Diagnosis and Management of Craniofacial Osteomas.

IMPORTANCE: Osteoid osteomas are benign bony overgrowths that can occur in any region of the body. However, they have a predilection to occur in the craniofacial region. Because of the rarity of this entity, there is a lack of literature detailing the management and prognosis of craniofacial osteoid osteomas. OBSERVATIONS: Craniofacial osteomas have a predilection to involve the paranasal sinuses, but can also be found within the jaw, skull base, and facial bones. Because of their slow-growing nature, craniofacial osteomas are often incidentally discovered on routine imaging or after they compress nearby structures or distort nearby anatomy. Osteoid osteomas of the face can be treated with resection via various approaches. Recent advancements describe minimally invasive endoscopic techniques and adjuvant therapy with radiofrequency ablation guided by cone biopsy computed tomography. Osteoid osteomas have an excellent prognosis with complete resection. They demonstrate a low incidence of recurrence when compared with other osteoblastic lesions of the craniofacial structures. CONCLUSIONS AND RELEVANCE: Craniofacial osteoid osteomas remain a developing topic within the field of craniofacial surgery. Their removal may be trending toward minimally invasive techniques. However, all treatment modalities appear to result in improved cosmetic outcomes and low recurrence rates.

Wound healing in endoscopic sinus surgery: Phase 1 clinical trial evaluating the role of Chitogel with adjuvants.

OBJECTIVES: This study aimed to determine the safety and efficacy of Chitogel, with and without Deferiprone (Def) and Gallium Protoporphyrin (GaPP), as a promoter of wound healing to improve surgical outcomes after endoscopic sinus susgery. DESIGN: A double-blinded, randomised control human clinical trial was conducted in patients undergoing ESS as a treatment for chronic rhinosinusitis. Participants underwent functional ESS or FESS with drill out as required and were randomised to receive test product Chitogel, Chitogel in combination with Def or Def-GaPP versus no packing (control). SETTING: Ostial stenosis and persistent inflammation are the main reasons for revision endoscopic sinus surgery (ESS). Post-operative (PO) dressings can improve PO wound healing and patient outcomes after ESS. PARTICIPANTS: Eighty two patients were included in this study with 79 patients completing the study with 40 undergoing full house FESS and 39 FESS plus frontal drillout. MAIN OUTCOME MEASURES: Patients were followed up at 2, 6 and 12 weeks PO, and outcome scores such as SNOT-22, VAS and LKS, pre and post-surgery (12 weeks) were compared. RESULTS: Seventy nine patients completed the study, there was a significant reduction in SNOT-22 score and improvement of VAS at 12 weeks in patients treated with Chitogel compared to control (p < .05). In those patients, the mean ostium area for the Chitogel and the Chitogel + Def + GaPP groups was higher across all three sinuses compared to the no-treatment control group, without statistical significance. Sphenoid sinus ostium was significantly more patent in patients treated with Chitogel compared to the control at the 12-week time point (p < .05). CONCLUSION: Chitogel as a PO dressing after ESS results in the best patient-reported symptom scores and objective measurements. The combination of Def and GaPP to Chitogel though proving safe, had no effect on the ostium patency or mucosal healing.

Synovial sarcoma: a rare neoplasm of paranasal sinus.

Synovial Sarcoma (SS) is a rare soft-tissue malignant tumour. Its presentation in the head and neck region is uncommon. Because of the complex anatomy of the head and neck region, surgery with clear margins is not achievable. In such cases, a multi-modality approach is required as there is no established standard of care. In this report, we share the case of a girl who presented with nasal obstruction. Imaging revealed a mass involving the left nasal cavity, paranasal sinuses without intracranial extension. It was diagnosed as synovial sarcoma. She underwent surgical excision and adjuvant radiation therapy (RT) to the tumour bed, followed by an incomplete course of chemotherapy. Later on, she developed systemic disease. Considering the rarity of this case and lack of guidelines for standard treatment, we report on this case to share our experience with management and treatment outcome.

A Handbook of Emergencies in ENT- Head and Neck Surgery.

