Septal Surgery Research Articles

Quality of life in patients after totally endoscopic atrial septal defect closure surgery

Background: Totally endoscopic atrial septal defect closure surgery was applied effectively and aesthetically. However, more specific assessments of the patient's quality of life after surgery are needed.[1]
 Methods: From June 2022 to August 2023, 47 patients after totally endoscopic atrial septal defect repair surgery were enrolled to evaluate quality of life before and 1-month after surgery using the SF-36 questionnaire.
 Results: 47 patients were an average age of 38.5 years old, and 72% of women. The overall quality of life SF-36 score was at a good level of 77.3. In particular, physical and mental health scores improved significantly after than before surgery, the difference was statistically significant, p<0,01. Occupation, history of comorbidities and surgical complications are related to poor quality of life after totally endoscopic atrial septal defect repair surgery with OR of 0.72 (0.52 - 0. 99); 0.24(0.06 – 0.98); and 0.08 (0.01 -0.78), respectively, with p<0.05.
 Conclusion: The quality of life of patients after totally endoscopic atrial septal defect repair surgery is significantly improved. Occupation, history of comorbidities, and surgical complications are some associated factors.

Prophylactic antibiotics in septoplasty with intranasal septal splints: A comparative analysis.

Postoperative antibiotic therapy is a common practice following septoplasty with intra-septal splints placement (ISS), even though there is a lack of evidence to support it. We sought to investigate the role of antibiotic therapy in septal surgeries with the placement of ISS. A retrospective comparative study was conducted using the electronic charts of adult patients who underwent septoplasty with the placement of ISS with or without turbinate reduction. Nasal cultures were taken routinely during surgery as part of the department's protocol for monitoring infectious diseases. The ISS were also routinely examined for the presence of bacteria after their removal on the eighth day following surgery. A large otolaryngology department in a tertiary medical center. Adult patients who underwent septoplasty in our institution. We analyzed all post-operative infections to search for risk factors in the cohort. Post-operative infection rates following septoplasty with ISS were low at 6%, which is consistent with previously published rates. Infection rates were significantly higher in patients who were not treated with antibiotics (OR = 8.2, 95%CI: 1.63-41.1; p = .01, φ = 0.04). Diabetes was associated with an increased risk of postoperative infection regardless of prophylactic antibiotic therapy (OR = 5.2, 95%CI: 1.15-23.5; p = .032, φ = .04). The detection of Klebsiella pneumonia before surgery was associated with an increased rate of postoperative infection (OR = 16.6, 95%CI: 3.02-91.54; p = .001, φ = 0.12). Patients undergoing septoplasty with the placement of ISS are at increased risk of gram-negative bacterial colonisation, and development of postoperative nasal infection. A single preoperative dose of IV antibiotic therapy should be considered a potential prophylactic option for septoplasty with ISS.

USING OF ROTATIONAL NASAL MUCOSA FLAPS IN POSTOPERATIVE NASAL SEPTAL PERFORATION REPAIR

Background. Postoperative nasal septum perforation (PNSP) is one of the complication of the nasal septum (NS) surgery, with an incidence of 1–8 %. Surgical repair of the nasal septum improves the patients' quality of life. The most effective techniques are the ones using two rotation flaps of the nasal mucosa, which are used for the plasty of traumatic and idiopathic perforations. The results of implementing this technique for the closure of PNSP require a comprehensive study Aim. To evaluate the effectiveness of rotary flaps of the nasal mucosa in postoperative nasal septum perforation repair. Materials and Methods. 18 patients with postoperative nasal septum perforation were operated on. The number of the patients depending on the area (S) of the PNSP was S <1cm2 — 4, S 1-2 cm2 — 10, S > 2cm2 — 4. The criterion for the technique efficiency was the fact of intraoperative complete closure of the PNSP, and the absence of recurrences of the PNSP within 1 year. We analysed the cause-and-effect relationships between the structural features of the PNSP (6 types were identified) with the technique of execution and long-term results. Results. Complete intraoperative closure of PNSP in 13 of 18 patients (72 %). In 5 patients, an additional sampling of temporal autofascia was performed with subsequent implantation between the flaps for intraoperative complete closure of the PNSP. In 4 out of 13 patients (30 %) with PNSP S 1-2 cm2 the PNSP relapse (type 3, 4) was noted. There was 1 relapse (type 5) with PNSP S > 2cm2 in 1 out of 5 patients (20 %), to whom autofascia was additionally used. Conclusions. The surgery of the PNSP according to the specified technique is effective with the PNSP S <1cm2; at S 1-2 cm2 it leads to distant relapses in 30 % of the cases, S > 2 cm2 is not effective. The use of a temporal fascia autograft allows to increase the efficiency of the postoperative nasal septum perforation regardless the area of it.

