Blood loss and haematological consequences related to nasal surgery

Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study

BACKGROUND

Bleeding is a major concern in endoscopic sinus surgery (ESS), as it may impede surgical progress and is often associated with complications. To improve the study and management of intraoperative bleeding, a standardized method of recording bleeding during ESS is needed. The aim of this study was to develop a standardized method of documenting bleeding in ESS and of grading the surgical field.

METHODS

Bleeding after endoscopic sinus surgery was recorded using video-endoscopy. Standardized and non-standardized video-endoscopies of 20 patients were graded using a previously published grading scale (the Boezaart scale) in randomized order on two different occasions. Effects of standardization on intra- and interrater reliability were evaluated.Based on this experience, a new 11-point surgical field grading scale was developed and simultaneously compared with the six-point Boezaart scale via means of a DVD in three international centers.

RESULTS

Inter and intrarater reliability of the Boezaart and new Wormald scales significantly improved by employing a standardized video-endoscopy technique. The Wormald scale had significantly higher interrater (0.80 vs. 0.74, P < .001) and intrarater (0.89 vs. 0.83, P < .001) reliability than the Boezaart scale. Linear regression analysis revealed the Wormald scale to be more sensitive to changes in the most common surgical fields experienced in ESS.

CONCLUSION

Standardized video-endoscopy has been demonstrated to significantly improve reliability and reproducibility of results and is recommended for future work evaluating bleeding in ESS. The new Wormald grading scale has been shown to be an inexpensive, reliable, and sensitive tool to rapidly evaluate intraoperative bleeding in ESS. It overcomes several limitations of the Boezaart scale, enabling us to analyze currently employed and newly developed hemostatic methods and agents.

Topical furosemide versus oral steroid in preoperative management of nasal polyposis

The efficacy of topical nasal furosemide treatment has been shown in the protection of nasal polyp recurrence. The aim of the study was to compare the effect of oral steroid, as standard preoperative treatment, and inhaled furosemide, as alternative treatment, for 7 days preoperatively in terms of subjective improvement of nasal symptoms, polyp size reduction, inflammation in the polyp tissue, and intraoperative blood loss. A group of 40 patients with nasal polyposis entered the study and they were randomly allocated to 7-day preoperative treatment with either oral methylprednisolon (1 mg/kg/day) or topical furosemide by inhalation (6.6 mmol/l solution). Subjective scores of rhinosinusitis symptoms, polyp scores at endoscopy, and biopsy of the most superficial polyp were taken at inclusion. All procedures were repeated on day 7. Intraoperative blood loss was estimated (scores 0-10) by the surgeon at the operation. Eosinophils, mastocytes, and oedema were quantified by histomorphometry. Subjective symptoms and endoscopy scores did not differ significantly between the groups after the treatment although improvement of olfaction was insignificantly better in the steroid group. Steroid treatment significantly reduced eosinophil count, with no effect on mastocytes and oedema. Furosemide treatment did not affect inflammatory cells count significantly, but it has significantly reduced oedema in previously unoperated patients. No difference in intraoperative bleeding was observed between the groups.

Screening and prevention of hearing loss in children

Congenital hearing loss is the most common neurosensory handicap in neonates. Recently, technology has become available that has allowed states to implement universal screening programs at a relatively low cost and with minimal expertise needed for hospital personnel to operate the screening machines. In successful programs, the age of diagnosis has been reduced from 2(1/2) years to 3 to 6 months. Children diagnosed with hearing loss before speech develops have been shown to have better speech and language outcomes than those who are diagnosed later. Strategies for screening and early intervention are discussed, as well as the causes, prevention, and treatment of more common forms of childhood hearing loss.