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Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation
Published on: June 20, 2018
Efficacy of targeted middle meatal antibiotics and endoscopic sinus surgery
Rohan C Wijewickrama1, Peter J Catalano, Rahul Gupta
1St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
Background:
Postoperative infection remains a significant comorbidity of endoscopic sinus surgery (ESS) delayed healing, synechia formation, etc. The objective of this study was to compare the incidence of postoperative infection after ESS in patients receiving conventional postoperative oral antibiotic prophylaxis versus a synthetic bioabsorbable antibiotic-soaked nasal sponge used in the middle meatus (MM) in lieu of oral antibiotics.
Methods:
A prospective randomized multicenter trial included 321 chronic rhinosinusitis patients undergoing minimally invasive ESS who received either 1 week of oral antibiotics and a saline-soaked bioabsorbable MM sponge (control group) or no oral antibiotics and the placement of a bacitracin-soaked bioabsorbable sponge in the MM (study group). Evaluations performed at baseline, 3-weeks, and 3-months postoperatively included the 20-item Sino-Nasal Outcome Test and nasal endoscopic examination.
Results:
The 3-week postoperative infection rate was not significantly different between the study (n = 165) and control groups (n = 156): 5.4% versus 3.8%; p > 0.05. In addition, there was no significant difference between the two patient groups on evaluation of MM granulations, synechia, middle turbinate lateralization, or sponge retention.
Conclusion:
Antibiotic-soaked synthetic bioabsorbable MM sponges show equivalent efficacy in controlling post ESS infections compared with conventional postoperative oral antibiotics. Topical antibiotic delivery to the MM via bioabsorbable sponges may reduce the need for postoperative systemic antibiotics and provide a cost-effective alternative that eliminates the issues of antibiotic side effects, drug-drug interactions, and medication compliance in the postoperative setting.
Insights
A new study found that antibiotic-soaked nasal sponges are as effective as oral antibiotics for preventing infection after endoscopic sinus surgery (ESS). This topical approach may reduce systemic antibiotic use and associated complications.
Area of Science:
- Otolaryngology
- Surgical Infection Prevention
- Rhinosinusitis Treatment
Background:
- Postoperative infection is a common complication of endoscopic sinus surgery (ESS).
- Existing treatments include oral antibiotic prophylaxis, which can have side effects and compliance issues.
Purpose of the Study:
- To compare the efficacy of a synthetic bioabsorbable antibiotic-soaked nasal sponge in the middle meatus (MM) versus conventional oral antibiotics for preventing postoperative infection after ESS.
Main Methods:
- A prospective randomized multicenter trial involved 321 chronic rhinosinusitis patients undergoing ESS.
- Patients received either oral antibiotics with a saline-soaked sponge or no oral antibiotics with a bacitracin-soaked sponge in the MM.
- Outcomes were assessed using the Sino-Nasal Outcome Test and nasal endoscopy at baseline, 3 weeks, and 3 months.
Main Results:
- No significant difference in the 3-week postoperative infection rate between the antibiotic sponge group (5.4%) and the oral antibiotic group (3.8%).
- No significant differences were observed in middle meatus granulations, synechia, middle turbinate lateralization, or sponge retention between groups.
Conclusions:
- Antibiotic-soaked bioabsorbable sponges are equivalent to oral antibiotics in controlling post-ESS infections.
- Topical antibiotic delivery via sponges offers a potential alternative to systemic antibiotics, reducing side effects, drug interactions, and compliance concerns.
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