Background Epistaxis is a very common ENT emergency with the idiopathic variety being the commonest type. Daflon® is a mixture of flavonoids with beneficial vascular effects that may help in the treatment of epistaxis. Objective To assess the efficacy and safety of Daflon® in the treatment of idiopathic epistaxis. Methods This is an open-label randomized clinical trial conducted on patients with idiopathic epistaxis comparing 1 group receiving Daflon® for 1 month and a second group receiving Daflon® for 3 months with a control group receiving nothing. The groups were evaluated regarding the number of visits to an emergency room and the number of patients needing cautery as indicators for the control of epistaxis. Also, the severity of epistaxis was assessed using epistaxis severity score (ESS) before and after treatment. We followed the patients for 1 year to determine the long-term effect of both drug protocols. Results The study included 450 patients distributed equally among the 3 study groups. The administration of Daflon® whether for 1 month or 3 months resulted in a significant improvement in our indicators for control of epistaxis including the number of patients visiting an emergency room and those needing cauterization after the failure of light nasal packing when compared with control group. Also, the severity of epistaxis as defined by the ESS was significantly less at the end of each treatment period and at 1-year follow-up when compared with the pretreatment severity. However, the use of Daflon® for 3 months was associated with a significantly more epistaxis control at 1-year follow-up when compared with the 1-month administration. Conclusion Daflon® is a very effective and safe method for controlling idiopathic epistaxis. However, the daily use of Daflon® for 3 months has a more significant long-term beneficial effect than 1 month of use.
Background Nasal polyposis is a common disease with steroids either systemic or topical being the key element in its medical treatment. With known side effects of systemic steroids, other anti-inflammatory agents should be evaluated, preferably the natural ones. Objective To evaluate the role of omega-3 polyunsaturated fatty acids in the treatment of nasal polyposis. Methods This is a single-blinded randomized-controlled trial including 164 patients with grade II nasal polyposis receiving a short course of systemic steroids until subsidence of polyposis. Patients were distributed equally after into 2 groups according to maintenance therapy with group I receiving omega-3 fatty acids in a dose of 3 g per day with local budesonide nasal spray and group II receiving only local budesonide nasal spray. Both groups were compared regarding incidence and grade of recurrence of polyposis and duration from onset of maintenance therapy to onset of recurrence. Results A nonsignificant effect for omega-3 was found on the incidence of recurrence of nasal polyposis ( P = .1) and the grade of recurrent polyposis ( P = .66). However, omega-3 intake had a highly significant effect on delaying the incidence of recurrence of polyposis ( P < .0001). Conclusion Omega-3 fatty acid has a beneficial effect on delaying the incidence of recurrence of nasal polyposis through its proven anti-inflammatory mechanism of action. This minimizes the need for systemic steroid administration with its known side effects. Omega-3 fatty acids supplementation should be considered while tailoring the maintenance regimen for medical treatment of chronic rhinosinusitis with nasal polyposis.
Background Inferior turbinate hypertrophy is a common cause of chronic nasal obstruction with many procedures for management including submucosal diathermy and coblation with a variation in their techniques. The aim of this study was to assess the protective role of submucosal saline injection in the inferior turbinates prior to submucosal diathermy or coblation techniques. A prospective cohort study was conducted on 80 patients diagnosed with bilateral hypertrophied inferior turbinates causing persistent nasal obstruction and not responding to medical treatment. The patients were distributed randomly and equally between 2 groups. Group I included 40 patients operated on with coblation of the inferior turbinates. Group II included 40 patients operated on with submucosal diathermy of the inferior turbinates. The right side of the nose of both groups had a saline injection of the inferior turbinates before the procedure and the left side of the nose did not have such injection. Each side of the nose in every patient was assessed for the degree of nasal crusting at 1 week postoperative, the presence of turbinate gangrene at 3 weeks postoperative, and the visual analog scale (VAS) of four symptoms (nasal discomfort, nasal pain, nasal obstruction, and thick nasal discharge) at 1 week postoperative. Results In the coblation group, there was a significant difference between the right and left sides regarding the degree of crusting at 1 week postoperative, and a non-significant difference between the two sides regarding the presence of gangrene at 3 weeks postoperative. In the diathermy group, there was a significant difference between the right and left sides regarding the same parameters. Comparison between the injection and non-injection sides in each group regarding the nasal symptoms showed a highly significant difference between the two sides in each group favoring the injection side. Conclusion Saline injection prior to inferior turbinate coblation or submucosal diathermy had a protective effect against crusting with both techniques and gangrene formation with submucosal diathermy. This was reflected on better postoperative nasal symptoms.
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