Efficacy of triamcinolone acetonide-impregnated Gelfoam nasal pack in management of chronic sinusitis with nasal polyps following endoscopic sinus surgery: a perfectly matched, placebo-controlled trial study

Samarei, Reza; Rasouli, Javad; Mehdikhani, Fatemeh

doi:10.1007/s00405-021-07071-2

Cited by 4 publications

(13 citation statements)

References 44 publications

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“…Although prior studies have initiated sinus irrigations around the same time point and still reported improvement in the steroid‐treated cavities, 10,11 it is conceivable that beginning sinus irrigations at this point may significantly dilute the steroid concentration contained within the packing material. Finally, it should be noted that the mean postoperative LK and POSE scores in our cohort appeared to be lower than what has been previously reported in the literature in similar studies 11,16,17 . This could be explained by the baseline LM CT scores in our cohort being lower than the mean scores of other cohorts which appear to average around 9 per side versus 5 per side in our cohort.…”

Section: Discussioncontrasting

confidence: 76%

“…Finally, it should be noted that the mean postoperative LK and POSE scores in our cohort appeared to be lower than what has been previously reported in the literature in similar studies. 11,16,17 This could be explained by the baseline LM CT scores in our cohort being lower than the mean scores of other cohorts which appear to average around 9 per side versus 5 per side in our cohort. Furthermore, the prescription of postoperative systemic steroids in some patients could outweigh any potential additional benefit of topical steroids to the effect that there is no noticeable difference between sides.…”

Section: Discussioncontrasting

confidence: 70%

“…9 Finally, a recent similar study reported on the effects of steroidimpregnated gelfoam and identified that patients without eosinophilic CRS demonstrated significant improvement in healing, while noneosinophilic patients did not have any difference in healing between the steroid-treated and nonsteroid-treated cavities. 17 Subgroup analysis of our patient population, however, did not find any difference in healing based on polyp status. Recently, Zhang et al published a systematic review on this topic including many of the studies cited above.…”

Section: Discussionmentioning

confidence: 52%

“…Another study using betamethasone‐impregnated Nasopore found a significant improvement in LK scores among the steroid‐treated sinuses at 90 days postoperatively 9 . Finally, a recent similar study reported on the effects of steroid‐impregnated gelfoam and identified that patients without eosinophilic CRS demonstrated significant improvement in healing, while noneosinophilic patients did not have any difference in healing between the steroid‐treated and non‐steroid‐treated cavities 17 . Subgroup analysis of our patient population, however, did not find any difference in healing based on polyp status.…”

Section: Discussionmentioning

confidence: 89%

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Triamcinolone‐impregnated bioabsorbable middle meatus packing following endoscopic sinus surgery: A prospective randomized controlled trial

McCormick

Suh

Yang

et al. 2022

Int Forum Allergy Rhinol

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Introduction: Topical steroids are a mainstay in the treatment of chronic rhinosinusitis (CRS). Multiple delivery methods of topical steroids following sinus surgery have been investigated. The purpose of this trial is to evaluate the effect of triamcinolone-impregnated absorbable nasal packing on healing following endoscopic sinus surgery (ESS). Methods: This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 22 subjects (14 without polyps and eight with polyps) were enrolled and were randomized to receive triamcinolone-impregnated packing in one sinus cavity and normal saline-soaked packing in the contralateral sinus cavity. Endoscopic evaluation was completed at the first two postoperative visits, and Lund-Kennedy (LK) endoscopic scores and perioperative sinus endoscopy (POSE) scores were calculated at each visit. Results:The results of this study found no significant difference in the appearance of the sinuses at either postoperative visit. Mean LK scores for the triamcinolone and saline groups at the first and second postoperative visits were 2.09 ± 1.23 versus 2.18 ± 1.01 (p = 0.79) and 1.79 ± 1.08 versus 1.68 ± 1.16 (p = 0.77), respectively. POSE scores were 2.59 ± 1.71 versus 2.68 ± 1.62 (p = 0.86) and 1.74 ± 1.15 versus 1.95 ± 1.22 (p = 0.59). Conclusion:The results of this study demonstrated no significant difference in healing, crusting, polyps, edema, or secretions between the triamcinolonetreated and non-triamcinolone-treated sinuses. There were no adverse effects from the use of triamcinolone-impregnated absorbable packing. Further studies will be necessary to determine the impact of triamcinolone-impregnated absorbable packing following ESS.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 89%

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Triamcinolone‐impregnated bioabsorbable middle meatus packing following endoscopic sinus surgery: A prospective randomized controlled trial

