Tranexamic acid versus adrenaline-soaked pledgets for the reduction of intraoperative bleeding in functional endoscopic sinus surgery.

OBJECTIVE: Aim: To examine the impact of locally applied tranexamic acid and adrenaline, separately and in combination, on intraoperative blood loss and surgical field quality during functional endoscopic sinus surgery. PATIENTS AND METHODS: Materials and Methods: The study involved 40 patients with chronic rhinosinusitis. They were divided into two groups. Group I received adrenaline alone in one side and a mixture of adrenaline and tranexamic acid in the other side. Group II received adrenaline alone in one side and tranexamic acid in the otherside. Parameters like surgery time, blood loss, and surgical field quality were studied. RESULTS: Results: In Group I, the combination of adrenaline and tranexamic acid significantly reduced blood loss and enhanced surgical field quality compared to adrenaline alone. In Group II, adrenaline outperformed tranexamic acid in shortening surgery duration and improving surgical field quality. However, there was no significant difference in blood loss reduction between adrenaline and tranexamic acid. CONCLUSION: Conclusions: The study concluded that tranexamic acid is less effective than adrenaline when introduced as topical intranasal pledgets in both decreasing the time needed for the surgery and improving the subjective satisfaction of the surgeon while there is no significant difference regarding decreasing intraoperative blood loss. The mixture of adrenaline and tranexamic acid pledgets are more effective than adrenaline-only pledgets in terms of decreasing the intraoperative blood loss and improving the surgeon's satisfaction with no significant difference regarding the time needed for the surgery.

The Effect of Cannula Drain in Reducing Edema and Ecchymosis after Rhinoplasty.

Rhinoplasty is one of the most common plastic surgeries and is commonly associated with postoperative edema, ecchymosis, and pain which play a role in patients' dissatisfaction. In this randomized comparative study, we discuss the effect of cannula drainage in the reduction of postoperative periorbital edema, ecchymosis, pain, and nasal obstruction after open structural septorhinoplasty. The study was conducted at a tertiary referral center from April to November 2022. We performed internal lateral osteotomy on all patients using the lateral saw and aided by lateral osteotome. At the end of the procedure, a cannula drain is prepared and inserted in the subperiosteal tunnel on the left side only. Patients were examined on the 1st, 3rd, 7th, 14th, and 21st days for periorbital edema, ecchymosis, pain, and nasal obstruction, and each side is scored separately. A total of 40 patients (80 sides in total) were recruited, 22 females (55%) and 18 males (45%), all of whom were adults (18-44 years old; mean age 29 years). The most frequent age group is those younger than 20 years representing 35% of the sample and the males forming 33.3%. The reduction in edema and pain was statistically significant in the drained sides (p = 0.000) during all the postoperative days. On the other hand, ecchymosis was lower on the drained side but statistically insignificant (p = > 0.29). Nasal obstruction was reduced significantly only on the seventh postoperative day (p = 0.000). The postoperative morbidities associated with rhinoplasty could have important functional and psychological effects on patients. This study demonstrates that inserting a cannula in the subperiosteal tunnel for drainage in rhinoplasty yields a significant clinical and statistical decrease in postoperative periorbital edema and pain with little effect on ecchymosis and nasal obstruction.

Coblation Versus Cold Dissection Tonsillectomy: A Comparative Study.

Tonsillectomy is the most frequently performed surgery in the recent years. Many techniques have been advocated to improve surgical efficacy and decrease postoperative morbidity. Probably the most update was coblation tonsillectomy. This is a comparative study which was conducted on 50 patients (23 females and 27 males) who underwent tonsillectomy operations, 25 patients using cold steel dissection method whereas coblation technique was used for the rest 25 patients. Follow up was done at day 1, 3, 7 and 14 and the related parameters were calculated. The mean age of patients was 11.6 years with a mean of 2.2-40 years. There were 27 (54%) males out of 50 and 23 (46%) were females. Male to female ratio was 54%:46% ≈ 1.17:1. The current study revealed significant difference between coblation versus cold dissection tonsillectomy. Postoperative pain was significantly less at day 3 and day 7 using coblation technique. Moreover, there were less intraoperative bleeding, less time in days to return to normal diet and less time to return to normal activities. We believe that coblation tonsillectomy carries less morbidity than cold steel dissection, hence we recommend it to be applied at our hospital.

Laryngeal injury and dysphonia after endotracheal intubation.

We carried out a prospective case series study in order to evaluate the laryngeal complications of the endotracheal tube. Two hundred patients aged 15 years and above who were subjected to endotracheal intubation for less than 5 hours were enrolled in the study. The data were collected from the Al-Salam Teaching Hospital in Mosul, Iraq. A preoperative assessment was accomplished clinically using 70º and/or 90º Hopkins rods or fiber optic laryngoscopy. As part of the assessment, the patients' voices were recorded as well. Five to seven days after the procedure, the same assessment was repeated and compared to the preoperative data. If the postoperative examination and the voices were similar to the preoperative data, no follow-up was performed. If any abnormality was found in the larynx, the examination was repeated once weekly for one month or until the voice was recovered. In our study, five patients (2.5%) had intubation-related laryngeal injuries. The intubation period, changes in the position of the head or body of the patient during anesthesia, and the difficulty of intubation raised the possibility of laryngeal injuries. In general, intubation is a safe procedure; however, a laryngeal injury may appear as a rare complication. We found that there is a relation between the intubation period, changing the position of the patient during intubation, and difficulty of intubation with the occurrence of laryngeal injury.

Vitamin D and Immunoglobulin E Status in Allergic Rhinitis Patients Compared to Healthy People.

Allergic rhinitis (AR) is a type of inflammatory condition that includes a group of symptoms, mainly affecting the nasal mucosa. Nasal obstruction, sneezing, stuffy or runny nose, in addition to swollen, itchy, red and watery eyes are the most common symptoms of the disease. These symptoms are triggered as a result of increased inflammatory mediators such as histamine and leukotrienes. Studies have recently shown the role of vitamin D (vit.D) in many allergic and immune conditions, where receptors for the active form of vit.D (1,25-dihydroxyvitamin D3) have been discovered on the surface of almost all types of inflammatory cells. Therefore, the present study was conducted to explore the level of vit. D in AR patients and its correlation with the severity of the disease. Two groups participated in the study; the first group included 49 patients who were diagnosed in a private otolaryngology clinic by the first author as having allergic rhinitis (AR group). The second one served as a control group and included 50 apparently healthy volunteers with no history of AR. The mean level of IgE and vit. D was found to be 326.3 and 10.2 ng/ml in the AR group, respectively, and 30.8 and 23.3 ng/ml in the control group, respectively. Ninety-three percent of AR patients have shown a deficiency in vit. D level, where 56% of this group showed severe deficiency. On the other hand, 34% of the control group has shown an insufficient level of vit. D. Additionally, 64% of AR patients have shown serum levels of IgE at values ranging between 100-299 ng/ml. Higher serum levels of IgE at values ranging between 300-599 ng/ml and 600-1000 ng/ml were observed in 25% and 11% of AR patients, respectively. The prevalence of low levels of vit. D in the AR group was significantly higher than that in the control group (P < 0.001). Vit. D deficiency is significantly related to severe AR symptoms and measuring serum vit. D level is recommended in the management plan of this group of patients.