This handbook is a unique addition in the field of emergencies in otorhinolaryngology and head and neck surgery. The authors had done their best to provide the good handbook. The authors have mentioned all the emergency conditions very precisely which helps the reader to find it. It is user-friendly in terms of reading. A Chapter in burns has been included in the handbook which is good and helpful. The nutshell mentioned within the chapter is like the cherry on the top for the handbook. The emergency procedure which is mentioned in detail helps the reader to find it easy for performing the procedure. All the features make this 262 pages handbook worthy of inclusion in any otorhinolaryngologists' library. It is particularly suitable for residents, medical doctors who work in emergency, General practitioner, Pediatricians and Otorhinolaryngologists. This handbook consists of variety of chapters and images depicting the emergency conditions in otorhinolaryngology. They are organized in a logical fashion: section A: The ear with variety of emergency conditions. Section B: The nose and paranasal sinuses with variety of emergency conditions. Section C: The throat and head and neck with variety of emergency conditions. Section D: Burns and Trauma. Section E: Emergency procedures. The main purpose of this handbook is to tackle the ENT emergencies in which the authors have been successful in fulfilling their job. However, I found the addition of mucormycosis chapter to be more relevant in current scenario. Nonetheless, the image quality could be better and on the cover page it is good to mask the identity of the patient. The handbook is published on high quality glossy paper with size that fits the pocket. So, this handbook is highly recommended for the residents, general practioners, pediatricians and the otorhinolaryngologists for immediate consultation during emergency management of ENT cases.

Rhinogenic and sinus headache - Literature review.

BACKGROUND: Headache is a common, yet challenging symptom to evaluate given its wide range of clinical presentations and different etiologies. For centuries, conceptual understanding of headache causation has been attributed to anatomic abnormalities of the nose and paranasal sinuses. METHODS: Structured literature review. RESULTS: The number of cases, categorized as migraines or other primary headaches, misdiagnosed as a "sinus headache" is high in the literature, ranging from 50 to 80%. The potential mechanisms for rhinogenic headaches were classically described as pain secondary to prolonged mucosal contact points, hypoxia in the paranasal sinuses secondary to poor ventilation, or pressure caused by the growth of nasal polyps. Additionally, other mechanisms were described and are still being studied. Corrective surgery for mucosal contact points in the nasal cavity is deemed necessary for relieving the headache, although patient outcomes are variable. CONCLUSION: Delay in proper diagnosis and treatment negatively impact patient quality of life. Most cases of "sinus headache" or "rhinogenic headache" seen in clinical practice are in fact misdiagnosed as either primary headaches or migraines. Because of increased misdiagnoses, Otolaryngologists should establish a direct and precise diagnosis congruent with a chief complaint being a headache. Vital information such as a good clinical history, well-performed nasal endoscopy, and occasional CT scan may decrease misdiagnosis probability.

Reducing the risks of endoscopic sinonasal surgery in the Covid-19 era.

OBJECTIVES: Many routine sinonasal procedures utilising powered instruments are regarded as aerosol-generating. This study aimed to assess how different instrument settings affect detectable droplet spread and patterns of aerosolised droplet spread during simulated sinonasal surgery in order to identify mitigation strategies. DESIGN: Simulation series using three-dimensional (3-D) printed sinonasal model. Fluorescein droplet spread was assessed following microdebriding and drilling of fluorescein-soaked grapes and bones, respectively. SETTING: University dry lab. PARTICIPANTS: 3-D printed sinonasal model. MAIN OUTCOME MEASURES: Patterns of aerosolised droplet spread. RESULTS AND CONCLUSION: There were no observed fluorescein droplets or splatter in the measured surgical field after microdebridement of nasal polyps at aspecific irrigation rate and suction pressure. Activation of the microdebrider in the presence of excess fluid in the nasal cavity (reduced or blocked suction pressure, excessive irrigation fluid or bleeding) resulted in detectable droplet spread. Drilling with either coarse diamond or cutting burs resulted in detectable droplets and greater spread was observed when drilling within the anterior nasal cavity. High-speed drilling is a high-risk AGP but the addition of suction using a third hand technique reduces detectable droplet spread outside the nasal cavity. Using the instrument outside the nasal cavity inadvertently, or when unblocking, produces greater droplet spread and requires more caution.

Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population-based sample.

BACKGROUND: Chronic rhinosinusitis (CRS) epidemiology has been largely studied using symptom-based case definitions, without assessment of objective sinus findings. OBJECTIVE: To describe radiologic sinus opacification and the prevalence of CRS, defined by the co-occurrence of symptoms and sinus opacification, in a general population-based sample. METHODS: We collected questionnaires and sinus CT scans from 646 participants selected from a source population of 200 769 primary care patients. Symptom status (CRSS ) was based on guideline criteria, and objective radiologic inflammation (CRSO ) was based on the Lund-Mackay (L-M) score using multiple L-M thresholds for positivity. Participants with symptoms and radiologic inflammation were classified as CRSS+O . We performed negative binomial regression to assess factors associated with L-M score and logistic regression to evaluate factors associated with CRSS+O . Using weighted analysis, we calculated estimates for the source population. RESULTS: The proportion of women with L-M scores ≥ 3, 4, or 6 (CRSO ) was 11.1%, 9.9%, and 5.7%, respectively, and 16.1%, 14.6%, and 8.7% among men. The respective proportion with CRSS+O was 1.7%, 1.6%, and 0.45% among women and 8.8%, 7.5%, and 3.6% among men. Men had higher odds of CRSS+O compared to women. A greater proportion of men (vs women) had any opacification in the frontal, anterior ethmoid, and sphenoid sinuses. CONCLUSION: In a general population-based sample in Pennsylvania, sinus opacification was more common among men than in women and opacification occurred in different locations by sex. Male sex, migraine headache, and prior sinus surgery were associated with higher odds of CRSS+O .

Epinephrine soaked tampons induced transient acute dilated cardiomyopathy during FESS procedure.

BACKGROUND: Epinephrine, in all modes of use, may pose a wide range of cardiotoxic events, ranging from sinus tachycardia to heart failure, life threatening arrhythmias, and even death. Because of daily and extensive use of epinephrine, these unusual and rare events tend to be forgotten by physicians. We present a case of dilated cardiomyopathy that developed following routine use of epinephrine-impregnated tampons during function endoscopic sinus (FESS) surgery. CASE PRESENTATION: A healthy, 24-year-old man with no family history of heart disease has undergone elective surgery under general anesthesia to repair the paranasal sinuses using endoscopic approach. During surgery, soon after being treated with 1: 1000 diluted epinephrine-soaked tampons, an hypertensive crisis was noticed followed by pulseless electrical activity. An extensive examination led to the diagnosis of non-ischemic dilated cardiomyopathy. After several days of heart failure medical therapy, complete resolution of all structural and functional changes was achieved. CONCLUSION: In our case, we present an unusual and rare event of acute dilated cardiomyopathy following the use of epinephrine-soaked tampons during elective FESS surgery. A prompt response was observed after several days of heart failure treatment. Awareness of the epinephrine cardiotoxic potential even in the form of soaked tampons is essential for proper diagnosis and prompt treatment.

Estimated versus actual; The accuracy of accounting for blood loss during endoscopic sinus surgery.

PURPOSE: Endoscopic sinus surgery (ESS) is the mainstay for chronic inflammatory and neoplastic sinonasal process and as a result many modalities have been studied to minimize blood loss and patient morbidity and to maximize intraoperative visualization. However, often conclusions of actual blood loss are based on surgeons' estimations without ever actually assessing the accuracy of these estimations. The objective of this study was to determine the accuracy of intraoperative blood loss estimates by attending otolaryngology surgeons among patients undergoing ESS. MATERIALS AND METHODS: After obtaining institutional review board approval, data were collected on six surgeons performing ESS at a military academic medical center for 21 surgical cases. Specifically, both hourly and end-of-case total "estimated" (EBL) and "calculated actual" (ABL) blood loss values were recorded and compared statistically. Surgeons were blinded to the results until after all data were collected. RESULTS: The difference between mean EBL and ABL was 62.5 ml and was statistically significant (p = .007, Power 86.2%). EBL lagged ABL for both hourly intervals during a surgical case and the total end-of-surgery values. CONCLUSION: The surgeons studied had EBL that were statistically significantly less than ABL both at hourly intervals during the surgery and at the conclusion of the case. As a result there exists potential for adverse consequences in clinical care and in efforts in medical research/advancement.

