Umfrage zum Einsatz von Nasentamponaden in der sinunasalen Chirurgie

Zusammenfassung

Hintergrund Die Ambulantisierung rhinochirurgischer Eingriffe wird derzeit intensiv diskutiert und insbesondere von politischer Seite stark propagiert. Viele Fragen zur Stratifizierung in ambulante oder stationäre Durchführung sind unklar. Insbesondere ist das Vorgehen bei Anwendung von Nasentamponaden bisher nicht ausreichend diskutiert.

Material und Methoden Deutschlandweite Umfrage unter niedergelassenen und in Kliniken tätigen Hals-, Nasen-, Ohrenärzten zur Verwendung von Nasentamponaden in der Rhinochirurgie und zum Auftreten von Komplikationen in Zusammenhang mit einer Tamponade.

Ergebnisse 85,6% der Antwortenden verwenden eine Nasentamponade zumindest manchmal bei der Chirurgie von Septum und Nasenmuscheln/lateraler Nasenwand, 44,2% grundsätzlich. Bei der Nasennebenhöhlenchirurgie sind dies 94,1% bzw. 49% der Antwortenden. Überwiegend wurde die Anwendung von sich nicht auflösenden Tamponaden angegeben. Die am häufigsten beobachteten Komplikationen waren eine Blutung unter liegender Nasentamponade (>50% der Antwortenden) und eine Dislokation nach dorsal (24% der Antwortenden), die ein notfallmäßiges Eingreifen erforderte. Eine Todesfolge wurde bei 5 Patienten beschrieben. Ein Patient erlitt eine dauerhafte Hirnschädigung nach Hypoxie.

Schlussfolgerungen Die Anwendung einer sich nicht auflösenden Nasentamponade mit Okklusion der Nasenhaupthöhle kann zu einer relevanten Gefährdung der Patienten führen, die ein notfallmäßiges Eingreifen erforderlich macht und deshalb die stationäre Überwachung erfordert.

Abstract

Objective Currently, there is an intensive discussion about enhancing and expanding outpatient rhinosurgical procedures. Many questions about how to stratify into out- and inpatient procedures are still not sufficiently clarified. Particularly, the use of nasal packing materials is not adequately discussed.

Material and Methods We performed a Germany-wide survey among otorhinolaryngologists regarding the use of nasal packing materials in sinonasal surgery. Additionally, we asked for any complication in relation to nasal packing.

Results In 85,6% nasal packing was used for septal and turbinate surgery at least occasionally, in 44,2% always. In sinus surgery these numbers are 94,1% and 49%, respectively. Non-resorbable nasal packing materials were predominantly used.

Most frequent complications were bleeding with nasal packing in situ (> 50% of respondents) and posterior dislocation (24% of respondents), requiring emergency treatment. Death was listed in 5 patients. One patient suffered from permanent brain damage due to hypoxia.

Conclusions Application of non-resorbable nasal packing materials with occlusion of the nasal cavity carry a substantial risk of complications, which necessitate emergency treatment, thus requiring inpatient care.

Schlüsselwörter

Rhinochirurgie - Septumplastik - Nasennebenhöhlenoperation - Nasentamponade - Komplikationen - Blutung - Aspiration

Keywords

Sinunasal surgery - FESS - nasal packing - complications - postoperative bleeding - aspiration

