Advances in absorbable biomaterials and nasal packing.

Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Road, Woodville, Adelaide, SA 5011, Australia.
Otolaryngologic Clinics of North America (Impact Factor: 1.46). 10/2009; 42(5):813-28, ix. DOI: 10.1016/j.otc.2009.07.009
Source: PubMed

ABSTRACT Absorbable biomaterials are commonly used after endoscopic sinus surgery, both for hemostatic and wound healing considerations. Although removable nasal packing is the traditional method of controlling ongoing bleeding and modulating wound healing, it is uncomfortable for patients and associated with several complications. Currently available absorbable agents frequently incite an inflammatory reaction and have been shown in animal and human trials to adversely affect the wound healing process. Newer agents offer distinct advantages because of their unique composition and rapid clearance profiles. The selection of packing material used in any given sinus procedure should be based on surgeon preference and the details of the specific case.

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    ABSTRACT: BACKGROUND: Middle meatal (MM) synechiae is the most common complication following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. To prevent synechiae formation, a variety of MM spacers have been employed, with varying success in the reported literature. There remains a continued debate on whether MM spacers actually reduce the risk of synechiae following ESS. METHODS: The Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was used for reporting this review of randomized controlled trials evaluating the effectiveness of MM spacers compared to no spacers in patients undergoing ESS. Where appropriate, a meta-analysis on outcome data using a random effects model was performed. RESULTS: Eight randomized controlled trials were included in this systematic review. A pooled analysis on relevant trials found a nonsignificant trend favoring MM spacers compared to no spacers for the prevention of synechiae following ESS (relative risk [RR], 0.40; 95% confidence interval [CI], 0.14-1.12). Subgroup analysis suggested that nonabsorbable spacers (NAS) may be more effective than absorbable spacers (AS) for reducing the risk of synechiae compared to no spacers. CONCLUSION: MM spacers may be more effective than no spacers for the prevention of synechiae following ESS, especially when employing the use of an NAS. However, significant heterogeneity is observed among included trials and future studies are needed to further validate these findings. © 2012 ARS-AAOA, LLC.
    International Forum of Allergy and Rhinology 05/2012; · 1.00 Impact Factor
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    ABSTRACT: OBJECTIVES/HYPOTHESIS: Intranasal resorbable packing, such as Nasopore, is commonly used during sinus surgery despite a paucity of evidence that demonstrates clinical benefit. We theorized that Nasopore supports bacterial growth and biofilm formation. The DNABII family of bacterial nucleic acid binding proteins stabilizes the extracellular polymeric substance of the biofilm, thus protecting bacteria from host defenses and traditional antibiotics. We tested the hypothesis that use of anti-IHF antibodies in conjunction with antibiotics would enhance biofilm eradication from Nasopore. STUDY DESIGN: In vitro experiments. METHODS: Nontypeable Haemophilus influenzae (NTHI) biofilms were grown on Nasopore. Following 24-hour incubation, biofilms were incubated for an additional 16 hours with either medium alone, naïve rabbit serum, rabbit anti-IHF serum, amoxicillin/clavulanate, or anti-IHF serum + amoxicillin/clavulanate. Computer statistics (COMSTAT) analysis was performed on images of biofilms obtained via confocal microscopy. RESULTS: NTHI readily formed a biofilm on Nasopore. Treatment with amoxicillin/clavulanate alone mediated an increase in biomass by 92% to 6.63 μ(2) /μ(3) compared to incubation in sterile medium alone (3.46 μ(2) /μ(3) ). Treatment with anti-IHF alone reduced the biomass by 77% to 1.29 μ(2) /μ(3) compared to incubation with naïve rabbit serum (5.53 μ(2) /μ(3) ). Anti-IHF + amoxicillin/clavulanate reduced biomass by 88% to 0.66 μ(2) /μ(3) (P <0.02) compared to incubation with naïve rabbit serum. CONCLUSION: Antibiotics alone were ineffective in eradicating NTHI biofilms that had formed on Nasopore in vitro. Anti-IHF antibodies plus amoxicillin/clavulanate therapy synergistically reduced biofilm biomass by 88%. These data support clinical studies for the use of anti-IHF combined with antibiotics to reduce biofilm formation on intranasal packing. LEVEL OF EVIDENCE: N/A. Laryngoscope, 2013.
    The Laryngoscope 05/2013; · 1.98 Impact Factor
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    ABSTRACT: OBJECTIVES/HYPOTHESIS: Absorbable packing materials are commonly used after endoscopic sinus surgery (ESS). Cutanplast is a novel gelatin sponge with a powerful hemostatic effect that is rapidly absorbed. The purpose of this study was to investigate the efficacy of Cutanplast in patients following ESS. STUDY DESIGN: A multicenter, prospective, randomized, double-blind, paired, controlled trial. METHODS: One hundred adult patients with chronic sinusitis requiring the same extent of ESS were included. Patients were excluded if they were undergoing septoplasty, turbinate surgery, revision surgery, and taking anticoagulants. Following surgery, one nasal cavity was packed with Cutanplast and the other one with Merocel. Hemostatic properties, patient discomfort while the packing was in situ, patient pain on removal, degree of bleeding on removal, time required to control bleeding after removal, the cost of the pack, and postoperative wound healing were evaluated. RESULTS: Both packs were effective at preventing postoperative hemorrhage. However, Cutanplast was significantly more comfortable while in situ (mean difference, 0.90; 95% confidence interval [CI], 0.75-1.25) and less painful on removal of the pack (mean difference, 1.36; 95% CI, 0.85-1.71). The Merocel pack was associated with significantly more bleeding on removal (mean difference, 1.23; 95% CI, 0.61-2.29), therefore much time was needed to control hemorrhage (mean difference, 1.05; 95% CI, 0.31-1.45). There was no significant difference in the cost of the pack used and outcome measure of wound healing. CONCLUSIONS: Cutanplast nasal pack results in significantly less pain and less bleeding compared to Merocel pack. Laryngoscope, 2012.
    The Laryngoscope 10/2012; · 1.98 Impact Factor

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