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b.
Surgery
i.
Perioperative management
Hauser LJ, Ir D, Kingdom TT, et al. Investigation of bacterial repopulation after
sinus surgery and perioperative antibiotics.
Int Forum Allergy Rhinol
. 2015;
6(11):34-40. EBM level 2b..........................................................................120-126
Summary:
This article examines the changes in the microbial flora after medical and
surgical therapies of chronic sinusitis. It demonstrates that surgery and postoperative
antibiotic treatment did not reduce bacterial burden, but instead shifted the microbial
consortia.
Macdonald KI, Wright ED, Sowerby LJ, et al. Squeeze bottle versus saline spray
after endoscopic sinus surgery for chronic rhinosinusitis: a pilot multicentre trial.
Am J Rhinol Allergy
. 2015; 29(1):e13-e17. EBM level 1...........................127-131
Summary
: This article compares low-volume saline to high-volume, high-pressure saline
irrigation after endoscopic sinus surgery. The authors demonstrate that both methods
result in improvement of sinus symptomology, but the study is not powered enough to rule
out a difference in the two modalities.
ii.
Complications
Suzuki S, Yasunaga H, Matsui H, et al. Complication rates after functional
endoscopic sinus surgery: analysis of 50,734 Japanese patients.
Laryngoscope
.
2015: 125(8):1785-1791. EBM level 2........................................................132-138
Summary
: This article examines complication rates of endoscopic sinus surgery (ESS) in a
very large cohort of patients. It demonstrates that in the modern era, complications after
ESS are uncommon, but the risk of orbital injury may be higher after previous surgical
intervention.
c.
Medical
i.
Systemic (antibiotics, steroids, and biologics)
Poetker DM. Oral corticosteroids in the management of chronic rhinosinusitis
with and without nasal polyps: risks and benefits.
Am J Rhinol Allergy
. 2015;
29(5):339-342. EBM level 5........................................................................139-142
Summary
: Oral corticosteroids are frequently used in the management of chronic
rhinosinusitis. In this review, an overview of the existing data on the risks of oral
corticosteroids is presented, along with associated medicolegal risks, and a discussion of
the data supporting the use of these drugs in patients with chronic rhinosinusitis.
Varvyanskaya A, Lopatin A. Efficacy of long-term low-dose macrolide therapy
in preventing early recurrence of nasal polyps after endoscopic sinus surgery.
Int
Forum Allergy Rhinol
. 2014; 4(7):533-541. EBM level 1.........................143-151
Summary
: In this prospective study, patients with chronic rhinosinusitis with nasal polyps
undergoing endoscopic sinus surgery were postoperatively randomized to receive
clarithromycin 250 mg daily for 12 weeks, 24 weeks, or to not receive any clarithromycin.
All patients were treated with mometasone nasal spray. At intervals for 24 weeks, patients
were assessed with visual analog scale (VAS), SNOT-20, acoustic rhinometry,
rhinomanometry, saccharin transit time, nasal endoscopy, Lund-Mackay CT score, and
eosinophilic cationic protein in nasal secretions. All parameters except for VAS and
acoustic rhinometry were significantly improved in the clarithromycin groups as
compared to the control.