title: Systemic effects and safety of triamcinolone-impregnated nasal packing after endoscopic sinus surgery: a randomized, double-blinded, placebo-controlled study.
abstract: BACKGROUND
  Steroid-infused absorbable nasal dressings after endoscopic sinus surgery (ESS) have been used to improve wound healing and to reduce the recurrence of polyps. However, their systemic effects are not well known. The purpose of this study was to evaluate the systemic effects and safety of steroid-impregnated absorbable nasal packing after ESS.
  
  
  METHODS
  Patients who underwent bilateral ESS for chronic rhinosinusitis were recruited and randomized into two groups. Ten patients in the triamcinolone (TA) group received a TA (20 mg)-soaked bioabsorbable dressing in both nasal cavities while 10 patients in the control group took saline-impregnated dressing in both nasal cavities. Nasal dressings were not removed until postoperative day 10. Serum cortisol, 12-hour urine cortisol, serum adrenal-corticotropic hormone (ACTH), and serum osteocalcin were measured preoperatively and on postoperative days 2 and 10. Serum cortisol levels were checked 1 day after surgery additionally, while urine cortisol levels were not checked at postoperative day 10.
  
  
  RESULTS
  All 20 patients completed this study. The serum cortisol levels were significantly suppressed at postoperative days 1 and 2 in the TA group. Serum ACTH and 12-hour urine cortisol levels were lower 2 days after surgery in the TA group, although these changes were not statistically significant. There were no differences in all other parameters between the TA and control groups on postoperative day 10.
  
  
  CONCLUSIONS
  TA-impregnated nasal dressings suppress serum cortisol levels during the early postoperative period. This systemic effect was recovered gradually and normalized 10 days after the operation.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sang Duk
authors.initials: SD
authors.lastname: Hong
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Hun-Jong
authors.initials: HJ
authors.lastname: Dhong
authors.forename: Hyo Yeol
authors.initials: HY
authors.lastname: Kim
authors.forename: Seung-Kyu
authors.initials: SK
authors.lastname: Chung
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Chang
authors.forename: Jung Heob
authors.initials: JH
authors.lastname: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D001458:Bandages; D001672:Biocompatible Materials; D002908:Chronic Disease; D004311:Double-Blind Method; D004724:Endoscopy; D004844:Epistaxis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000187:drug effects / Q000601:surgery*; D011182:Postoperative Care; D012220:Rhinitis / Q000601:surgery / Q000628:therapy*; D012852:Sinusitis / Q000601:surgery / Q000628:therapy*; D014221:Triamcinolone / Q000008:administration & dosage / Q000009:adverse effects; D014945:Wound Healing; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D001672:Biocompatible Materials; D014221:Triamcinolone; D006854:Hydrocortisone