Two different therapies for the middle turbinate during endoscopic sinus surgery for chronic rhinosinusitis.

BACKGROUND: The population of patients with chronic rhinosinusitis (CRS) has greatly increased. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. In the present study, the value of two different therapies for the middle turbinate to optimize surgical outcomes was observed. Our objective was to determine a better management approach for the middle turbinate to effectively preserve the middle turbinate mucosa and function and avoid complications following ESS, such as nasal adhesions on the operative side. METHODS: Thirty patients [group A; treated prior to 2015 (primary surgery)] undergoing resection of the middle turbinate bone during complete ESS for CRS and 30 patients [group B; treated after 2015 (later surgery)] undergoing middle turbinate preservation and multiapproach therapy during complete ESS for CRS were observed. Nasal cavities were compared using perioperative sinus endoscopy (POSE) and Lund-Kennedy (LKES) scores preoperatively and at 15 days, 2 months and 1 year after ESS. RESULTS: Preoperatively, the POSE (8.83 ± 3.81 vs 9.15 ± 3.85, p = 0.45, for groups A and B, respectively) and LKES (4.23 ± 0.74 vs 4.13 ± 0.70, p = 0.34) scores were similar between groups. In group A, anterior adhesions were reported on six sides of the middle turbinate, severe adhesions were observed on two sides, mild adhesions were observed on one side, and adhesions occurred on two sides during follow-up. After retreatment, adhesions were still observed on two sides at 1 year. In group B, only mild anterior adhesions were observed on two sides. There was no difference between group A and group B at 15 days, and the POSE (4.31 ± 1.19 vs 4.07 ± 1.42, p = 0.11, for groups A and B, respectively) and LKES (3.35 ± 0.82 vs 3.33 ± 0.90, p = 0.91) scores were similar between groups. There was no significant difference in LKES (0.22 ± 0.49 vs 0.10 ± 0.35, p = 0.15) scores at 1 year between the two groups. There was a significant difference in the nasal cavities between group A and group B at 2 months and 1 year, where group B showed a better endoscopic appearance than group A at 2 months and 1 year (with POSE scores of 3.48 ± 0.83 vs 2.43 ± 1.38 (p = 0.00) and LKES scores of 1.35 ± 0.86 vs 1.15 ± 0.90 (p = 0.02) at 2 months for groups A and B, respectively, and POSE scores of 1.00 ± 0.96 vs 0.62 ± 0.87 (p = 0.001) at 1 year for groups A and B, respectively). CONCLUSIONS: Our results show that middle turbinate preservation and combined therapy was a better ESS method for CRS. Multiapproach middle conchoplasty, which is predominately a submucoperiosteal surgery, can preserve more of the mucosa and functions of the middle turbinate. Unlike the single-approach middle conchoplasty described in previous research, multiapproach middle conchoplasty is achieved by combining a three-step surgical procedure ("surgery, packing and removal") with "cocktail-style" postoperative packing and removal.

Greater palatine canal injections reduce operative bleeding during endoscopic sinus surgery: a systematic review and meta-analysis.

