A prospective randomized blinded clinical trial: large‐volume nasal irrigation with fluticasone propionate in the early postoperative period following septoplasty

Tuğrul, Selahattin; Doğan, Remzi; Şentürk, Erol; Eren, Sabri Baki; Meriç, Ayşenur; Özturan, Orhan

doi:10.1002/alr.21527

Cited by 7 publications

(12 citation statements)

References 16 publications

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“…The improvement in QoL scores at day 21 was greater than that obtained in the previous studies at day 28. These values are similar to those of an asymptomatic population in both groups [23, 24, 30, 31]. Our results are equivalent to the combined effect of high-volume irrigation plus nasal corticosteroid [31].…”

Section: Discussionsupporting

confidence: 89%

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Prospective, randomized, controlled, open-label study to compare efficacy of a mineral-rich solution vs normal saline after complete ethmoidectomy

Gabory¹,

Escabasse²,

Boudard³

et al. 2018

Eur Arch Otorhinolaryngol

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Purposes The purpose of this study was to compare the efficacy of a mineral-rich solution vs normal saline solution (0.9% NaCl) following endoscopic complete bilateral ethmoidectomy. Methods This was a prospective, multicenter, randomized, controlled, open-label trial in subjects suffering from steroid-resistant sinonasal polyposis. Adults performed 4 nasal irrigations of mineral or saline solutions daily for 28 days. Evaluations included subject-reported RHINO quality of life (QoL) and NOSE scores, tolerability, and satisfaction, the Lund–Kennedy endoscopic score and assessments of crusting, secretions and mucociliary clearance (rhinoscintigraphy). Results A total of 189 subjects were randomized. Clinically relevant improvements (> 20 points) in RhinoQOL and NOSE scores were measured in both groups without any significant inter-group difference. Among the subjects with impaired RhinoQOL at pre-inclusion, the change in Impact-RhinoQOL score was significantly superior in mineral-rich vs saline solution at day 21 ( p = 0.028) and day 28 ( p = 0.027). The Lund–Kennedy score continuously improved in both groups earlier with the mineral-rich solution. Crusts were significantly fewer in number and less severe/obstructive in patients receiving mineral-rich vs saline solution at day 7 ( p = 0.026) and day 14 ( p = 0.016). Furthermore, secretions disappeared significantly more quickly and were less thick/purulent with mineral-rich solution at day 14 ( p = 0.002) and day 21 ( p = 0.043). Less epistaxis was reported in the mineral vs saline solution ( p = 0.008 at day 21). Conclusions Our findings indicate that the composition of a nasal irrigation solution influences endoscopic scores and QoL after sinus surgery for patients over 60, those with an initially poor QoL and higher symptom score, and smokers.

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Section: Discussionsupporting

confidence: 89%

“…Nasal irrigation shortly following ESS has been reported to promote wound healing and reduce nasal discharge and edema within the tissue [29–31], but evidence of the efficacy of various salt-based solutions in post-operative settings is lacking [32]. The present findings could impact post-operative care in several ways.…”

Section: Discussionmentioning

confidence: 76%

Prospective, randomized, controlled, open-label study to compare efficacy of a mineral-rich solution vs normal saline after complete ethmoidectomy

Gabory¹,

Escabasse²,

Boudard³

et al. 2018

Eur Arch Otorhinolaryngol

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“…Operative and postoperative use of iced salinesoaked gauze applied to the external nose 101 2. Postoperative use of low-pressure, high-volume nasal irrigation with normal saline and fluticasone by the patient after discharge 59 3. Eliminating nasal packing as a routine practice 92,102 4.…”

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confidence: 99%

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Ishii

Tollefson

Basura

et al. 2017

Otolaryngol.--head neck surg.

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Objective. Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work.The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre-and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri-and postoperative strategies to maximize patient safety and to optimize surgical results for patients.Purpose. The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age.Action Statements. The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for...

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“…Although nasal steroids are commonly used after FESS, there has been only one study to report the effect of steroid irrigation after septoplasty . In that study the researchers recommended fluticasone propionate combined with a saline irrigation solution for 30 days . The shorter treatment duration and faster treatment response may increase patient compliance to nasal decongestant treatment vs steroids, but further studies are needed to compare the effects.…”

Section: Discussionmentioning

confidence: 99%

Effects of early postoperative nasal decongestant on symptom relief after septoplasty

Dağlı¹,

Ocak

Mirici³

et al. 2018

Int Forum Allergy Rhinol

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A prospective randomized blinded clinical trial: large‐volume nasal irrigation with fluticasone propionate in the early postoperative period following septoplasty

Abstract: Nasal irrigation with the LPHVNS+FP combination during the early postoperative period following septoplasty is an effective method, resulting not only in increased patient satisfaction and nasal air flow but also in decreased edema and crust formation.

Cited by 7 publications

References 16 publications

Prospective, randomized, controlled, open-label study to compare efficacy of a mineral-rich solution vs normal saline after complete ethmoidectomy

Prospective, randomized, controlled, open-label study to compare efficacy of a mineral-rich solution vs normal saline after complete ethmoidectomy

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Effects of early postoperative nasal decongestant on symptom relief after septoplasty

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