J Rhinol.  2020 May;27(1):16-20. 10.18787/jr.2019.00288.

The Effect of Triamcinolone-Soaked Gelfoam in Patients with Polypoid Mucosal Change after Endoscopic Sinus Surgery

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
  • 2Departments of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Abstract

Background and Objectives
Chronic rhinosinusitis with nasal polyps (CRSwNP) recurs frequently after endoscopic sinus surgery (ESS). The aim of study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurred polypoid changes after ESS.
Subjects and Method
A total of 35 patients and 57 nasal cavities was retrospectively reviewed. All patients underwent triamcinolone- infused gelfoam packing for 1 week under nasal endoscopic guidance. Endoscopic scores were evaluated at 1 week, 1 month, and 3 months. We analyzed clinical characteristics between success and failure groups.
Results
Endoscopic scores were significantly improved after triamcinolone-soaked gelfoam packing, and the effects were maintained at 3-month follow-up (1.85±0.61 vs. 0.82±0.77, p<0.001). Duration between surgery and gelfoam packing was shorter in the success group compared to the failure group (8.2±6.9 vs. 13.7±8.4 weeks, p=0.033). Serum eosinophil cationic protein and tissue eosinophil counts were significantly higher in the failure group (p=0.025 and p=0.010, respectively).
Conclusion
Triamcinolone-soaked gelfoam packing is an effective and safe method for managing recurrent polypoid change in patients with CRSwNP after ESS. Early intervention contributed to a successful result, and eosinophilic inflammation was associated with poor outcomes.

Keyword

Nasal polyp; Polypoid change; Triamcinolone; Gelfoam; 비강폴립; 폴립양 변화; 트리암시놀론; 젤폼

Figure

  • Fig. 1. Endoscopic findings before and after gelfoam packing. A: Polypoid sinonasal mucosa after endoscopic sinus surgery. B: Recovery state of polypoid edema 3 months after gelfoam packing.

  • Fig. 2. Endoscopic scores (0: normal, 1: edema, 2: polypoid change, 3: polyp) were significantly improved after gelfoam packing and the effects were maintained until 3 months follow-up (*: p<0.05, **: p<0.01, ***: p<0.001).


Reference

1. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012; 50:1–12.
2. DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2017; 127:550–5.
3. Stein NR, Jafari A, DeConde AS. Revision rates and time to revision following endoscopic sinus surgery: A large database analysis. Laryngoscope. 2018; 128:31–6.
4. Wynn R, Har-El G. Recurrence rates after endoscopic sinus surgery for massive sinus polyposis. Laryngoscope. 2004; 114:811–3.
5. Bachert C, Watelet JB, Gevaert P, Van Cauwenberge P. Pharmacological management of nasal polyposis. Drugs. 2005; 65:1537–52.
6. Head K, Chong LY, Hopkins C, Philpott C, Schilder AG, Burton MJ. Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016; 4:Cd011992.
7. Kalish LH, Arendts G, Sacks R, Craig JC. Topical steroids in chronic rhinosinusitis without polyps: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2009; 141:674–83.
8. Wang C, Lou H, Wang X, Wang Y, Fan E, Li Y, et al. Effect of budesonide transnasal nebulization in patients with eosinophilic chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2015; 135:922–29. e6.
9. Smith KA, French G, Mechor B, Rudmik L. Safety of long-term high-volume sinonasal budesonide irrigations for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016; 6:228–32.
10. Kang IG, Yoon BK, Jung JH, Cha HE, Kim ST. The effect of highdose topical corticosteroid therapy on prevention of recurrent nasal polyps after revision endoscopic sinus surgery. Am J Rhinol. 2008; 22:497–501.
11. More Y, Willen S, Catalano P. Management of early nasal polyposis using a steroid-impregnated nasal dressing. Int Forum Allergy Rhinol. 2011; 1:401–4.
12. Kim SW, Kim DW, Khalmuratova R, Kim JH, Jung MH, Chang DY, et al. Resveratrol prevents development of eosinophilic rhinosinusitis with nasal polyps in a mouse model. Allergy. 2013; 68:862–9.
13. Chang DY, Joo YH, Kim SJ, Kim JH, Jung MH, Kim DW, et al. Therapeutic effects of intranasal cyclosporine for eosinophilic rhinosinusitis with nasal polyps in a mouse model. Am J Rhinol Allergy. 2015; 29:e29. –32.
14. Hong SD, Kim JH, Dhong HJ, Kim HY, Chung SK, Chang YS, et al. Systemic effects and safety of triamcinolone-impregnated nasal packing after endoscopic sinus surgery: a randomized, double-blinded, placebo-controlled study. Am J Rhinol Allergy. 2013; 27:407–10.
15. Bonfils P, Nores JM, Halimi P, Avan P. Corticosteroid treatment in nasal polyposis with a three-year follow-up period. Laryngoscope. 2003; 113:683–7.
16. Small CB, Hernandez J, Reyes A, Schenkel E, Damiano A, Stryszak P, et al. Efficacy and safety of mometasone furoate nasal spray in nasal polyposis. J Allergy Clin Immunol. 2005; 116:1275–81.
17. Dijkstra MD, Ebbens FA, Poublon RM, Fokkens WJ. Fluticasone propionate aqueous nasal spray does not influence the recurrence rate of chronic rhinosinusitis and nasal polyps 1 year after functional endoscopic sinus surgery. Clin Exp Allergy. 2004; 34:1395–400.
18. Pletcher SD, Goldberg AN. Treatment of recurrent sinonasal polyposis with steroid-infused carboxymethylcellulose foam. Am J Rhinol Allergy. 2010; 24:451–3.
19. Rudmik L, Smith TL. Economic Evaluation of a Steroid-Eluting Sinus Implant following Endoscopic Sinus Surgery for Chronic Rhinosinusitis. Otolaryngol Head Neck Surg. 2014; 151:359–66.
20. Van Zele T, Holtappels G, Gevaert P, Bachert C. Differences in initial immunoprofiles between recurrent and nonrecurrent chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2014; 28:192–8.
21. Hull BP, Chandra RK. Refractory Chronic Rhinosinusitis with Nasal Polyposis. Otolaryngol Clin North Am. 2017; 50:61–81.
22. Tokunaga T, Sakashita M, Haruna T, Asaka D, Takeno S, Ikeda H, et al. Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study. Allergy. 2015; 70:995–1003.
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