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Prospective, randomised controlled trial comparing intense endoscopic cleaning versus minimal intervention in the early post-operative period following functional endoscopic sinus surgery

  • J M Fishman (a1), S Sood (a1), M Chaudhari (a1), P Martinez-Devesa (a1), L Orr (a1) and D Gupta (a1)...

Abstract

Objective:

There is currently no standardised management protocol following functional endoscopic sinus surgery. This study assessed frequent endoscopic cleaning versus minimal intervention in the early post-operative period following such surgery.

Study design:

Prospective, randomised controlled, single-blinded, within-subject trial involving 24 patients with bilateral chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery.

Main outcome measure:

The primary outcome measure was ethmoid cavity healing, based on endoscopic appearance, graded using a modified Lund–MacKay endoscopic score.

Secondary outcome measure:

Lund–MacKay symptom score before and after surgery.

Results:

There was no overall statistically significant difference between the two groups (p = 0.37). Subgroup analysis revealed a significant effect of regular suction clearance on adhesions at three months (p = 0.048), but not on oedema, polyps, granulation, discharge or crusting.

Conclusion:

There is no evidence from this study to support frequent endoscopic cleaning in the early post-operative period after functional endoscopic sinus surgery. Less intensive post-operative management is recommended, resulting in decreased patient morbidity and fewer post-operative follow-up appointments.

Copyright

Corresponding author

Address for correspondence: Mr Jonathan Fishman, ENT Registrar & Royal College of Surgeons of England Surgical Research Fellow, Department of Otolaryngology, The Great Western Hospital, Swindon, Wiltshire SN3 6BB, UK E-mail: jfishman@doctors.org.uk

Footnotes

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Presented and awarded first prize for best oral presentation at the 8th Annual Meeting of the British Rhinological Society, 15 May 2009, Cheltenham, UK

Footnotes

References

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1Wigand, ME. Endoscopic Surgery of the Paranasal Sinuses and Anterior Skull Base. New York: Thieme, 1990
2Lund, VJ, MacKay, IS. Outcome assessment of endoscopic sinus surgery. J R Soc Med 1994;87:70–2
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5Schulz, KF, Altman, DG, Moher, D, for the CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c332
6Lund, VJ, Mackay, IS. Staging in rhinosinusitis. Rhinology 1993;31:183–4
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9Lee, JY, Byun, JY. Relationship between the frequency of postoperative debridement and patient discomfort, healing period, surgical outcomes, and compliance after endoscopic sinus surgery. Laryngoscope 2008;118:1868–72
10Kemppainen, T, Seppa, J, Tuomilehto, H, Kokki, H, Nuutinen, J. Repeated early debridement does not provide significant symptomatic benefit after ESS. Rhinology 2008;46:238–42
11Bugten, V, Nordgard, S, Steinsvag, S. The effects of debridement after endoscopic sinus surgery. Laryngoscope 2006;116:2037–43

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