DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20211569

Comparative study on the effects of pre-operative intranasal steroid spray versus oral steroid on intraoperative bleed in FESS for nasal polyposis

Jagannath B., Nikitha Pillai, Bharath Kumar K. L.

Abstract


Background: Nasal polyps are associated with chronic inflammation of the nasal cavity and sinus mucosa. Steroids are the main stay of medical treatment. FESS is indicated when medical treatment fails. Bleeding during surgery can impair the surgical field during operation and increase the time duration and risks of complications. Pre-operative corticosteroids help reduce bleeding during surgery. The objectives of the study was to study and compare the effects of pre operative intra nasal steroid spray and oral steroid on intra-operative bleed in FESS for nasal polyposis.

Methods: 60 patients diagnosed with nasal polyposis were sequentially divided into 2 groups. Group A received intranasal steroid spray and Group B received oral steroid each for 7 days. Patients of both groups underwent FESS under general anaesthesia. Bleeding volume and quality of surgical field were assessed during the procedure to evaluate the effect of pre operative steroids in bleeding in FESS.

Results: Majority of our study patients of both the groups had moderate bleed. 33.3% of Group B patients showed the best outcome of surgery with just slight bleeding while 33.3% patients of Group B had moderate to severe bleed. Majority of our study patients (53.3%) had a blood loss of about 50-100 ml, of which 66.7% patients belonged to Group B.

Conclusions: Preoperative steroids are truly beneficial. Oral steroids has been found to be relatively better than intra nasal steroid spray in improving symptoms, reducing intra operative bleeding, and in providing better quality of surgical field.  

 


Keywords


Nasal polyps, Steroids, Fluticasone, Prednisolone, FESS

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References


Settipane GA. Epidemiology of nasal polyps. Allergy Asthma Proc. 1996;17:231-6.

Bernstein JM. Nasal polyps: finding the cause, determining treatment. J Respir Dis. 1997;18:847-56.

Small P, Frenkiel S, Black M. Multifactorial etiology of nasal polyps. Ann Allerg. 1981;46:317-20.

Fein B. Aspirin shock associated with asthma and nasal polyps. Ann Allergy. 1971;29:598.

Perkins JA, Blakeslee DB, Andrade P. Nasal polyps: A manifestation of allergy? Otolaryngol Head Neck Surg. 1989;101:641-5.

Bonfils P, Nore`s JM, Halimi P, Avan P. Corticosteroid treatment in nasal polyposis with a three-year follow-up period. Laryngoscope. 2003;113:683-7.

Lal D, Stankiewicz JA. Primary sinus surgery. In: Flint PW, Haughey BH, Lund VJ (eds) Cummings otolaryngology, head and neck surgery. Mosby Elsevier, Philadelphia. 2012;743.

Thongrong C, Kasemsiri P, Carrau RL, Bergese SD. Control of Bleeding in Endoscopic Skull Base Surgery: Current Concepts to Improve Hemostasis. ISRN surgery. 2013;191543.

Rino K, Chettri MN, Moirenthem NS, Zoramthari R. Effects of oral prednisolone and fluticasone nasal spray in the management of nasal polypi. Journal of Medical Society. 2016.

Ullian ME. The role of corticosteroids in the regulation of vascular tone. Cardiovasc Res. 1999;41(1):55-64.

Uri N, Cohen-Kerem R, Barzilai G, Greenberg E, Doweck I, Weiler-Ravell D. Functional endoscopic sinus surgery in the treatment of massive polyposis in asthmatic patients. J Laryngol Otol. 2002;116:185-9.

Daley-Yates PT, Baker RC. Systemic bioavailability of fluticasone propionate administered as nasal drops and aqueous nasal spray formulations. Br J Clin Pharmacol. 2001;51:103-5.

Holmstrom M. Clinical performance of fluticasone propionate nasal drops. Allergy. 1999;54(suppl 53):21-5.