OBJECTIVES: The use of greater palatine canal (GPC) injections of a local anesthetic and a vasoconstrictor to decrease surgical bleeding during endoscopic sinus surgery (ESS) is controversial. We investigated the role of a preoperative GPC injection to minimize intraoperative bleeding during ESS in patients with chronic sinusitis through a meta-analysis of the relevant literature. DATA SOURCES: PubMed, SCOPUS, and the Cochrane database. REVIEW METHODS: We screened the relevant literature published before May of 2018. Five articles that compared the pre-operative GPC injection (treatment group) with a placebo or no treatment (control group) were included for this analysis of the outcomes, which included an endoscopic grade of nasal bleeding and intraoperative hemodynamic stability during ESS. RESULTS: The endoscopic grade in the treatment group was significantly reduced when compared with the control group. No significant adverse effects were reported in the enrolled studies. The subgroup analyses of these results compared the concentrations of adrenalin (1:80,000 or 1:100,000), and adrenalin 1:80,000 showed significant effects on intraoperative bleeding when compared to adrenalin 1:100,000. CONCLUSION: This study demonstrated that GPC injections of local anesthesia with 1:80,000 adrenaline for ESS effectively reduced intraoperative bleeding. Additionally, this procedure showed no significant adverse effects, such as hemodynamic instability. However, the standardized dosing needs further investigation and more trials. LEVEL OF EVIDENCE: Ia.

Outcomes of endoscopic sinus surgery in adult lung transplant patients with cystic fibrosis.

PURPOSE: Cystic Fibrosis (CF) is the most common autosomal recessive disease in Caucasian population. Due to its pathological mechanism, chronic rhino sinusitis (CRS) associated or not with nasal polyposis usually occurs in adults and affects close to one-half of all CF patients. The goal of our work was to evaluate the impact of Endoscopic Sinus Surgery (ESS) in the quality of life (QoL) of the CF patients and demonstrate an improvement of the functional outcomes in the patients underwent the surgical procedure rather than in the not treated ones, particulary in lung transplant patients. METHODS: We studied 54 adult patients affected by CF. Lund-Kennedy, Lund-Mackay scores, and SNOT-22 were analysed. 14 had lung transplant and 9 had both lung tranplant and ESS procedures. RESULTS: 22 (40.7%) out of 54 CF patients underwent ESS. This group presented more likely complaints consistent with CRS. Lund-Kennedy and Lund-Mackay scores appeared higher in the ESS group: 10 (range of 6-12) and 15 (range of 12-20), respectively. SNOT-22 showed median values for non-ESS and ESS group of 20 (range of 3-68) and 40 (range of 10-73), respectively. CONCLUSIONS: ESS represents the best option to improve clinical QoL of CF patients who do not response to conventional medical therapy, with a stabilization of respiratory function after transplantation.

Randomized clinical trial to compare the efficacy to improve the quality of surgical field of hypotensive anesthesia with clonidine or dexmedetomidine during functional endoscopic sinus surgery.

PURPOSE: Intense bleeding of the surgical field is a potential factor influencing success of functional endoscopic sinus surgery (FESS). Hypotensive anesthesia with α2 intravenous agonists reduces intraoperative bleeding, but which is the best agent is unknown. The main objective of this trial was to compare the current standard adjuvant drug for hypotensive anesthesia, clonidine, with the recently available alternative dexmedetomidine. METHODS: A randomized clinical trial compared the efficacy of clonidine and dexmedetomidine during FESS. Treatment was open label for the anesthesiologist and operating surgeon, but blind for an external evaluator who evaluated video-recorded surgeries. A Boezaart scale was assessed every 30 min during FESS until surgery completion. Main end-point was the proportion of patients with mean Boezaart scores > 2 (heavy bleeding) by external blinded evaluator. Secondary end-points included other bleeding parameters, surgery duration, hemodynamic measures and surgical complications. RESULTS: 94 patients were randomized. There were no significant differences in the proportion of patients with mean Boezaart scores > 2 in clonidine (42.6%) and dexmedetomidine (42.6%). Consistently, no differences were observed in secondary variables of bleeding, duration or complications. Small differences in mean heart rate were observed that might reflect different pharmacological profiles of the products, but are of uncertain clinical relevance. CONCLUSIONS: No significant differences were observed between clonidine and dexmedetomidine when used as anesthetic adjuvants in the reduction of surgical bleeding in FESS. A longer experience with clonidine and its lower costs suggest it may be a preferable option as an adjuvant for hypotensive anesthesia.

