Ipratropium Bromide Nasal Spray in Non-Allergic Rhinitis: A Systematic Review and Meta-Analysis.

OBJECTIVE: This study aims to compare the effectiveness of intranasal ipratropium bromide (INIB) to a placebo in reducing nasal symptoms, particularly rhinorrhea, and enhancing quality of life in non-allergic rhinitis (NAR) patients. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A comprehensive review of the literature was conducted on Medline, Embase, and Cochrane libraries. Randomized controlled trials (RCTs) and non-randomized comparative parallel group trials comparing IB nasal spray to placebo were included. RESULTS: Five RCTs assessed a total of 472 participants with a diagnosis of NAR. IB nasal spray 0.03% were used across all studies. IB has a better impact on decreasing rhinorrhea than the placebo, with a standardized mean difference (SMD) of 0.93 (95% CI 0.06-1.8). The mean change in rhinorrhea severity was 85% (95% CI 77-92%) and I^2 26% (p = 0.24). IB outperformed the placebo in terms of shortening the symptom's duration/day, as shown by an SMD of 0.35 (95% CI 0.15-0.55). The difference between treatments was noticeable within the first week and remained consistent throughout the treatment. Patients who were administered IB experienced a substantially greater improvement in physical and mental outcomes. Nasal adverse events with IB were generally intermittent and brief. CONCLUSION: Compared with a placebo, IB nasal spray is both safe and effective in treating the rhinorrhea associated with NAR. IB significantly reduces the severity and duration of rhinorrhea. The treatment was determined to be beneficial by both patients and physicians and resulted in a better quality of life. LEVEL OF EVIDENCE: 1 Laryngoscope, 133:3247-3255, 2023.

Safety and Efficacy of the Draf IIb Procedure: A Systematic Review.

OBJECTIVES: To systematically review the literature to evaluate the indications, safety, and efficacy of the Draf IIb procedure and to evaluate the added advantages of technical factors such as stents and flaps. DATA SOURCES: Articles published until July 2019 on Medline and Cochrane databases. REVIEW METHODS: After a systematic review based on the 2018 PRISMA guidelines was conducted, 26 of 1533 articles were included and reviewed for indications of Draf IIb; surgical technique; use of flaps, stents, grafts, or mitomycin; complications during and after surgery; and success or recurrence rate. RESULTS: The main indication for Draf IIb was chronic frontal rhinosinusitis (61.82%). The postoperative patency rate was 87.85%. When flaps/grafts were applied, the rate was 93.5%, but their added value was not statistically significant. Stents could be an alternative for revision surgery. Treating frontal pathologies other than chronic rhinosinusitis was also satisfying. Safety was comparable to Draf III: no perioperative complications were reported, only a few postoperative ones (eyelid ecchymosis and periorbital cellulitis in 0.2% of the cases, hyposmia in 1.55%). CONCLUSION: When properly indicated, Draf IIb frontal drilling is a safe and highly effective surgical technique for frontal pathology treatment, with efficiency and safety comparable to the Draf III, making it a valid option when a bilateral approach is not needed. More studies are required to confirm the added values of flaps, grafts, and stents.

Exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma: a systematic review of the literature.

OBJECTIVE: To systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications. DATA SOURCES: Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. REVIEW METHODS: The literature was searched by 2 reviewers with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. We were only able to perform a meta-analysis on the categorical outcomes using DerSimonian and Laird random effects models. RESULTS: Ninety-two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (minimum, 20 mL; maximum, 1482 mL). It was 414.6 mL (minimum, 20 mL; maximum, 1000 mL) and 774.2 mL (minimum, 228 mL; maximum, 1482 mL), respectively, in the group with and without embolization. No conclusion could be made because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval [CI], 8.3-11.7). It was 9.3% (95% CI, 7.2-11.5) for complications and 7.7% (95% CI, 5.4-10.1) for residual tumor. CONCLUSION: The endoscopic treatment is an evolving modality. It is considered today the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.

Bacterial flora in normal adult maxillary sinuses.

BACKGROUND: Conflicting data exist about the presence of bacteria in healthy maxillary sinus cavities. This study was designed to determine the bacterial flora and to quantify the level of bacterial presence in healthy maxillary sinus cavities. METHOD: Subjects included 34 patients undergoing Lefort I osteotomy for orthognathic surgery. All patients were preoperatively evaluated by a questionnaire and a complete physical examination including sinus endoscopy. Our exclusion criteria were presence of sinonasal symptoms, asthma, antibiotic treatment in the past 3 months, treatment with local steroids, previous sinonasal surgery, traumatic surgery, and an abnormal CT scan or sinus endoscopy. Washes were obtained from maxillary sinuses before surgery through an antral puncture. The sinus was irrigated with sterile saline followed by aspiration with a syringe attached to the trocar. Basic sterility rules were rigorously applied. Specimens were transported to the laboratory in an air-free syringe. Time between collection of materials and inoculation of the specimen did not exceed 15 minutes. Specimens were inoculated for aerobic and anaerobic organisms. RESULTS: After applying the selection criteria, 14 patients (28 sinuses) remained. Eight (57.1%) were men with a mean age of 22.7 years; 82.14% of the specimens were sterile. Bacterial organisms were recovered in only four patients with two different coagulase-negative staphylococci in the same patient: one in each sinus with 200 UFC/mL in the left sinus and 10 UFC/mL in the right sinus, one Citrobacter fundii (70 UFC/mL) and two polymorphic floras. CONCLUSION: This descriptive study shows the large predominance of sterile maxillary sinus cavities in asymptomatic adults with endoscopically normal mucosa.

Bacteriology of the sinus cavities of asymptomatic individuals after endoscopic sinus surgery.

OBJECTIVE: To determine the resident flora and the level of bacterial presence of the healthy sinus cavity post-endoscopic sinus surgery (ESS). SETTING: University-based prospective trial. METHOD: Subjects included asymptomatic patients who had undergone ESS for inflammatory disease more than 12 weeks previously. Endoscopic cultures of the sinus cavities were performed with swab and a novel lavage technique and were processed for identification of bacterial species and the level of bacterial presence. RESULTS: Thirty-two patients were recruited. Bacterial organisms were recovered in 97% of subjects (mean 1.5 organisms/patient). The flora predominantly consisted of coagulase-negative staphylococci (69%) and diphtheroids (25%). Staphylococcus aureus was recovered in 31% of subjects and Pseudomonas aeruginosa in 3% only. No gram-negative rods were recovered in any individual. The Gram stains of 29 individuals were identified; 20 (69%) had no white blood cells, 9 (31%) had 1+ white blood cells, and none had >1 white blood cells. All quantitative lavage fluid cultures were negative at the 10(4) detection level. CONCLUSION: Coagulase-negative staphylococci, diphtheroids, and S. aureus constitute the predominant flora of the healthy post-ESS sinus cavity and probably represent colonization of the cavity by nasal flora from the contiguous nasal mucosa. These data offer a basis for interpreting sinus cultures obtained in symptomatic patients after ESS. S. aureus may be frequently recovered in asymptomatic patients; thus, not all instances of S. aureus recovery on culture require therapy. Future testing of individuals with this organism will probably have to be modified to better assess factors associated with pathogenicity, such as bacterial load, biofilm formation, or superantigen production. In contrast, gram-negative rods and P. aeruginosa should probably be treated when identified on culture.