Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2024, Vol. 38 ›› Issue (3): 38-42.doi: 10.6040/j.issn.1673-3770.0.2023.375

• Original Article • Previous Articles    

Short-term clinical observation of drugsustained-release stent implantation in patients with refractory sinusitis

LI Hao1, YANG Liyuan2, ZHANG Shoukai1   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery;
    2. Department of Ophthalmology and Optometry, GanSu Provincial Hospital, Lanzhou 730000, GanSu, China
  • Published:2024-06-04

PDF (PC)

54

Abstract: Objective To explore the short-term clinical effect of drug sustained-release stent implantation in functional endoscopic sinus surgery for refractory sinusitis. Methods Sixty patients with refractory sinusitis were randomized observation group and control group. Both groups of patients underwent functional endoscopic sinus surgery. The observation group received sinus drug sustained-release stent during surgery, while the control group received routine medication after surgery. Four weeks after surgery, all patients underwent the sino-nasal outcome test-20(SNOT-20)for subjective symptom scoring, and nasal endoscopy and CT scan were performed for objective evaluation of mucosal recovery based on the Lund-Kennedy and CT Lund-Mackay scores of the sinuses. The clinical efficacy, incidence of complications, and recurrence of the two groups were compared. Results Four weeks after surgery, the total clinical efficacy in the observation group(93.33%)was significantly higher than that of the control group(86.67%), while the SNOT-20 score in the observation group was lower(P=0.02). The Lund-Kennedy and Lund-Mackay scores in the observation group were lower(P=0.04,0.03); the recurrence rate was not statistically different between the two groups(P=0.27). Conclusion Implantation of drug sustained-release stent in the nasal sinus in functional endoscopic sinus surgery has a significant effect in the short-term for the treatment of refractory sinusitis, which can effectively improve the morphology of nasal mucosa, improve the quality of life, and result in fewer complications.

Key words: Drug sustained release stent implantation, Refractory sinusitis, Functional endoscopic sinus surgery, Sinus mucosa, Complications

CLC Number: 