[Evaluation of clinical effectiveness of 'erespal' preparation with surgical treatment of patients with the pathology of the surgery crops]. / Éffektivnost' perioperatsionnoi protivovospalitel'noi terapii u patsientov s patologiei okolonosovykh pazukh.

The article presents the results of the evaluation of the effectiveness of anti-inflammatory therapy in the perioperative period in patients with pathology of the paranasal sinuses. The study included patients (n=150) who underwent endoscopic surgery on the paranasal sinuses. All patients were divided into 3 groups. In the first (control) group (n=50) in the postoperative period, patients received standard therapy, which included antibiotic therapy and irrigation of the nasal cavity with saline. In the second comparison group (n=50), in addition to the standard treatment in the postoperative period, the preparation Erespal was added to 2 tab/day for 1 month. The third comparison group (n=50) started taking Erespal 2 tab/day 7 days before the surgery, and in the postoperative period the treatment continued in the same way as in the 2nd group (standard therapy and Erespal 2 tab/day after the operation for 1 month). The study showed that Erespal's effectiveness after endoscopic operations on the paranasal sinuses makes it possible to accelerate the recovery period of patients, leading subjectively to the normalization of well-being and objective positive changes from the mucous membrane of the nasal cavity (decrease in edema, hyperemia, smaller changes in postoperative CT of the ONP).

[The injuries to the nose and paranasal sinuses in the children resulting from shooting an air rifle]. / Povrezhdeniia nosa i okolonosovykh pazukh u detei pri strel'be iz pnevmaticheskogo oruzhiia.

This article reports two clinical cases of the successful treatment of the gunshot wounds in the nasal cavity and paranasal sinuses of the children resulting from the careless use of the pneumatic weapons. Despite the fact that the shots were fired from a close distance, the intracranial structures and the eyeballs remained unaffected. The bullets were localized in the nasal septum of one child and in the frontal recess of the other as is typical of the injuries inflicted to the nose and paranasal sinuses by the shots from the air rifles. Multi-slice spiral computed tomography (MSCT) is known to have a number of important advantages over the roentgenological examination for determining the location of the bullets. Bullets for pneumatic rifles are manufactured in the form of the balls either from lead or copper-coated steel; therefore, they are a priory can not be removed with the use of a magnet.

Post-operative nebulized sodium hyaluronate versus spray after functional endoscopic sinus surgery for chronic rhinosinusitis.

We prospectively evaluated the efficacy of nebulized Hyaluronic Acid (HA) as an adjuvant treatment to hasten the improvement of nasal respiration and to minimize patients’ discomfort in the postoperative functional endoscopic sinus surgery (FESS) for chronic rhino-sinusitis (CRS). We enrolled 33 CRS adult patients who underwent endoscopic functional sinus surgery. They were randomly assigned into two groups: Spray-Sol group (18 patients) with HA nebulized with a new nasal device named Spray-Sol and Spray group (15 patients) with a HA nebulized with a common spray. Both groups were treated twice daily for 4 weeks. CRS questionnaire, Visual analogic scale (VAS) and nasal endoscopy were used to assess the outcomes of the treatments during the 1st month of follow up. The mean VAS score of the Spray-Sol group at 2 weeks was significantly lower than the Spray group (5.2±2.1 vs 10.5±3.7; p less than 0.05). The VAS score remained significantly lower in the Spray-Sol group also at the 4 weeks (2.9±0.8 vs 6.1±3.4; p less than 0.05). The CRS score was significantly better at week 2 and 4 in both groups in comparison with baseline values, with better results in the Spray-Sol group. Since the first visit the Spray-Sol group also showed significantly lower crusts, edema and secretions than the Spray group (p less than 0.05). The compliance to treatment was similar in both groups. The results of this prospective study suggest a role nebulized of HA through new device (Spray-sol) as a supportive treatment for faster improvement of nasal respiration, also minimizing patient discomfort, promoting nasal mucosa healing in postoperative FESS for CRS.

Efficacy and Safety of 3 Nasal Packing Materials Used After Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Comparative Study in China.

