Efficacy of Absorbable Steroid-Impregnated Nasal Packing in Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review.

OBJECTIVE: To evaluate the efficacy of absorbable steroid-impregnated nasal packing on postoperative outcomes following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS). METHODS: A systematic review of the literature was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twelve databases (including Journals@Ovid, Embase®, Medline®, EBM Reviews and Joanna Briggs Institute EBP Database) were searched using relevant keywords and expanded with corresponding MeSH/Emtree terms. Results were narrowed to English articles assessing the efficacy of absorbable packing impregnated with steroids post-production placed at time of surgery under general anesthetic, with hollow-lumen devices and devices inserted in-office excluded. RESULTS: Eight studies met criteria and were included in this review. Five evaluated the efficacy of the intervention in only CRS with nasal polyposis (CRSwNP) patients, two included all subtypes of CRS, and one included only CRS without nasal polyposis (CRSsNP). Of the eight studies, four studied the efficacy of Nasopore®, three studied bioabsorbable gels, and one studied bioabsorbable calcium alginate. Four studies applied triamcinolone as the operative steroid, with the other studies utilizing betamethasone, budesonide, mometasone, and dexamethasone. Seven studies demonstrated statistically significant improvements in endoscopic outcomes using validated scoring scales, albeit at differing timepoints. The one study which included only CRSsNP patients failed to find a significant difference. CONCLUSION: Steroid-impregnated nasal packing appears to have positive effects on postoperative endoscopic outcomes in CRSwNP patients undergoing FESS. Additional research is needed to evaluate the efficacy of these interventions in more recently defined subtypes of CRS, and whether these interventions differ in their efficacy in eosinophilic and non-eosinophilic CRS. Laryngoscope, 131:1704-1714, 2021.

Endoscopic Management of Pediatric Cholesteatoma.

Pediatric cholesteatoma occurs in one of two forms: congenital cholesteatoma, developing from embryonic epidermal cell rests or acquired cholesteatoma, associated with a focal defect in the tympanic membrane. This disease has been traditionally managed with the operating microscope, often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities. Recently, advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive, transcanal endoscopic approach. This review discusses the current literature relating to the etiopathogenesis, assessment and endoscopic management of pediatric cholesteatoma. Early outcomes of endoscopic treatment, emerging trends and technologies are also reviewed.

An improved version of the Kornyshev-Eigen-Wicke model for the diffuse double layer in concentrated electrolytes.

The Kornyshev-Eigen-Wicke model for the diffuse double layer in concentrated electrolytes has been improved in two ways. First, the role of the compressibility factor a(0) has been included in the expressions for the electrochemical potentials of the component ions. As a result this quantity also appears in the equations for the potential drop across the diffuse layer, and its differential capacity. Second, an estimate is made of the ion atmosphere effect using the reciprocal of the thickness of the ionic atmosphere. It is shown that these changes result in considerable improvement in the estimates of the diffuse layer potential drop and differential capacity on the basis of Monte Carlo data.

Properties of the diffuse double layer at high electrolyte concentrations.

The equations necessary to calculate the potential drop across the diffuse layer and its differential capacity are derived for 1:1 electrolytes on the basis of the Eigen and Wicke theory for concentrated electrolyte solutions. The results of this model are then compared with Monte Carlo data for more concentrated solutions and solutions with ions of large diameters. It is shown that the Eigen-Wicke model is inadequate because it fails to consider the change in potential at a given ion due to its surrounding atmosphere.