Benefit of Antibiotic Nasal Irrigations after Surgical Resection of Inverted Papilloma

Objective: Inverted papilloma (IP) is a benign tumor that originates in the sinonasal tract and is often locally aggressive. Treatment of IP consists of surgical resection with endoscopic sinus surgery (ESS). Infection represents a potential postoperative complication that is prophylactically managed with systemic antibiotics. The goal of this study is to determine if the addition of antibiotic nasal irrigations to the medical regimen will improve patient quality of life, as measured by the Sinonasal Outcome Test (SNOT 22).

Methods: A retrospective chart review was conducted of patients who underwent ESS for IP at a tertiary care center between 2012 and 2019. Patients who met inclusion criteria were divided into two cohorts: (1) control arm receiving postoperative systemic antibiotics with saline nasal irrigations and (2) treatment arm receiving both postoperative systemic antibiotics and topical antibiotic nasal irrigations. Preoperative SNOT 22 scores were recorded for patients, along with scores at 1-, 3-, 6-, 12-, and 18-month postoperative time points. A Student's t-test was used to compare SNOT 22 scores between the two cohorts at all time points. A p-value of 0.05 was considered statistically significant.

Results: There were 132 patients who met inclusion criteria (70 control arm, 62 treatment arm). There was no significant difference in SNOT 22 score between the two cohorts at the preoperative time point (p = 0.671). On the other hand, patients in the treatment arm who received both systemic and topical postoperative antibiotics had significantly lower SNOT 22 scores at all postoperative time points (1 month, p = 0.00; 3 month, p = 0.007; 6 month, p = 0.027; 12 month, p = 0.021; 18 month, p = 0.009; [Fig. 1]).

Conclusion: Utilization of antibiotic nasal irrigations in conjunction with systemic antibiotics after surgical resection of IP was observed to improve patient quality of life, as measured by the SNOT 22. These findings suggest that antibiotic nasal irrigations may aid in postoperative management after IP resection. This may be related to the treatment of the exposed bone in the sinonasal cavity with topical antibiotics. Antibiotic nasal irrigations should be considered for patients undergoing surgery for resection of IP.

Fig. 1 Outcomes after resection of inverted papilloma with and without postoperative antibiotic (abx) nasal irrigations. Patients were separated into two cohorts based on if they were prescribed postoperative antibiotic nasal irrigations (abx+) or if they were not (abx−). The Sinonasal Outcome Test (SNOT 22) was measured at the preoperatively (preop) and subsequent follow-up visits at the 1 month postoperative (1 mo), 3 months postoperative (3 mo), 6 months postoperative (6 mo), 12 months postoperative (12 mo), and 18 months (18 mo) postoperative time points.

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Artikel online veröffentlicht:
15. Februar 2022