Postoperative Efficacy Of Different Glucocorticoids Applied Locally Under Nasal Endoscopy In Patients With Chronic Rhinosinusitis With Nasal Polyps

Objective: We compared the therapeutic effect of dexamethasone and triamcinolone acetonide on patients with chronic rhinosinusitis with nasal polyps(CRSw NP)after functional endoscopic sinus surgery(FESS),in order to explore the clinical efficacy of triamcinolone acetonide gelatin sponge combined with endoscopic sinus surgery in the treatment of CRSw NP.Methods: 60 patients with CRSw NP were recruited from Department of Otolaryngology Head and neck surgery of Affiliated Hospital of Guilin Medical College from October 2019 to July 2020,and randomly divided into three groups after FESS(group A,group B and group C).Group A: filled the middle nasal canal with gelatin sponge containing sterilization water;In group B,gelatin sponge containing dexamethasone was used to fill the middle nasal meatus;In group C,the middle meatus was filled with gelatin sponge containing triamcinolone acetonide.All patients were followed up regularly(1 to 2 weeks within 1 month after operation and then once a month)and dispose of in accordance with the above group scheme.The follow-up information included: 1.Visual analog scale(VAS)scores of nasal congestion,headache,hypoolfaction and runny nose in three groups at 3 months after FESS;2.The first,third and sixth month after operation were examined under nasal endoscope;3.Six months after operation,the patient had CT scan of nasal sinus.Lund Kennedy and Lund Mackay were used to evaluate the nasal sinuses quantitatively.Results: 1.There was no statistical difference between the clinical data of the three groups in terms of gender and age(P > 0.05).2.There was no significant difference in VAS scores of nasal obstruction,runny nose,hypoolfaction and headache among the three groups before operation(P > 0.05);There was no significant difference in Lund Kennedy endoscopic score and Lund Mackay sinus CT score among the three groups before operation(P> 0.05).3.All three groups showed significant improvement in subjective symptoms at 3 months postoperatively compared to preoperatively.There were significant differences in VAS scores of nasal congestion,headache,hypoolfaction and runny nose among the three groups(P< 0.01).The improvement of nasal symptoms in group B and C was significantly better than that in group A(P < 0.01);Except for headache,there was no significant difference between group B and group C(P=0.08),the improvement of other three nasal symptoms in group C was better than that in group B(P<0.05).4.In terms of the Lund-Kennedy nasal endoscopy score,the three groups of patients had a significant decrease after surgery compared with preoperative.There were significant statistical differences in Lund-Kennedy nasal endoscopy scores in the three groups at 1 month,3 months,and 6 months after surgery(P<0.01).One month after operation,the Lund-Kennedy nasal endoscopy scores of patients in groups B and C were significantly lower than those of group A(P<0.01),while the difference in nasal endoscopy scores of patients in groups B and C was not statistically significant(P=0.091);At three months postoperatively,the nasal endoscopy scores of patients in groups B and C were significantly lower than those of group A(P<0.01),and the nasal endoscopy scores of patients in group C were lower than those of group B(P<0.05);Six months after surgery,the nasal endoscopy scores of patients in group B and C were significantly lower than those of group A(P<0.01),while the nasal endoscopy scores of patients in group C were lower than those of group B(P<0.05).5.The three groups of patients had reexamination of sinus CT at 6months after operation,the Lund-Mackay sinus CT scores were lower than those before operation,and the difference was statistically significant(P<0.05).There were significant statistical differences in the CT scores of the three groups of patients’ sinuses at 6 months after surgery(P<0.01).The Lund-Mackay sinus CT score of group B patients was lower than that of group A(P<0.05),and the Lund-Mackay sinus CT score of group C patients was lower than that of group B(P<0.05)and significantly lower than group A(P<0.01).Conclusion:Combined with the above studies,we found that local application of glucocorticoid on CRSw NP patients after FESS is beneficial to nasal mucosa recovery,reduce local edema,reduce polyp recurrence and promote the recovery of nasal mucosa.In addition,we observed that compared with dexamethasone,triamcinolone acetonide,as a long-acting adrenocortical hormone,may have better clinical effect on the late recovery of CRSw NP patients after FESS.