Intranasal Septal Splints: Prophylactic Antibiotics and Nasal Microbiology.

OBJECTIVES: Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. METHODS: Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. RESULTS: Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. CONCLUSIONS: Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations / Efeitos do tempo de permanência de splints intranasais sobre a colonização bacteriana, complicações no pós-operatório e desconforto do paciente após septoplastia

Abstract Introduction: The main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. Objective: The current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. Methods: Patients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. Results: No significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. Conclusions: Silicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential.

Resumo Introdução: A principal razão para a colocação de tampões nasais em septoplastias é a prevenção de hemorragia pós-operatória, enquanto o objetivo secundário é a estabilização interna após cirurgias que envolvam o esqueleto cartilaginoso do nariz. Os splints intranasais de silicone são tão eficazes como outros materiais para o controle de hemorragias do septo no pós-operatório. A possibilidade de manter os splints intranasais por longos períodos ajuda a estabilizar o septo na linha média. No entanto, não há nada na literatura sobre quanto tempo esses splints podem ser mantidos na cavidade nasal sem aumentar o risco de infecção, complicações no pós-operatório e causar desconforto ao paciente. Objetivos: O presente estudo teve como objetivo avaliar a associação entre o tempo de tamponamento com splints intranasais e colonização bacteriana, complicações no pós-operatório e desconforto do paciente. Método: Os pacientes submetidos a septoplastia foram divididos em três grupos, de acordo com o dia da remoção dos splints de silicone. Os splints foram removidos no 5°, 7° e 10° dias de pós-operatório, e a seguir, cultivados microbiologicamente. Complicações precoces e tardias foram avaliadas, incluindo infecções locais e sistêmicas, necrose do tecido, formação de granulomas, crostas na mucosa, sinéquias e perfuração do septo. O desconforto do paciente no pós-operatório foi avaliado com o uso de pontuação dos níveis de dor e de obstrução nasal. Resultados: Nenhuma diferença significante foi encontrada na taxa de colonização bacteriana entre os diferentes grupos. Diminuições da formação de crostas na mucosa e de sinéquias foram detectadas com tempos mais longos de uso de splints de silicone. A dor e a obstrução nasal também diminuíram no terceiro dia de pós-operatório. Conclusões: O uso de splints de silicone foi bem tolerado pelos pacientes, e seus efeitos negativos sobre o conforto do paciente no pós-operatório foram limitados. De fato, o tempo prolongado de uso teve um efeito redutor sobre as complicações tardias. O uso prolongado de splint nasal de silicone é um método confiável, eficaz e pouco desconfortável em pacientes com lesão excessiva da mucosa e naqueles cuja estabilização óssea e cartilaginosa do septo a longo prazo é essencial.

Quantification of biofilm formation on silicone intranasal splints: An in vitro study.

OBJECTIVES: Biofilms are associated with persistent infections and resistant to conventional therapeutic strategies. The aim of this study was to investigate the quantity of biofilm produced on silicone intranasal splints. METHODS: Quantity of biofilm formation on silicone splints (SS) was tested on 15 strains of Staphylococcus aureus and Moraxella catarrhalis, respectively. Antimicrobial susceptibility testing was performed in accordance with European Committee on Antimicrobial Susceptibility Testing recommendations. RESULTS: All tested strains formed different amounts of biofilm on SS: 66.7% S. aureus and 93.3% M. catarrhalis were weak biofilm producers and 33.3% S. aureus and 6.7% M. catarrhalis were moderate biofilm producers. S. aureus formed significantly higher quantity of biofilm compared with M. catarrhalis (p < 0.05). Multidrug resistant S. aureus produced significantly higher amount of biofilm compared with non-multidrug resistant strains (p < 0.05). CONCLUSION: Quantity of biofilm on SS is highly dependent on bacterial species and their resistance patterns. Future studies are needed to ascertain another therapeutic option for prophylaxis prior to SS placement.

Do we really need to coat the novel silicone intranasal splints with antibiotics?

PURPOSE: The novel silicone intranasal splints are suggested to resist biofilm formation due to their surface characteristics. We aimed to ascertain the necessity of coating these splints with antibiotics to prevent splint associated infections, in vitro. MATERIALS AND METHODS: Pieces of Doyle II airway nasal splints made of medical grade silicone were divided into two test groups, treated with either (i) 0.2% nitrofurazone solution or (ii) 0.2% nitrofurazone containing ointment, and a control group, treated with (iii) 0.9% saline. Splint pieces were then incubated with Staphylococcus aureus solutions at 37°C for 48 and 96h. Following this, the splint pieces were incubated in 20ml Mueller Hinton agar and appearing colonies were counted. RESULTS: Following 48and 96h of incubation, the colonization rates in the saline group were significantly higher than the nitrofurazone ointment group (p<0.001). The colonization rates in the liquid nitrofurazone group were significantly lower in comparison to the nitrofurazone ointment group (p<0.001 and p=0.019 respectively). CONCLUSIONS: The method of coating the splints with antibiotic was superior to using uncoated splints in terms of preventing S. aureus colonization. The rather smooth surfaces of the splints were insufficient to block bacterial colonization and coating them with antibiotics seems to be beneficial for the prevention of infections.

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations.

INTRODUCTION: The main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. OBJECTIVE: The current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. METHODS: Patients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. RESULTS: No significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. CONCLUSIONS: Silicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential.