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Efficacy of triamcinolone acetonide-impregnated Gelfoam nasal pack in management of chronic sinusitis with nasal polyps following endoscopic sinus surgery: a perfectly matched, placebo-controlled trial study

  • Rhinology
  • Published:
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Abstract

Purpose

This perfectly matched, double-blinded, placebo-controlled trial study was performed to investigate the efficacy of triamcinolone acetonide (TAA)-impregnated Gelfoam nasal pack in management of different endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) following endoscopic sinus surgery (ESS).

Methods

One hundred and four patients with bilateral CRSwNP undergoing ESS were selected and randomized to receive TAA-soaked nasal packing in one nostril and saline-impregnated dressing contra-laterally. Validated Perioperative Sinus Endoscopy (POSE) scoring system was used to assess the participants’ condition at postoperative months 1, 3, 6, 12, and 18.

Results

The treatment side of eosinophilic CRSwNP (EosCRSwNP) group had significantly better endoscopic scores than the contralateral control side in all follow-up visits (P < 0.05 for all comparisons) except for the first postoperative month. No significant difference was detected between the TAA- and saline-treated nostrils in the non-eosinophilic CRSwNP (nonEosCRSwNP) subgroup during the follow-up period. Intergroup comparisons revealed a borderline better POSE score for the treatment side of the EosCRSwNP group compared with the treatment nostril of the nonEosCRSwNP group at months 12 (P = 0.041) and 18 (P = 0.044). At the end of the study period, the treatment side of the EosCRSwNP group demonstrated better clinical response than the saline-treated side in terms of the total POSE scores (P = 0.019), middle turbinate synechia (P = 0.008), middle meatal narrowing (P = 0.010), ethmoid polypoid changes (P = 0.039), ethmoid polyposis (P = 0.027), ethmoid cavity secretions (P = 0.042), and sphenoid severity (P = 0.018).

Conclusion

TAA-soaked Gelfoam dressing following bilateral ESS was found to be an effective method for treating CRSwNP particularly for the eosinophilic endotype of the disease.

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Acknowledgements

The authors acknowledge all the participants of this study and nursing staff of the Imam Hospital for their help with data collection.

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Otolaryngology, Urmia University of Medical Sciences, 57147-83734, Urmia, Iran

    Reza Samarei

  2. Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, 57561-51818, Urmia, Iran

    Reza Samarei

  3. Department of Epidemiology and Biostatistic, Urmia University of Medical Sciences, 57147-83734, Urmia, Iran

    Javad Rasouli

  4. School of Medicine, Urmia University of Medical Sciences, 57147-83734, Urmia, Iran

    Fatemeh Mehdikhani

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  1. Reza Samarei
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Contributions

Conceptualization, methodology, analysis and investigation and writing—review and editing were performed by RS, JR and FM. RS and FM were involved in writing—original draft preparation. RS was involved in supervision.

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Correspondence to Reza Samarei.

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All procedures performed in studies involving human participants were approved by the Health Research Ethics Committee of the Urmia University of Medical Sciences and were in accordance with the 1964 Helsinki Declaration and its later amendments.

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Samarei, R., Rasouli, J. & Mehdikhani, F. Efficacy of triamcinolone acetonide-impregnated Gelfoam nasal pack in management of chronic sinusitis with nasal polyps following endoscopic sinus surgery: a perfectly matched, placebo-controlled trial study. Eur Arch Otorhinolaryngol 279, 2915–2924 (2022). https://doi.org/10.1007/s00405-021-07071-2

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