Bioabsorbable dressing impregnated with betamethasone and ciprofloxacin after endoscopic sinus surgery: A randomized, double-blind, placebo-controlled study

Abstract

Background In addition to its hemostatic and stabilization role, biodegradable nasal packing can be used as a carrier for drugs after functional endoscopic sinus surgery (FESS). The aim of this study was to compare the influence of biodegradable synthetic polyurethane foam (NasoPore) soaked with ciprofloxacin, or betamethasone, or both to the same foam soaked with saline after FESS. Methods 120 adults with chronic rhinosinusitis, with and without polyps, directed for bilateral full-house FESS were enrolled for the study. The patients were randomized and blinded into 3 groups, depending on the type of postoperative procedure applied. Thus, NasoPore soaked with antibiotic was provided to the first group; in the second group, the steroid was used; and the combination of both, in the third group. In each case, the aforementioned procedure was administered on one side of the nose, while NasoPore was soaked in saline on the other, at the end of the surgery, respectively. The patients were requested to complete a questionnaire during their postoperative visits at 2, 10, 30, 90, and 180 days, scoring the level of complaints on the VAS scale, separately for each side. The evaluation of the healing process was performed at each visit using rigid endoscopy and subsequently rated on numerical scales. Results Decreased mucosal edema and secretion; reduced Lund-Kennedy score; and favorable influences on facial pressure, nasal blockage, and smell were most evidently seen in the group receiving the antibioticsteroid combination. Conclusions The application of biodegradable nasal packing with betamethasone and ciprofloxacin in sino-nasal surgery has positive effects not only on the healing process but also impacts patient’s comfort. To optimize it, however, further research is needed.

Effect of absorbable nasal packing saturated with ciprofloxacin and dexamethasone following endoscopic sinus surgery: A prospective cohort study

“…Our routine postoperative systemic steroids or budesonide rinses for CRSwNP, AFS, and AERD patients could have influenced the difference between the treatment and control sides. The sample size was small but comparable with sample sizes in earlier studies 2,3,10 . This limited our subgroup analysis due to already low power for the entire cohort.…”

“…However, each time-point was evaluated for 9 different endoscopic parameters. 2 The majority differences seen on endoscopic assessment would lose statistical significance if a Bonferroni correction was performed for multiple comparisons.…”

“…The sample size was small but comparable with sample sizes in earlier studies. 2,3,10 This limited our subgroup analysis due to already low power for the entire cohort. The small sample was exacerbated by a lower total number of endoscopic exams due to unavailable recordings and poor patient follow up.…”

“…In contrast, a recent study by Wierzchowska et al showed that betamethasone‐ciprofloxacin–saturated absorbable dressing decreased mucosal edema from 10 to 90 days, secretion at 10 and 90 days, and total LK scores throughout a 180‐day period (all p < 0.05) compared with a saline control. However, each time‐point was evaluated for 9 different endoscopic parameters 2 . The majority differences seen on endoscopic assessment would lose statistical significance if a Bonferroni correction was performed for multiple comparisons.…”

“…Enhancing wound healing in the immediate postoperative setting may reduce complications and improve outcomes after endoscopic sinus surgery (ESS). [1][2][3] A certain combination of sinus rinses, nasal packing, antibiotics, or steroids is frequently prescribed. Both antibiotics and steroids may be topical, which has the advantage of limited systemic side effects.…”