Impact of microdebrider in surgical treatment of nasal polyposis in terms of health related quality of life and objective findings: A comperative randomized single blinded clinical study

Amaç: Prospektif, randomize ve tek kör bir klinik çalışma ile toplam 97 hastadan oluşan iki grupta nazal polipozisin cerrahi tedavisinde mikrodebrider ve klasik enstrümanların karşılaştırılması. Metodlar: Üçüncü basamak referans merkezinde nazal polipozis nedeniyle cerrahi tedavi uygulanan 97 hasta randomize olarak iki grup halinde çalışmaya dahil edildi. SF-36 Genel sağlık düzeyi anketi yaşam kalitesi ölçütü olarak alınırken Lund-Mackay radyolojik ve endoskopik skorlaması ve akustik rinometri ile nazal volüm ölçümü objektif değerlendirmede kullanıldı. Sonuçlar operasyon öncesi ve postopeartif 6. ayda değerlendirildi. İstatistiksel değerlendirmede eşleştirilmiş t testi ve ANOVA testi kullanıldı. Bulgular: Klasik gruptaki radyolojik skorlama hariç her iki grupta objektif ve subjektif parametreler postoperatif olarak anlamlı iyileşme göstermiştir. Ancak iki grup arasında her iki tür parametre yönünden anlamlı fark oluşmamıştır. Majör komplikasyon izlenmemiştir. Sonuç: Mikrodebrider ve klasik cerrahi enstrümanlar arasında objektif ve subjektif parametreler yönünden farkının olmadığına işaret eden bu çalışma mikrodebrider ile doyurucu cerrahi sonuçlar, minimal mobidite ve artmış hasta ve cerrah konforu unsurlarını rapor eden literatürdeki önceki çalışmalara tamamlayıcı bir unsur oluşturmaktadır.

Mikrodebriderin nazal polipozisin cerrahi tedavisinde objektif bulgular ve yaşam kalitesi yönünden etkisi: Randomize ve tek kör klinik çalışma

Background: A prospective randomized single-blinded clinical study to compare the outcomes of a total of 97 patients in two groups with nasal polyposis treated surgically with traditional instruments and powered instruments. Methods: Prospective randomized single-blinded clinical study in a tertiary care center with 97 patients evaluated in two groups undergoing endoscopic sinus surgery for nasal polyposis. Medical Outcomes Study Short Form (SF-36)-general health status survey was used for quality of life assessment and Lund-Mackay radiologic and endoscopic scoring and acoustic rhinometric nasal volume measurements were used for objective evaluation between randomly allocated study and control groups in a single-blinded manner. The comparison was performed between the results preoperatively and 6-months postoperatively. Paired-t test was used for comparison of preoperative and postoperative results in each group. ANOVA test was used for inter-groups differences. Results: Endoscopic, tomographic and acoustic rhinometric findings and self reported health status survey scores were improved postoperatively in both groups. However, there was an exception in radiologic scores for the forceps group; there was not any statistically significant difference between the preoperative and postoperative radiologic scores for both sides. When two groups were compared postoperatively there was no statistically significant difference. Both techniques showed no major complications. Conclusion: Emphasizing on the identical results with objective and subjective outcomes measures between through cutting traditional instruments and microdebrider, this study stands as complementary to the previous papers stating satisfactory outcomes, minimal morbidities and improved surgeon and patient comfort with powered instruments in the treatment of nasal polyposis

Kaynakça

1) Setliff RC 3rd. The hummer: a remedy for apprehension in functional endoscopic sinus surgery. Otolaryngol Clin North Am 1996; 29(1): 95-104. [ Abstract ].

2) Gross WE. Soft-tissue shavers in functional endoscopic sinus surgery (Standard technique). Otolaryngol Clin North Am 1997; 30(3):435-441. [ Abstract ]

3) Christmas DA, Krouse JH. Powered instrumentation in functional endoscopic sinus surgery I: Surgical technique. Ear Nose Throat J 1996; 75(1): 33-6. [ Abstract ]

4) Bernstein JM, Lebowitz RA, Jacobs JB. Initial report on postoperative healing after endoscopic sinus surgery with the microdebrider. Otolaryngol Head Neck Surg 1998; 118(6):800-3. [ Abstract ]

5) Krouse JH, Christmas DA: Powered instrumentation in functional endoscopic sinus surgery. II: A comperative study. Ear Nose Throat J 1996; 75(1): 39-43. [ Abstract ]

6) McGarry GW, Gana P, Adamson B. The Effect of microdebriders on tissue for histological diagnosis. Clinical Otolaryngology 1999; 22: 375-376. [ Abstract ]

7) Zweig JL, Schaitkin BM, Fan CY, Barnes EL. Histopathology of tissue samples removed using the microdebrider technique: implications for endoscopic sinus surgery. Am J Rhinology 2000; 14(1): 27-32. [ Abstract ]

8) Leopold D, Ferguson JB, Piccirillo JF. Outcomes assessment. Otolaryngol Head Neck Surg 1997; 117(3): 58-68. [ Abstract ]

9) Rice DH. Endoscopic Sinus Surgery: Results at 2 -year follow-up. Otolaryngol Head Neck Surg 1989; 101: 476-9. [ Abstract ]

10) Lund VJ, Kennedy DW. Staging for rhinosinusitis. Otolaryngology-Head and Neck Surgery 1997; 117: 35-40. [ Abstract ]

11) Kennedy DW, Wright ED, Goldberg AN. Objective and subjective outcomes in surgery for chronic sinusitis. Laryngoscope 2000; 110(Suppl.94): 29-31. [ Abstract ]

12) Metson RB, Glicklich RE. Clinical outcomes in patients with chronic sinusitis. Laryngoscope 2000; 110(Suppl.94): 24-28. [ Abstract ]

13) Selivanova O, Kuehnemund M, Mann WJ, Amedee RG. Comparison of conventional instruments and mechanical debriders for surgery of patients with chronic sinusitis. Am J Rhinology 2003; 17(4): 197-202. [ Abstract ]

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