randomised controlled trial. A water-soaked throat pack gauze was inserted in the mouth to occlude the oropharynx was used in the throat pack group. The second group received no throat pack. A validated PONV questionnaire was completed 6 h post-operatively. Visual analogue scores (VAS) for throat pain were completed in recovery, 2, and 6 h post-operatively. 80 patients were enrolled (40 into each group based on power calculation). With regard to the primary outcome measure, mean PONV score for the throat pack group was 2.75 [median 0, standard deviation (SD 10.86)] and the mean PONV score for the non-packed group was 0.36 (median 0, SD 1.39). The difference in PONV was not statistically significant [P value 0.375, 95% confidence interval (CI) -1.19 to 3.32]. With regard to throat pain VAS scores (our secondary outcome measure), in recovery, the mean throat pain VAS score for the throat packed group was 2.5 (median 1, SD 2.8) and the mean throat pain VAS score for the non-throat packed group was 1.3 (median 0, SD 2.5). Statistical analysis showed a significant difference between the two groups with the throat pack group experiencing more throat pain in recovery (P value 0.018 (95% CI 1.13-2.52). At 2 and 6 h post-operatively, the mean throat pain VAS scores for the throat packed group were 2.1 and 2.3, respectively, and the mean throat pain VAS score for the non-throat packed group was 2.3 and 1.4, respectively. Statistical analysis showed non-significant difference between the two groups at 2 and 6 h post-operatively. The use of throat packs in nasal surgery does not confer PONV reduction benefit. The use of throat pack, however, is associated with a small but statistically significant more throat pain in the initial recovery period from nasal operations.
Objectives
Tonsillectomy is an extremely common ENT surgical procedure. There is a growing interest in the role of intracapsular dissection tonsillectomy (ICDT) due to reported reduced perioperative complications. We aim to compare the outcomes associated with ICDT versus traditional extracapsular dissection tonsillectomy (ECDT) in the adult population.
Methods
Systematic review of all randomized controlled trials (RCTs) comparing ICDT and ECDT for all indications in the adult population. Electronic searches performed through CENTRAL, PubMed, Ovid EMBASE, Web of Science, http://clinicaltrials.gov, and WHO ICTRP. Review Manager 5.3 (RevMan 2014) was used to carry out the meta‐analysis.
Results
Nine RCTs were included with a total of 11 reports with mean age of 23.9 years including 181 patients who received ICDT compared to 176 patients receiving ECDT. We found statistically significant reduced postoperative pain and analgesia requirement as well as a reduced rate of secondary postoperative bleeding in patients undergoing ICDT versus ECDT. There appears to be no significant difference in controlling recurrent tonsillitis between the ICDT and ECDT groups.
Conclusion
Across the recorded outcomes we noted no clear benefit to performing ECDT over ICDT and evidence suggests high patient satisfaction with ICDT. Laryngoscope, 130:2325–2335, 2020
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