The role of antibiotics in endoscopic sinus surgery

Coughlan, Carolyn A.; Bhandarkar, Naveen D.

doi:10.1097/moo.0000000000000122

Cited by 9 publications

(12 citation statements)

References 40 publications

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“…toxic shock syndrome, but this remains an extremely rare complication. 30,34 That the majority of our respondents prescribed antibiotics when packing was placed is suggestive of this ongoing concern.…”

Section: Discussionmentioning

confidence: 90%

“…The majority of our respondents utilized a regimen consistent with these recommendations. Similarly, limited data exist to suggest a definitive postoperative antibiotic regimen in the setting of nasal packing placement following endoscopic sinus surgery or ESBS . Antibiotics have been prescribed in this situation for fear of toxic shock syndrome, but this remains an extremely rare complication .…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, limited data exist to suggest a definitive postoperative antibiotic regimen in the setting of nasal packing placement following endoscopic sinus surgery or ESBS. 28,34 Antibiotics have been prescribed in this situation for fear of Fig. 13.…”

Section: Discussionmentioning

confidence: 99%

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Survey of endoscopic skull base surgery practice patterns among otolaryngologists

Wannemuehler

Rabbani

Burgeson

et al. 2018

Laryngoscope Investig Oto

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BackgroundEndoscopic skull base surgery (ESBS) is a rapidly expanding field. Despite divergent reported preferences for reconstructive techniques and perioperative management, limited data exist regarding contemporary practice patterns among otolaryngologists performing ESBS. This study aims to elucidate current practice patterns, primarily the volumes of cases performed and secondarily a variety of other perioperative preferences.MethodsAn anonymous 32‐item electronic survey examining perioperative ESBS preferences was distributed to the American Rhinologic Society membership. Statistical significance between variables was determined utilizing Student t, chi‐square, and Fisher exact tests.ResultsSeventy otolaryngologists completed the survey. The effective response rate was approximately 22.5%. Sixty percent of respondents were in full‐time academic practice and 70% had completed rhinology/skull base fellowships. Annually, 43.3 mean ESBS cases were performed (29.1 private practice vs. 52.9 academic practice, P = .009). Academic practice averaged 24.1 expanded cases versus only 11 in private practice (P = .01). Of respondents, 55.7% stood on the same side as the neurosurgeon and 72.9% remained present for the entire case. Current procedural terminology coding and antibiotic regimens were widely divergent; 31.4% never placed lumbar drains preoperatively, while 41.4% did so for anticipated high‐flow cerebrospinal fluid leaks. While considerable variation in reconstructive techniques were noted, intradural defect repairs utilized vascularized flaps 86.3% of the time versus only 51.3% for extradural repairs (P < 0.001). Major complications were rare. Postoperative restrictions varied considerably, with most activity limitations between 2–8 weeks and positive airway pressure use for 2–6 weeks. Most respondents started saline irrigations 0–2 weeks postoperatively.ConclusionsBased on responses from fellowship‐ and non‐fellowship‐trained otolaryngologists in various practice settings, there remains considerable variation in the perioperative management of patients undergoing ESBS.Level of Evidence5

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Survey of endoscopic skull base surgery practice patterns among otolaryngologists

Wannemuehler

Rabbani

Burgeson

et al. 2018

Laryngoscope Investig Oto

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“…Grade B evidence exists for the use of postoperative oral antibiotics to improve symptom and endoscopic scores in the first few weeks after ESS; however, these findings are temporary, and in controlled studies, there was no difference in outcome between treated and nontreated cohorts after 6 months. 41 Likewise, postoperative oral corticosteroids have been shown to improve endoscopic outcomes but only in the early postoperative period. In an evidence-based review by Rudmik and Smith, 42 a recommendation was made for early saline irrigations, topical steroid sprays, and debridement, whereas oral antibiotics and steroids, steroid-impregnated saline irrigations, and drug-eluting stents were considered optional.…”

Section: Postoperative Phasementioning

confidence: 99%

Avoiding Complications in Endoscopic Sinus Surgery

Humphreys

Hwang

2015

Otolaryngologic Clinics of North America

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“…The theoretical benefits of antibiotic use perioperatively, namely a reduction in infection risk, improvement in patient‐reported symptoms, and enhanced surgical site healing, must be weighed against the potential risks of antibiotics. These risks include the development of antimicrobial resistance, allergic reactions, and gastrointestinal sequelae, a known cost burden on the healthcare system, and a theoretical alteration of the sinonasal microbiome that may affect disease progression …”

mentioning

confidence: 99%