关键词: 慢性鼻窦炎, 鼻息肉, 曲安奈德, 高浓度, 预后

Abstract: Objective The present study aimed to investigate the efficacy of nasal packing with gelatin sponges soaked in two different concentrations of glucocorticoids following functional endoscopic sinus surgery(FESS)on the outcome of chronic rhinosinusitis with nasal polyps(CRSwNP)in patients. Methods A total of sixty patients diagnosed with CRSwNP were enrolled in the study and underwent FESS at the Otorhinolaryngology Department between 6 November 2023 and24 March 2025.The subjects were divided into two groups through a randomization process. Group A,the high-concentration group, received gelatin sponges soaked with triamcinolone acetonide injection(40 mg/mL)into the diseased sinus ostia, while Group B,the low-concentration group, received sponges soaked with triamcinolone nasal spray(1.1 mg/mL). Both groups underwent identical surgical procedures and postoperative management. Patients were subjected to follow-up assessments at 2, 4, 8, and 12 weeks postoperatively, in addition to 6 months. The subjective symptoms including nasal obstruction, rhinorrhea, hyposmia, and facial fullness/pressure were assessed using the visual analogue scale(VAS). Furthermore, the following parameters were recorded: objective endoscopic scores(Lund Kennedy score), incidence of postoperative complications, and rate of postoperative intervention. The study comprised two groups, with each group consisting of 30 patients. All patients completed the followup process. Results Unadjusted ttestsshowedthat VAS scores in Group A were lower than those in Group B at 2, 4, 8, and 12 weeks postoperatively(all P<0.05). Following the implementation of the Bonferroni correction for multiple comparisons(six comparisons, α' =0.0083), the differencein VAS scores between the two groups remained statistically significant only at the 4-week postoperative stage(t=3.479, unadjusted P=0.001, adjusted P=0.006); the variations observed at 2, 8, and 12 weeks did not attain the corrected significance level. With Regard to the endoscopic scores, the application comparison to unadjusted t-tests revealed that Group A exhibited lower scores in comparison to Group B at all designated time points(P<0.05). However, subsequent to theimplementation of the Bonferroni correction, none of the observed differences attained statistical significance.At the 6 -month postoperative stage, no statistically significant differences were observedin either VAS or endoscopic scores between the two groups. The rate of postoperative intervention in Group A was lower than that in Group B at 4, 8, and 12 weeks(χ2=4.593, 4.444, and 4.320, respectively; all P<0.05). However, no statistically significant differences were observed at 2 weeks or 6 months postoperatively(χ2=1.196 and 1.196, respectively; P>0.05). A subsequent analysis revealed no statistically significant difference in the incidence of postoperative complications between the two groups(χ2=0.098, P>0.05). Conclusion In patients undergoing FESS, postoperative nasal packing with gelatin sponge impregnated with high-concentration glucocorticoids significantly improves subjective symptom scores at the 4-week but does not significantly improve endoscopic scores. This regimen reduces the rate of early re-intervention(within 4-12 weeks postoperatively), with no significant difference in adverse events compared with the control group. As a safe, economical intervention that facilitates early recovery, this approach merits widespread clinical adoption.

Key words: Chronic rhinosinusitis, Nasal polyps, Triamcinolone, Concentration, Prognosis