BACKGROUND This study aimed to investigate the efficacy and safety of 3 nasal packing products (silicone tube, Beschitin-F, and Aquacel1-Ag) after functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS) patients in China. MATERIAL AND METHODS Sixty-six CRS patients undergoing FESS surgery were randomly divided into 3 groups (22 patients in each group): the silicone tube group, the Beschitin-F group, and the Aquacel1-Ag group. Postoperative headache, nasal pain, nasal bleeding, and swelling of the nasal mucosa were observed at 1 month after FESS surgery. Bacteriology of chronic rhinosinusitis was conducted by culturing the removed nasal packing. RESULTS The VAS scores of nasal pain in the silicone tube group were lower than in the Beschitin-F and the Aquacel1-Ag groups. The volume of nasal bleeding in the Beschitin-F group was higher than in the silicone tube and Aquacel1-Ag groups. The adhesion rate of the nasal cavity in the Beschitin-F1 group (2/22, 9.1%) was also higher than in the silicone tube group (0/22, 0%) and the Aquacel1-Ag group (0/22, 0%). The results of bacterial culture from removed nasal packing showed that coagulase-negative staphylococci (CNS) was more frequent in the silicone tube group than in the Beschitin-F and Aquacel1-Ag groups, but Streptococcus pneumonia, Haemophilus influenza, and Gram-negative rods were more common in the Aquacel1-Ag group than in the silicone tube and Beschitin-F groups. CONCLUSIONS These results indicate that the silicone tube may be more effective and safe than Beschitin-F and Aquacel1-Ag as nasal packing after FES surgery for CRS.

Efficacy of chitosan dressing on endoscopic sinus surgery: a systematic review and meta-analysis.

Chitosan dressing might be promising to promote the recovery following endoscopic sinus surgery (ESS). However, the results remain controversial. We conducted a systematic review and meta-analysis to explore the influence of chitosan dressing on ESS. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of chitosan dressing on endoscopic sinus surgery were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were synechia and hemostasis. Meta-analysis was performed using random-effect model. Four RCTs involving 268 patients were included in the meta-analysis. Overall following ESS, compared with control intervention, chitosan dressing significantly reduced synechia (RR = 0.25; 95% CI 0.13-0.49; P < 0.0001) and promoted hemostasis (RR = 1.70; 95% CI 1.37-2.11; P < 0.00001), but showed no impact on granulations (RR = 1.18; 95% CI 0.72-1.95; P = 0.52), mucosal edema (RR = 0.88; 95% CI 0.60-1.29; P = 0.51), crusting (RR = 0.85; 95% CI 0.48-1.53; P = 0.60), and infection (RR = 0.88; 95% CI 0.51-1.52; P = 0.64). Compared to control intervention, chitosan dressing could significantly decrease edema and improve hemostasis, but had no effect on granulations, mucosal edema, crusting and infection.

A Retrospective Analysis of Adverse Events in Hyperbaric Oxygen Therapy (2012-2015): Lessons Learned From 1.5 Million Treatments.

OBJECTIVE: To describe the distribution and occurrence of adverse events recorded during hyperbaric oxygen (HBO) therapy from 2012 to 2015. In this analysis, events are defined as otic/sinus barotrauma, confinement anxiety, hypoglycemia, oxygen toxicity, pneumothorax, seizure, and shortness of breath. DATA AND ANALYSIS: The data for the analysis were drawn from a proprietary electronic health data system that contained information on 1,529,859 hyperbaric treatments administered during 53,371 treatment courses from 2012 to 2015 in outpatient wound care centers across the United States managed by Healogics, Inc, Jacksonville, Florida. RESULTS: Of the 1.5 million treatments included in the analysis, 0.68% were associated with an adverse event. Barotrauma and confinement anxiety were the most frequently reported events. Medically severe events were extremely uncommon, with fewer than 0.05 instances of oxygen toxicity per 1000 treatments and only 1 confirmed case of pneumothorax. CONCLUSIONS: Results indicate that the occurrence of adverse events associated with HBO therapy is infrequent and typically not serious. The findings of this study suggest that when administered according to the appropriate therapeutic protocols HBO therapy is a safe and low-risk intervention.