  • R765.4
[1] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020[J]. Rhinology, 2020, 58(Suppl S29): 1-464. doi:10.4193/Rhin20.600
[2] Kato A, Peters AT, Stevens WW, et al. Endotypes of chronic rhinosinusitis: relationships to disease phenotypes, pathogenesis, clinical findings, and treatment approaches[J]. Allergy, 2022, 77(3): 812-826. doi:10.1111/all.15074
[3] Tabaee A, McCoul ED. Refractory chronic rhinosinusitis[J]. Otolaryngol Clin N Am, 2017, 50(1): xvii-xviii. doi:10.1016/j.otc.2016.11.001
[4] 赵传亮, 余少卿. 难治性慢性鼻窦炎的临床研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(1): 19-22. doi:10.13201/j.issn.1001-1781.2020.01.005 ZHAO Chuanliang, YU Shaoqing. Recent clinical advances in refractory chronic sinusitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(1): 19-22. doi:10.13201/j.issn.1001-1781.2020.01.005
[5] Han JK, Marple BF, Smith TL, et al. Effect of steroid-releasing sinus implants on postoperative medical and surgical interventions: an efficacy meta-analysis[J]. Int Forum Allergy Rhinol, 2012, 2(4): 271-279. doi:10.1002/alr.21044
[6] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018)[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(2):81-100. doi: 10.3760/cma.j.issn.1673-0860.2019.02.001 Subspecialty group of rhinology, editorial board of Chinese journal of otorhinolaryngology head and neck surgery; subspecialty group of rhinology, society of otorhinolaryngology head and neck surgery, Chinese medical association. Chinese guidelines for diagnosis and treatment of chronic rhinosinusitis(2018)[J]. Chin J Otorhinolaryngol Head Neck Surg, 2019, 54(2):81-100. doi: 10.3760/cma.j.issn.1673-0860.2019.02.001
[7] 左可军, 方积乾, Piccirillo JF, 等. 鼻腔鼻窦结局测试-20(SNOT-20)量表中文版的研制[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(10): 751-756. doi:10.3321/j.issn: 1673-0860.2008.10.007 ZUO Kejun, FANG Jiqian, PICCIRILLO JF, et al. Development of the Sino-Nasal Outcome Test-20 Chinese version(SNOT-20 CV)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2008, 43(10): 751-756. doi:10.3321/j.issn: 1673-0860.2008.10.007
[8] Massoth L, Anderson C, McKinney KA. Asthma and chronic rhinosinusitis: diagnosis and medical management[J]. Med Sci, 2019, 7(4): 53. doi:10.3390/medsci7040053
[9] Wang ZJ, Han L, Yu LS. Effects of surgery and topical medication on eosinophilic granulomatosis with polyangiitis with otitis media and sinusitis: a case report[J]. J Int Med Res, 2020, 48(4): 300060520920049. doi:10.1177/0300060520920049
[10] Hao ZP, Gu HY, Li W. The efficacy of functional endoscopic sinus surgery combined with triamcinolone acetonide aqueous nasal spray for the treatment of chronic rhinosinusitis[J]. Front Surg, 2022, 9: 855618. doi:10.3389/fsurg.2022.855618
[11] 李华斌, 赖玉婷. 慢性鼻-鼻窦炎的发病机制及诊疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 4-9. doi:10.6040/j.issn.1673-3770.1.2018.004 LI Huabin, LAI Yuting. Pathogenesis, diagnosis, and treatment of chronic rhinosinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(3): 4-9. doi:10.6040/j.issn.1673-3770.1.2018.004
[12] Goshtasbi K, Abouzari M, Abiri A, et al. Efficacy of steroid-eluting stents in management of chronic rhinosinusitis after endoscopic sinus surgery: updated meta-analysis[J]. Int Forum Allergy Rhinol, 2019, 9(12): 1443-1450. doi:10.1002/alr.22443
[13] 李德宏, 倪茂美, 任娟娟, 等. 鼻窦药物支架在复发性鼻窦炎中的短期疗效[J]. 实用医学杂志, 2023, 39(3): 315-320. doi:10.3969/j.issn.1006-5725.2023.03.009 LI Dehong, NI Maomei, REN Juanjuan, et al. Short-term efficacy of sinus drug stents in patients with recurrent rhinosinusitis[J]. The Journal of Practical Medicine, 2023, 39(3): 315-320. doi:10.3969/j.issn.1006-5725.2023.03.009
[14] Huang ZX, Hwang P, Sun Y, et al. Steroid-eluting sinus stents for improving symptoms in chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery[J]. Cochrane Database Syst Rev, 2015: 10436. doi:10.1002/14651858.cd010436
[15] Ralph Haddad, Nadim Khoueir, Hussein Smaily, et al. Safety and efficacy of the draf IIb procedure: a systematic review[J]. Otolaryngol Head Neck Surg, 2021, 165(6): 784-790. doi:10.1177/01945998211004237
[16] Lee VS, Patel P, O'Brien D, et al. Indications for absorbable steroid-eluting sinus implants: viewpoint via the Delphi method[J]. Int Forum Allergy Rhinol, 2022, 12(10): 1225-1231. doi:10.1002/alr.23044
[17] Cho SH, Ledford D, Lockey RF. Medical management strategies in acute and chronic rhinosinusitis[J]. J Allergy Clin Immunol Pract, 2020, 8(5): 1559-1564. doi:10.1016/j.jaip.2020.02.020
[18] Sanan A, Rabinowitz M, Rosen M, et al. Topical therapies for refractory chronic rhinosinusitis[J]. Otolaryngol Clin N Am, 2017, 50(1): 129-141. doi:10.1016/j.otc.2016.08.011
[1] LU Huan, HE Benchao, LIAO Hongming. Acute sinusitis combined with orbital cellulitis and intracranial infection in a child: a case report and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(1): 46-50.
[2] LI Xiaoying, LI Yan, WU Yungang, ZHANG Hui, MA Linxiang, ZHAO Yufeng, SUN Juxing, ZHANG Jin. Nasal ameloblastoma: a case report and literature analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(3): 30-34.