Publication History

Received: 22 June 2024

Accepted: 23 June 2024

Article published online:
30 September 2024

• Literatur

• 1 Weber RK. Nasal packing after FESS-time is over?. Laryngorhinootologie 2009; 88: 379-384 DOI: 10.1055/s-0029-1220765. (PMID: 19504407)
• 2 Weber RK. Nasal packing and stenting. Laryngorhinootologie 2009; 88 (Suppl. 01) S139-155 DOI: 10.1055/s-0028-1119504. (PMID: 22073095)
• 3 McMahon I, Weber R. Epistaxis – Banalität oder lebensbedrohliche Erkrankung? Retrospektive Studie mit 25 Patienten, die lebensbedrohliche Komplikationen einer Epistaxis erlitten. 86 Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde 2015: Kopf und Hals DOI: 10.3205/15HNOD612.
• 4 Weber RK, Sommer F, Heppt W. et al. Grundlagen und Praxis der Anwendung von Nasentamponaden in der endonasalen Chirurgie. HNO 2024; 72: 3-15 DOI: 10.1007/s00106-023-01369-9.
• 5 Orlandi RR, Lanza DC. Is nasal packing necessary following endoscopic sinus surgery?. Laryngoscope 2004; 114: 1541-1544 DOI: 10.1097/00005537-200409000-00007. (PMID: 15475778)
• 6 Kastl KG, Betz CS, Siedek V. et al. Control of bleeding following functional endoscopic sinus surgery using carboxy-methylated cellulose packing. Eur Arch Otorhinolaryngol 2009; 266: 1239-1243 DOI: 10.1007/s00405-008-0881-8. (PMID: 19082836)
• 7 Kastl KG, Betz CS, Siedek V. et al. Effect of carboxymethylcellulose nasal packing on wound healing after functional endoscopic sinus surgery. Am J Rhinol Allergy 2009; 23: 80-84 DOI: 10.2500/ajra.2009.23.3267. (PMID: 19379618)
• 8 Kastl KG, Reichert M, Scheithauer MO. et al. Patient comfort following FESS and Nasopore packing, a double blind, prospective, randomized trial. Rhinology 2014; 52: 60-65 DOI: 10.4193/Rhino13.020. (PMID: 24618630)
• 9 Leunig A, Betz CS, Siedek V. et al. CMC packing in functional endoscopic sinus surgery: does it affect patient comfort?. Rhinology 2009; 47: 36-40
• 10 Eliashar R, Gross M, Wohlgelernter J. et al. Packing in endoscopic sinus surgery: is it really required?. Otolaryngol Head Neck Surg 2006; 134: 276-279 DOI: 10.1016/j.otohns.2005.10.012.
• 11 Mo J-H, Han DH, Shin H-W. et al. No packing versus packing after endoscopic sinus surgery: pursuit of patients’ comfort after surgery. Am J Rhinol 2008; 22: 525-528 DOI: 10.2500/ajr.2008.22.3218. (PMID: 18954514)
• 12 Chandra RK, Kern RC. Advantages and disadvantages of topical packing in endoscopic sinus surgery. Current Opinion in Otolaryngology & Head and Neck Surgery 2004; 12: 21-26 DOI: 10.1097/00020840-200402000-00007. (PMID: 14712115)
• 13 Weber RK. Comprehensive review on endonasal endoscopic sinus surgery. Laryngorhinootologie 2015; 94 (Suppl. 01) S64-S142 DOI: 10.1055/s-0035-1545353. (PMID: 26770282)
• 14 Weber R, Hochapfel F, Leuwer R. et al. Tampons and place holders in endonasal surgery. HNO 2000; 48: 240-256 DOI: 10.1007/s001060050041. (PMID: 10768119)
• 15 Baumbach P, Dreiling J, Arnold C. et al. Pain after outpatient surgical procedures – a survey of 330 000 patients. Deutsches Ärzteblatt international 2024; DOI: 10.3238/arztebl.m2023.0235.
• 16 Belleudy S, Kérimian M, Legrenzi P. et al. Assessment of quality and safety in rhinologic day surgery. European Annals of Otorhinolaryngology, Head and Neck Diseases 2021; 138: 129-134 DOI: 10.1016/j.anorl.2020.06.019.
• 17 Bhattacharyya N. Ambulatory sinus and nasal surgery in the United States: Demographics and perioperative outcomes. The Laryngoscope 2010; 120: 635-638 DOI: 10.1002/lary.20777. (PMID: 20058315)
• 18 Bhattacharyya N. Unplanned revisits and readmissions after ambulatory sinonasal surgery: Unplanned Revisits after Sinonasal Surgery. The Laryngoscope 2014; 124: 1983-1987 DOI: 10.1002/lary.24584. (PMID: 24390859)
• 19 Eisenberg G, Pérez C, Hernando M. et al. Nasosinusal endoscopic surgery as major out-patient surgery. Acta Otorrinolaringol Esp 2008; 59: 57-61 (PMID: 18341861)
• 20 Ganesan S, Prior AJ, Rubin JS. Unexpected overnight admissions following day-case surgery: an analysis of a dedicated ENT day care unit. Ann R Coll Surg Engl 2000; 82: 327-330 (PMID: 11041031)
• 21 Gengler I, Carpentier L, Pasquesoone X. et al. Predictors of unanticipated admission within 30 days of outpatient sinonasal surgery. Rhinology 2017; 55: 274-280 DOI: 10.4193/Rhino16.251.
• 22 Georgalas C, Obholzer R, Martinez-Devesa P. et al. Day-case septoplasty and unexpected re-admissions at a dedicated day-case unit: a 4-year audit. Ann R Coll Surg Engl 2006; 88: 202-206 DOI: 10.1308/003588406X95039. (PMID: 16551420)
• 23 Kérimian M, Bastier P-L, Réville N. et al. Feasibility study of bilateral radical ethmoidectomy in ambulatory surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135: 377-382 DOI: 10.1016/j.anorl.2018.08.002. (PMID: 30126729)
• 24 Lecanu J-B, Pages L, Lazard D. et al. Outpatient bilateral ethmoidectomy in a private non-profit structure: Retrospective study of 204 patients. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139: 13-16 DOI: 10.1016/j.anorl.2021.05.003. (PMID: 34083168)
• 25 Lee JT, DelGaudio J, Orlandi RR. Practice Patterns in Office-Based Rhinology: Survey of the American Rhinologic Society. Am J Rhinol Allergy 2019; 33: 26-35 DOI: 10.1177/1945892418804904. (PMID: 30306790)
• 26 Menezes AS, Guimarães JR, Breda M. et al. Septal and turbinate surgery: is overnight essential?. Eur Arch Otorhinolaryngol 2018; 275: 131-138 DOI: 10.1007/s00405-017-4813-3. (PMID: 29159751)
• 27 Oker N, Dupuch V, Herman P. et al. Outcomes of endoscopic ethmoidectomy performed on a day-case basis: a prospective bi-centric study. Eur Arch Otorhinolaryngol 2017; 274: 305-310 DOI: 10.1007/s00405-016-4263-3. (PMID: 27535844)
• 28 Scott JR, Sowerby LJ, Rotenberg BW. Office-based rhinologic surgery: A modern experience with operative techniques under local anesthetic. Am J Rhinol Allergy 2017; 31: 135-138 DOI: 10.2500/ajra.2017.31.4414. (PMID: 28452711)
• 29 Schuldt T, Ovari A, Guder E. et al. Inpatient vs. outpatient costs analysis of septumplasty in Germany. Laryngorhinootologie 2015; 94: 18-24 DOI: 10.1055/s-0034-1377006. (PMID: 25111448)
• 30 Tewfik MA, Frenkiel S, Gasparrini R. et al. Factors affecting unanticipated hospital admission following otolaryngologic day surgery. J Otolaryngol 2006; 35: 235-241 DOI: 10.2310/7070.2006.0018. (PMID: 17176798)
• 31 Buchberger AMS, Baumann A, Johnson F. et al. The role of oral anticoagulants in epistaxis. Eur Arch Otorhinolaryngol 2018; 275: 2035-2043 DOI: 10.1007/s00405-018-5043-z. (PMID: 29936627)
• 32 Kallenbach M, Dittberner A, Boeger D. et al. Hospitalization for epistaxis: a population-based healthcare research study in Thuringia, Germany. Eur Arch Otorhinolaryngol 2020; 277: 1659-1666 DOI: 10.1007/s00405-020-05875-2. (PMID: 32124006)
