What is the impact of steroid-impregnated absorbable nasal dressing on wound healing and surgical outcomes after endoscopic sinus surgery (ESS)?
Explore this issue:June 2010
Background: Wound healing has been a significant determinant of successful outcomes in ESS, with factors leading to poor surgical outcomes including scarring/synechiae, ostial or middle meatal obstruction, infection and persistent inflammation in the opened sinus cavities. Intranasal triamcinolone acetonide has been evaluated in clinical trials and found to be beneficial in minimizing nasal secretory response and reducing inflammation, which has led to recommendations for intranasal steroids as a first-line therapy in allergic rhinosinusitis. The use of topical corticosteroid sprays post operatively, however, has met with mixed results. A short course of systemic steroids has been found to be helpful after ESS, but there remains a lack of consensus regarding optimal perioperative nasal dressing and packing as well as the optimal postoperative medical regimen.
Study Design: A prospective, randomized, double-blinded, placebo-controlled trial
Setting: Alberta Sinus Centre, University of Alberta, Edmonton, Alberta, Canada
Synopsis: Researchers recruited 19 chronic rhinosinusitis patients with polyposis who were to undergo bilateral ESS and randomized them to receive triamcinolone-impregnated bioresorbable dressing in one nasal cavity and saline-impregnated dressing contralaterally. Nasal packing remained in situ until about one week after surgery. Postoperative healing assessments of edema, crusting, secretions and scarring were done at postoperative days seven, 14, 28 and at three and six months using validated Lund-Kennedy and Perioperative Sinus Endoscopy (POSE) scores. There were no significant differences between the cavity scores preoperatively. A statistically significant difference, however, was seen at days seven and 14 and between the groups at the three- and six-months. The researchers said limitations to the study included the likely variable consistency and duration of delivery of the steroid. Additionally, ideal dosage needs further clarification.
Bottom Line: There is significant improvement in early postoperative healing in sinonasal cavities receiving triamcinolone-impregnated absorbable nasal packing following ESS and this is associated with significant improved healing up to six months postoperatively.
Citation: Côté DWJ, Wright ED. Triamcinolone-impregnated nasal dressing following endoscopic sinus surgery: a randomized, double-blind, placebo-controlled study. The Larynogoscope. 2010;120(6):1269-1273.
—Reviewed by Sue Pondrom