[3] YUE Tao, ZHUANG Dayong, ZHOU Peng, LI Xiaolei, XU Jing, ZHU Jian, HE Qingqing. The complications of tracheal injury in da Vinci robotic thyroidectomy: four case reports and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(3): 46-50.
[4] CHAI Lina, LEI Chunyan, GAO Sheng, ZHANG Meixia. Isolated congenital retinal arteriovenous malformation with vitreous hemorrhage and sub-inner limiting membrane hemorrhage:a case report and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(2): 67-70.
[5] LI Ying. Importance of standardized methods in corneal refractive surgery and the prevention of complications [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 1-6.
[6] CIREN Qiongda, WU Yuan. A case of long-term ocular complications caused by toxic epidermal necrolysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 147-150.
[7] ZHAO Yaming, SHI Song. Three cases of diagnosis and treatment of cervical necrotizing fasciitis with a primary diagnosis of acute epiglottitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 12-16.
[8] SUN Chuan, LIU Yaqun, HE Shuangba, ZHANG Qingxiang. Cryogenic plasma-assisted nasal resection of seventeen cases of anterior and middle skull base tumors [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 55-59.
[9] ZHANG Jinzhuang, YIN Pu, LIU Ning, WANG Jiangyu, JIA Yunfen, DING Yuanji, WU Yao. Comparative study of the Xiangju capsule and Kangfuxin liquid in the treatment of chronic rhinosinusitis with nasal polyps after functional endoscopic sinus surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 69-76.
[10] This study was conducted to explore the preoperative risk factors for postoperative adhesion in patients with chronic rhinosinusitis(CRS)undergoing functional endoscopic sinus surgery(FESS), and to construct a risk score model to evaluate their predictive effect. MethodsA retrospective study was conducted on 323 patients with CRS who underwent FESS at our hospital between January 2015 and June 2018. The risk factors for postoperative adhesion were screened using a multivariate logistic regression analysis. The risk score was assigned according to the odds ratio(OR)value, and a receiver operating characteristic(ROC)curve was drawn to evaluate the predictive effect. ResultsPostoperative adhesion occurred in 35 patients(10.8%). The logistic regression results showed that concha bullosa, primary FESS, operative experience less than 10 years, and a history of middle turbinate resection were independent risk factors for postoperative adhesion in FESS. The OR values were 1.12(95% CI: 1.06-1.18), 3.87(95% CI: 2.23-5.51), 3.19(95% CI: 2.07-4.31), and 2.24(95% CI:1.95-2.53), respectively. The risk score model assigned 1 point for vesicular middle turbinate, 4 points for first time FESS, 3 points for operative experience less than 10 years, and 2 points for middle turbinate resection. The ROC curve analysis showed that the area under the curve(AUC)was 0.784(95% CI: 0.672-0.896, P<0.05). When 4 points were selected as the cut-off point, the Jordan index was the largest, with a sensitivity of 75.1% and a specificity of 73.6%. ConclusionThe incidence of postoperative adhesion in 323 patients with CRS who underwent FESS was 10.8%. The risk score model has certain reference value for predicting high-risk postoperative adhesion.. Potential risk factors and evaluation of a predictive risk score model for postoperative adhesion in functional endoscopic sinus surgeryCHEN Dong1, YU Hong2, LI Yang1, HUANG Qiang1, FANG Min1 1. Department of Otolaryngology, Jiangyou Peoples Hospital, Jiangyou 621700, Sichuan, China; 2. Department of Pathology, Jiangyou Peoples Hospital, Jiangyou 621700, Sichuan, ChinaAbstract:Objective〓 [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 87-91.
[11] FANG Zhongju, ZHANG Yongxia, ZHAO Jiandong, ZONG Liang, ZHAI Xingyou, LI Xinjian, PENG Xin, REN Nan, CHEN Liwei, LIU Mingbo. Combined treatment of chylous leakage after lymph node dissection for thyroid cancer [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 64-68.
[12] SU Caipei, YANG Yabo. Surgical skills required for small incision lenticule extraction(SMILE), and the prevention and management of SMILE-related complications [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(2): 13-16.
[13] LIU Jia, FU Yong. Advances in the surgical treatment of pediatric patients with chronic rhinosinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 29-33.
[14] ZHANG Chanyuan, SUN Yulin, WANG Lin, ZHANG Li, CHEN Min, YI Longgang, LI Na, CUI Xin, JIANG Yan. Clinical diagnosis and treatment of orbital complications following pediatric acute rhinosinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 34-40.
[15] WANG Panpan. Effects of a quality control circle-based discharge plan on rehabilitation after ear deformity reconstruction [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 165-168.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd