There are different postsurgical medical treatments to improve the results of DCR. These include topical ocular antibiotics and steroids, topical nasal antibiotics and steroids, nasal vasoconstrictors, and oral antibiotics. However, there is no definitive data demonstrating that these treatments are actually effective. In addition, some studies recommend local antifibrinogenic and anti-inflammatory treatments such as 5-fluorouracil and mitomycin-C[14, 15]. However, a standard postoperative treatment protocol has not been established. On the other hand, although steroids are generally included in postoperative treatment due to their anti-inflammatory effects, there are very few studies on the use of steroids.
Corticosteroids are known to suppress inflammation and fibroblast formation and reduce scarring. Steroids have been shown to have positive effects on wound healing after nasal sinus surgery. It has been demonstrated that the use of oral steroids before and after nasal polypectomy and the use of triamcinolone-impregnated nasal packs after endoscopic sinus surgery can reduce nasal mucosal inflammation [16, 4]. Another study showed that the use of triamcinolone-impregnated nasal packs in endoscopic sinus surgery provides a significant reduction in the incidence of complications such as mucosal edema and crusting . A similar effect was observed in EDCR. There are a few studies evaluating the effect of steroid use in EDCR. Kang et al. found that the functional success rate was significantly higher in the group in which triamcinolone-impregnated nasal pack was used in EDCR compared to the control group (p = 0.033). The use of triamcinolone was shown to be effective in reducing the incidence of postoperative granulation and epiphora . Ali et al. showed that nasal steroid spray reduced granulation in 43 of 47 patients with granulation after DCR . Further, Jo et al. performed intralesional steroid injection treatment on 65 patients who developed granulation after EDCR and observed regression in all the patients . In the present study, anatomical success (95.7%, 84.0%, respectively) and functional success (91.3%, 76.0%, respectively) were higher in the triamcinolone group compared to the control group. However, the differences were not statistically significant.
There may be many reasons for granulation formation, which is one of the causes of failure after DCR. One of these reasons is believed to be immune response induced by silicone intubation . In the present study, to prevent such a possible reaction, we preferred the use of triamcinolone nasal steroid spray until the 3rd month, when the silicone tubes were removed. Whereas no complications were observed in the triamcinolone group, we observed inflammation due to silicone tube in one patient and intranasal synechiae in another patient in the control group (0.0% and 8.0%, respectively).
While evaluating the success of the surgery after DCR, anatomical and functional successes are generally emphasized. Anatomical success is defined as the presence of a patent ostium, and functional success is defined as the recovery of epiphora [7, 8]. Another evaluation method focuses on the patient's perception of benefit and improvement of symptoms after surgery. Recently, the use of patient-reported outcome measures has gained importance. The Lac-Q questionnaire, which was developed by Mistry et al., allows the evaluation of lacrimal symptomatology such as epiphora, sticky eye, pain, and swelling, as well as social impact of the disease and the effect on quality of life . The validity and reliability of this method have been demonstrated in several studies. Ali et al. conducted a study on 55 patients who underwent augmented DCR, in which preoperative and postoperative Lac-Q questionnaire survey was performed. The change in the Lac-Q score and anatomical and functional success were analyzed, and the authors found that postoperative scores correlated well with anatomical and functional success rates . In another study comparing external and endoscopic DCR, the Lac-Q questionnaire was applied to 59 patients preoperatively and at the postoperative 4th week, 3rd month, and 6th month. The changes in social impact, lacrimal symptomology, and total scores were compared between the two treatment groups. Preoperative and postoperative differences in total Lac-Q scores, lacrimal symptom scores, and social impact scores were significantly different between endoscopic and external DCR groups (p = 0.008, p = 0.004, and p = 0.040, respectively). In this study, the authors showed that Lac-Q is sensitive enough to highlight the magnitude of the change in lacrimal symptoms and social impact . In the present study, the total Lac-Q score and social impact score were significantly higher in the triamcinolone group, which also showed higher anatomical and functional success compared to the control group (p = 0.011 and p = 0.005, respectively). There was no statistically significant difference in the lacrimal symptom score.
The limitations of the present study include the small number of cases, the lack of long-term postoperative follow-up data, and the absence of placebo application in the control group. In addition, we evaluated the anatomical and functional outcomes and the effects of surgery on quality of life at the postoperative 6th month. Examination data from the earlier period and the 3rd month when the silicone tubes were removed were not available and could not be shared in the present study.
In conclusion, we demonstrated that the use of topical nasal triamcinolone spray after EDCR is effective in reducing the incidence of postoperative complications. In addition, positive results were obtained in the questionnaires evaluating the social impact and lacrimal symptomatology of the disease. There is a need for prospective, randomized, placebo-controlled studies on this subject with a larger number of patients.