Efficacy of targeted middle meatal antibiotics and endoscopic sinus surgery.

Background: Postoperative infection remains a significant comorbidity of endoscopic sinus surgery (ESS) delayed healing, synechia formation, etc. The objective of this study was to compare the incidence of postoperative infection after ESS in patients receiving conventional postoperative oral antibiotic prophylaxis versus a synthetic bioabsorbable antibiotic–soaked nasal sponge used in the middle meatus (MM) in lieu of oral antibiotics. Methods: A prospective randomized multicenter trial included 321 chronic rhinosinusitis patients undergoing minimally invasive ESS who received either 1 week of oral antibiotics and a saline-soaked bioabsorbable MM sponge (control group) or no oral antibiotics and the placement of a bacitracin-soaked bioabsorbable sponge in the MM (study group). Evaluations performed at baseline, 3-weeks, and 3-months postoperatively included the 20-item Sino-Nasal Outcome Test and nasal endoscopic examination. Results: The 3-week postoperative infection rate was not significantly different between the study (n 165) and control groups (n 156): 5.4% versus 3.8%; p 0.05. In addition, there was no significant difference between the two patient groups on evaluation of MM granulations, synechia, middle turbinate lateralization, or sponge retention. Conclusion: Antibiotic-soaked synthetic bioabsorbable MM sponges show equivalent efficacy in controlling post ESS infections compared with conventional postoperative oral antibiotics. Topical antibiotic delivery to the MM via bioabsorbable sponges may reduce the need for postoperative systemic antibiotics and provide a cost-effective alternative that eliminates the issues of antibiotic side effects, drug–drug interactions, and medication complianc ei n the postoperative setting. (Am J Rhinol Allergy 27, 329–332, 2013; doi: 10.2500/ajra.2013.27.3900) E ndoscopic sinus surgery (ESS) is a commonly performed surgical procedure in otolaryngology. Although early reports described a complication rate of 29%,1 more recent evaluations of patients with chronic rhinosinusitis (CRS) who underwent ESS have reported a major complication rate of 1% and minor complication rate of 6.6%.2,3 Experience, advancements in technology, and improved safety measures continue to help reduce the morbidity associated with ESS. Prior assessments of the minor complications after ESS have identified bleeding, synechia, and breach of the lamina papyracea; however, no prospective evaluation has identified the rate of postoperative infection. Evidence-based studies have given merit to the use of postoperative oral antibiotics after ESS 4,5 ; however, antibiotic duration, rates of intolerance, and noncompliance remain unresolved issues. During the past 10 years, multiple middle meatal stents and dressings have been introduced and initially were found to drastically reduce the rate of postoperative scarring and middle turbinate lateralization. 6 Early stents required postoperative removal and were associated with significant patient discomfort. Advancements in bioabsorbable middle meatus (MM) sponge technology have established the safety of polyurethane sponge dressings for patients undergoing rhinologic surgery.7 The goal of this study was to compare the incidence of postoperative infection after ESS in patients receiving conventional postoperative oral antibiotics versus a synthetic bioabsorbable antibiotic–soaked MM sponge.