Preoperative treatment with topical corticoids and bleeding during primary endoscopic sinus surgery.
OBJECTIVE
To find out whether the constant preoperative use of a topical corticoid (mometasone furoate [MF]) could really improve the operative field quality and decrease bleeding during endoscopic sinus surgery (ESS).


METHODS
Double-blind, randomized controlled trial.


METHODS
Tertiary referral center.


METHODS
Seventy patients with chronic rhinosinusitis (CRS) with and without polyps underwent ESS under standardized general anesthesia with equal randomization into two groups. During four weeks within the preoperative period, 35 cases were treated with MF, while the other half received placebo matching sprays. Total blood loss, operation time, and surgical field quality were recorded.


RESULTS
Intraoperative blood loss in the MF-treated group was 142.8 mL, less than in the control group (170.6 mL). The difference between the groups is 27.7 mL (95% confidence interval [CI] 3.5-51.92), statistically significant: P = 0.025. Time of surgery was 59 minutes in the MF group and 70 minutes in the control group. The difference was 11.2 minutes (95% CI 2.82-19.51), which is statistically significant: P = 0.009. The quality of the endoscopic surgical field was significantly better for patients treated with MF. Treatment with topical corticoid enables significantly reduced bleeding, decreased operation time, and improved endoscopic vision during ESS for CRS.


CONCLUSIONS
The use of topical corticoid (MF) in the preoperative period can improve endoscopic vision, reduce bleeding, and decrease operation time in CRS patients with and without polyps undergoing ESS, but our sample size cannot exclude small, and possibly trivial, group differences.
Albu
Silviu
S
Second Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania. silviualbu63@gmail.com
Gocea
Anamaria
A
Mitre
Ileana
I
D000281:Administration, Intranasal; D000285:Administration, Rectal; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002908:Chronic Disease; D004311:Double-Blind Method; D004724:Endoscopy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D000068656:Mometasone Furoate; D009298:Nasal Polyps / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery*; D011244:Pregnadienediols / Q000008:administration & dosage* / Q000009:adverse effects; D011300:Preoperative Care; D012220:Rhinitis / Q000150:complications / Q000601:surgery; D012852:Sinusitis / Q000150:complications / Q000601:surgery
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011244:Pregnadienediols; D000068656:Mometasone Furoate