• 33 Ketterer MC, Reuter TC, Knopf A. et al. Risk profile analysis of stationary epistaxis patients. Laryngorhinootologie 2022; 101: 120-126 DOI: 10.1055/a-1342-0090. (PMID: 33461228)
• 34 Varga D, Pfeiffer J, Laszig R. et al. Epidemiologie und Therapie der Epistaxis. Das Freiburger Patientengut. 86 Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde 2015: Kopfund Hals DOI: 10.3205/15HNOD634.
• 35 Send T, Bertlich M, Horlbeck F. et al. Management and outcome of epistaxis under direct oral anticoagulants: a comparison with warfarin. Int Forum Allergy Rhinol 2019; 9: 120-124 DOI: 10.1002/alr.22210.
• 36 Fitzpatrick MF, McLean H, Urton AM. et al. Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 2003; 22: 827-832 DOI: 10.1183/09031936.03.00047903. (PMID: 14621092)
• 37 Johannessen N, Jensen PF, Kristensen S. et al. Nasal packing and nocturnal oxygen desaturation. Acta Otolaryngol Suppl 1992; 492: 6-8 DOI: 10.3109/00016489209136799. (PMID: 1632254)
• 38 Regli A, von Ungern-Sternberg BS, Strobel WM. et al. The impact of postoperative nasal packing on sleep-disordered breathing and nocturnal oxygen saturation in patients with obstructive sleep apnea syndrome. Anesth Analg 2006; 102: 615-620 DOI: 10.1213/01.ane.0000184814.57285.5b.
• 39 Suratt PM, Turner BL, Wilhoit SC. Effect of intranasal obstruction on breathing during sleep. Chest 1986; 90: 324-329 DOI: 10.1378/chest.90.3.324. (PMID: 3743143)
• 40 Turhan M, Bostancı A, Akdag M. et al. A comparison of the effects of packing or transseptal suture on polysomnographic parameters in septoplasty. Eur Arch Otorhinolaryngol 2013; 270: 1339-1344 DOI: 10.1007/s00405-012-2199-9. (PMID: 23053381)
• 41 Friedman M, Maley A, Kelley K. et al. Impact of Nasal Obstruction on Obstructive Sleep Apnea. Otolaryngol--head neck surg 2011; 144: 1000-1004 DOI: 10.1177/0194599811400977. (PMID: 21493302)
• 42 Suzuki M, Kawai K, Kawai Y. et al. Preoperative apnea-hypopnea index predicts increased postoperative intrathoracic pressure during sleep in patients who underwent endoscopic nasal surgery. Auris Nasus Larynx 2022; 49: 805-809 DOI: 10.1016/j.anl.2022.02.001.
• 43 Armengot M, Hernandez R, Miguel P. et al. Effect of Total Nasal Obstruction on Nocturnal Oxygen Saturation. American Journal of Rhinology 2008; 22: 325-328 DOI: 10.2500/ajr.2008.22.3175. (PMID: 18588768)
• 44 Beule AG, Weber RK, Kaftan H. et al. Übersicht: Art und Wirkung geläufiger Nasentamponaden. Laryngorhinootologie 2004; 83: 534-551 DOI: 10.1055/s-2004-825695.
• 45 Guan S, Zhao T, Ye J. et al. Influence of bilateral nasal packing on sleep oxygen saturation after general anesthesia: A prospective cohort study. Front Surg 2023; 10: 1083961 DOI: 10.3389/fsurg.2023.1083961. (PMID: 36793309)
• 46 Koudounarakis E, Chatzakis N, Papadakis I. et al. Nasal packing aspiration in a patient with Alzheimer’s disease: a rare complication. Int J Gen Med 2012; 5: 643-645 DOI: 10.2147/IJGM.S34676.
• 47 Novoa E, Junge H. Nasal packing: When a routine practice becomes a life-threatening emergency. Clin Case Rep 2020; 8: 2638-2640 DOI: 10.1002/ccr3.3241.
• 48 Smith J, Reddy E. Aspiration of Nasopore nasal packing. BMJ Case Rep 2017; 2017 DOI: 10.1136/bcr-2017-221969. (PMID: 28978608)
• 49 Hopkins C, Browne J, Slack R. et al. Variation in day-case nasal surgery – why cannot we improve our day-case rates?. Clin Otolaryngol 2007; 32: 12-18 DOI: 10.1111/j.1365-2273.2007.01368.x. (PMID: 17298304)