McCormick

Suh

Yang

et al. 2022

Int Forum Allergy Rhinol

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“…This can slow recovery, potentially leading to the need for revision surgery [5,6]. To overcome this problem, steroid-impregnated spacers have been devised to reduce local inflammation around the surgical area and prevent stenosis during postoperative recovery [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. In this study, we reviewed the steroid-impregnated spacers reported to date and evaluated their effects on treatment outcomes using validated scales.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Steroid-Impregnated Spacers After Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

Hwang¹,

KIM²,

Basurrah³

et al. 2023

Clin Exp Otorhinolaryngol

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Objectives: To compare the effect of steroid-impregnated spacers to conventional management after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Methods: Six databases were searched from inception until November 2022. Sixteen studies were found that compared the improvement of chronic sinusitis-related symptoms and postoperative outcomes between a steroid-impregnated spacer group and control group (non-steroid impregnated spacers). The Cochrane risk of bias tool (randomized controlled studies) and Newcastle–Ottawa Scale (non-randomized controlled studies) were used to assess the quality of the works included.Results: Regarding the endoscopic findings, the degree of mucosal edema, ethmoid inflammation, crust formation at 2–3 months postoperatively, nasal discharge, polyposis, and scarring/synechia were significantly lower in the steroid-impregnated spacers group. Also, the steroid-impregnated spacer significantly reduced the Lund–Kennedy score and perioperative sinus endoscopy score compared with the control group at 2–3 weeks postoperatively. Also, the steroid-impregnated spacer group had lower rates of adhesions, middle turbinate lateralization, polypoid change, the need for oral steroid, the need for postoperative therapeutic intervention, and lysis of adhesions compared to controls. However, there were no significant group differences in the short-term (2–3 weeks postoperatively) endoscopic findings regarding nasal discharge, postoperative crusting, polyposis, or scarring/synechia.Conclusion: Steroid-impregnated nasal packing reduced the rates of postoperative intervention and recurrent polyposis and inflammation in CRS patients undergoing ESS.

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Outcomes of Frontal Sinus Stenting With Steroid Impregnated Microsponge Versus Steroid-Eluting Implant

Brar

Brown

Miglani

et al. 2023

Am J Rhinol�Allergy

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Background Mometasone-eluting poly-L-lactide-coglycolide (MPLG) is available commercially for frontal sinus ostium (FSO) stenting. An alternative chitosan polymer-based drug delivery microsponge is also available at a lower cost per unit. Objective To compare the outcomes of MPLG stents versus triamcinolone-impregnated chitosan polymer (TICP) microsponge in frontal sinus surgery. Methods Patients who underwent endoscopic sinus surgery from December 2018 to February 2022 were reviewed to identify those with the intraoperative placement of TICP microsponge or MPLG stent in the FSO. FSO patency was evaluated by endoscopy at follow-up. Twenty-two-item sinonasal outcome test (SNOT-22) was also recorded, and complications were noted. Results A total of 68 subjects and 96 FSOs were treated. TICP was first used in August 2021 and MPLG in December 2018. MPLG placement in a Draf 3 cavity was excluded since TICP had not been used during Draf 3 procedure. Both cohorts (TICP 20 subjects, 35 FSOs; MPLG 26 subjects, 39 FSOs) had similar clinical characteristics. At a mean total follow-up of 249.2 days for TICP and 490.4 days for MPLG, FSO patency was 82.9% and 87.1%, respectively ( P = .265). At an equivalent follow-up of 130.6 days in TICP and 154.0 days in MPLG, patency was 94.3% and 89.7%, respectively ( P = .475). Both groups showed significant reductions in SNOT-22 ( P < .001). MPLG demonstrated crusting within the FSO at 1 month (none in TICP). Conclusion FSO patency for both stents was similar, although TICP had significantly lower costs per unit. Additional comparative trials may be helpful for guiding clinicians on the appropriate clinical situations for the use of these devices.

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Efficacy of triamcinolone acetonide-impregnated Gelfoam nasal pack in management of chronic sinusitis with nasal polyps following endoscopic sinus surgery: a perfectly matched, placebo-controlled trial study

Cited by 4 publications

References 44 publications

Triamcinolone‐impregnated bioabsorbable middle meatus packing following endoscopic sinus surgery: A prospective randomized controlled trial

Triamcinolone‐impregnated bioabsorbable middle meatus packing following endoscopic sinus surgery: A prospective randomized controlled trial

Efficacy of Steroid-Impregnated Spacers After Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

Outcomes of Frontal Sinus Stenting With Steroid Impregnated Microsponge Versus Steroid-Eluting Implant

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