Yonezaki M, Akiyama K, Karaki M. Preference evaluation and perceived sensory comparison of fluticasone furoate and mometasone furoate intranasal sprays in allergic rhinitis. Auris Nasus Larynx. 2016;43(3):292-7.

Cassano P, Marini F, Indraccolo AS. Corticosteroid therapy in the prevention of recurrent post-surgical nasal polyposis. Acta Otorhinolaryngol Ital. 1996;16(4):334-338.

Lund VJ, Flood J, Sykes AP, Richards DH. Effect of fluticasone in severe polyposis. Arch Otolaryngol Head Neck Surg. 1998;124:513-8.

Seidman MD, Gurgel RK, Lin SY. Guideline Otolaryngology Development Group. AAO-HNSF. Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg. 2015;152(1 Suppl):S1-S43.

Mygind N, Lund V. Intranasal Corticosteroids for Nasal Polyposis. Treat Respir Med. 2006;5:93-102.

Hardy JG, Lee SW, Wilson CG. Intranasal drug delivery by spray and drops. J Pharm Pharmacol. 1985;37:294-7.

Albu S, Gocea A, Mitre I. Preoperative treatment with topical corticoids and bleeding during primary endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2010;143:573-8.

Kang G, Yoon BK, Jung JH, Cha HE, Kim ST. The Effect of High-dose Topical Corticosteroid Therapy on Prevention of Recurrent Nasal Polyps after Revision Endoscopic Sinus Surgery. American Journal of Rhinology. 2008;22(5):497-501.

Bridgeman MB. Overcoming barriers to intranasal corticosteroid use in patients with uncontrolled allergic rhinitis. Integr Pharm Res Pract. 2017;6:109-19.

Fokkens WJ, Lund VJ, Mullol J. European position paper on rhinosi¬nusitis and nasal polyps 2012. Rhinology. 2012;50(1):1-12.

Nash JJ, Nash AG, Leach ME, Poetker DM. Medical malpractice and corticosteroid use. Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2011;144(1):10-5.

Blomqvist E, Lundblad L, Änggård A, Haraldsson P-O, Stjärne P. A randomized controlled study evaluating medical treatment versus surgical treatment in addition to medical treatment of nasal polyposis. The Journal of Allergy and Clinical Immunology. 2001;107(2):224-8.

Khosla, AJ, Pernas, FG, Maeso, PA. Meta‐analysis and literature review of techniques to achieve hemostasis in endoscopic sinus surgery. Int Forum Allergy Rhinol. 2013;3:482-7.

Pathak RK, Kumar N, Mohit Bagde M. A Study onthe Effect of Preoperative Systemic Corticosteroids on Intraoperative Outcome in Patients Undergoing Functional Endoscopic Sinus Surgery for Sinonasal Polyposis. IOSR Journal of Dental and Medical Sciences. 2020;19(1):19-24.

Günel, C, Basak, HS, Bleier, BS. Oral steroids and intraoperative bleeding during endoscopic sinus surgery. B-ENT. 2015;11:123-8.

Sieskiewicz A, Olszewska E, Rogowski M, Grycz, E. Preoperative corticosteroid oral therapy and intraoperative bleeding during functional endoscopic sinus surgery in patients with severe nasal polyposis: a preliminary investigation. Ann Otol Rhinol Laryngol. 2006;115:490-4.

Pundir V, Pundir J, Lancaster G. Role of corticosteroids in Functional Endoscopic Sinus Surgery--a systematic review and meta-analysis. Rhinology. 2016;54(1):3-19.

Wright ED, Agrawal S. Impact of perioperative systemic corticosteroids on surgical outcomes in patients with chronic rhinosinusitis with polyposis: Evaluation with the novel Perioperative Sinus Endoscopy (POSE) scoring system. Laryngoscope. 2007;117(115):1-28.

Tuncer U, Soylu L, Aydogan B. The effectiveness of steroid treatment in nasal polyposis. Auris Nasus Larynx. 2003;30(3):263-8.

Kowalski ML. Oral and nasal steroids for nasal polyps. Curr Allergy Asthma Rep. 2011;11(3):187-8.