Ayoub Noel, Chitsuthipakorn Wirach, Nayak Jayakar V, Patel Zara M, Hwang Peter H
Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.
Laryngoscope. 2018 Jun;128(6):1268-1273. doi: 10.1002/lary.26907. Epub 2017 Oct 25.
Patients frequently are advised to abstain from nose blowing following endoscopic sinus surgery (ESS), despite a lack of evidence supporting this recommendation. This randomized study assessed whether nose blowing in the first postoperative week affects subjective and objective clinical outcomes.
Forty patients undergoing ESS were randomized into an interventional arm in which patients blew their nose at least twice daily for the first 7 postoperative days, or a control arm in which patients refrained from nose blowing. All patients were allowed to blow their nose after 7 days. The frequency and degree of epistaxis was documented by daily diary and visual analog scale (VAS). At 1 and 4 weeks postoperatively, Nasal Obstruction Symptom Evaluation (NOSE) and Sino-Nasal Outcome Test-22 (SNOT-22) were collected, and endoscopies were recorded for blinded Lund-Kennedy scale scoring.
There were no differences between the two groups in terms of frequency and duration of bleeding events, VAS epistaxis scores, SNOT-22 scores, and NOSE scores at every postoperative timepoint. Lund-Kennedy scores also were similar at the 1-week (P = 0.0762) and 4-week (P = 0.2340) postoperative visits, but the nose-blowing group had improved nasal discharge subscores at the first (P = 0.0075) and second (P = 0.0298) postoperative visits.
Nose blowing after ESS does not appear to measurably improve symptoms of nasal congestion or general sinonasal quality of life, nor does it seem to adversely affect the frequency or severity of postoperative epistaxis during the first postoperative week. Judicious nose blowing may be permissible immediately after uncomplicated ESS.
1b. Laryngoscope, 128:1268-1273, 2018.
尽管缺乏证据支持，但内镜鼻窦手术（ESS）后患者常被建议避免擤鼻。这项随机研究评估了术后第一周擤鼻是否会影响主观和客观临床结果。
40例行ESS的患者被随机分为干预组，术后前7天患者每天至少擤鼻两次；或对照组，患者避免擤鼻。7天后所有患者都可擤鼻。鼻出血的频率和程度通过每日日记和视觉模拟量表（VAS）记录。术后1周和4周，收集鼻阻塞症状评估（NOSE）和鼻窦结局测试-22（SNOT-22），并记录内镜检查结果用于盲法Lund-Kennedy量表评分。
两组在出血事件的频率和持续时间、VAS鼻出血评分、SNOT-22评分以及每个术后时间点的NOSE评分方面均无差异。术后1周（P = 0.0762）和4周（P = 0.2340）随访时Lund-Kennedy评分也相似，但擤鼻组在术后第一次（P = 0.0075）和第二次（P = 0.0298）随访时鼻分泌物子评分有所改善。
ESS后擤鼻似乎并不能显著改善鼻塞症状或鼻窦总体生活质量，在术后第一周也似乎不会对术后鼻出血的频率或严重程度产生不利影响。对于无并发症的ESS，术后可立即谨慎擤鼻。
1b。《喉镜》，2018年，第128卷，第1268 - 1273页。