Deep sedation for nasal septal surgery: an observational retrospective study with an inverse probability weighting model

BackgroundSeptoplasty, a common surgical procedure to correct a deviated septum, can be performed under either general anesthesia or deep sedation anesthesia. The choice of anesthesia can influence the duration of anesthesia and surgical outcomes, impacting the feasibility of outpatient procedures.MethodsThe institutional review board approved the protocol, and we obtained written informed consent from all participants. This retrospective, single-center observational study analyzed data from 586 patients who underwent rhino septoplasty at Santo Stefano Hospital in Prato, Italy, from 2017 to 2021. Patients received either general anesthesia or deep sedation anesthesia. Propensity score matching and inverse probability weighting were used to balance patient characteristics. The main outcome variable was discharge time, with anesthesia time and surgical time as covariates. Statistical analysis was conducted using R software.ResultsPatients who received deep sedation anesthesia had a significantly shorter duration of anesthesia compared to those who received general anesthesia. A multivariate linear regression model showed that the type of anesthesia had a strong positive association with discharge time, while anesthesia time had a weaker negative association, although not statistically significant.ConclusionsDeep sedation anesthesia is associated with a shorter duration of anesthesia compared to general anesthesia during nasal septal surgery, suggesting it could be a more feasible option for outpatient procedures. However, the choice of anesthesia should be tailored to individual patient factors and surgical requirements. Further research is needed to confirm these findings and explore the potential benefits of sedation anesthesia in outpatient nasal septal surgery.QuestionHow do general anesthesia and deep sedation anesthesia compare in terms of duration of anesthesia and surgical outcomes during nasal septal surgery?FindingsOur study found that deep sedation anesthesia was associated with a shorter duration of anesthesia compared to general anesthesia in patients undergoing nasal septal surgery. However, there were no significant differences in the duration of the surgical procedure.MeaningThe findings suggest that deep sedation anesthesia could potentially make nasal septal surgery more feasible as an outpatient procedure.

Is endoscopic septoplasty effective in all types of septal deviations? An observational study on subjective and objective assessment of nasal airway

BackgroundEndoscopic septoplasty has become the preferred choice for septal surgeries for most surgeons due to its precise manipulation and reduced wear and tear. However, the improvement of the airway may vary depending upon the type of septal deviation the patient presents with. Cottle in 1946 stated that just mere dealing with deviated septum alone would not ensure a good functional outcome and he further emphasized on addressing portions of the nose obstructing nasal airflow during surgery. The purpose of our study is to subjectively and objectively assess the effectiveness and corrective extent of endoscopic septal correction in different types of septal deviations (Mladina classification) using NOSE scores and Peak Nasal Inspiratory Flowmetry (PNIF). A prospective cross-sectional study was conducted in 87 patients presented in our department from July 2021 to June 2022 for endoscopic septoplasty.ResultsPost-surgery 1-month follow-up (N1), the correction in terms of NOSE scores was highest in Mladina IV and least in Mladina I deviations, and at the end of 3 months (N2), the correction was best recorded in Mladina VI deviations while the least remained in Mladina I. Similarly, PNIF 1-month follow-up (P1) result had the best correction in the Mladina IV and V groups with the least in Mladina I. 3 months of follow-up (P2) ended up showing a maximum improvement in the Mladina VI group. Paired t test values for improvement of NOSE and PNIF scores were significant (p value < 0.001) between preoperative, 1-month, and 3-month follow-up values and also for repeated measure ANOVA.ConclusionOur study reveals that the corrective power of endoscopic septoplasty differs with respect to different types of septal deviation in terms of nasal airflow, both subjectively and objectively. Thus, proper counseling and preoperative assessment is essential for better postoperative outcome and compliance.

Pediatric Functional Rhinoplasty.

Surgery on the growing pediatric nose poses many questions regarding the indications and proper timing. Historically, surgeries on the pediatric nose led to facial growth alterations so many urged caution and waiting until skeletal maturity at the age of 18. However, animal studies showed some promise that facial growth may not be affected. Investigations into effects of pediatric sinus surgery and septal surgery on facial growth showed no issues. The external nose is somewhat different in that minor variations potentially can grow to a cosmetic deformity. However, numerous studies on facial growth show, to date, that it is not affected, and that surgery is safe. The caveat that one uses is the techniques of cartilage sparing and preservation, which have been studied and shown to be safe. There are ways to measure the effectiveness of surgery in relieving nasal airway obstruction both objectively and, more recently, subjectively. It is essential to treat pediatric nasal airway obstruction to avoid other facial growth problems, such as mouth breathing, snoring, malocclusion, and obstructive sleep apnea.

Septoplasty and Bilateral Inferior Turbinate Surgery under Local Anesthesia with Deep Sedation versus General Anesthesia, A Retrospective Randomized Comparative Control Study

AIM: The main target of this study was to investigate the safety and efficacy and the benefits of the use of local anesthesia during septal and bilateral turbinate surgery. METHODS: This prospective, randomized control study was conducted on 140 patients between the ages of 17 and 65, though the period from march 2021 to November 2022, who were booked for septal and bilateral turbinate surgery who were randomly allocated into two groups study group (1) involving 35 patients (42 males and 28 females with mean age 34.3 ± 11.9 years old) who were received local anesthesia with deep sedation and control group (2) involving 35 patients (52 males and 18 females with mean age 33.3 ± 11.4) who were received general anesthesia from march 2021 to November 2022. RESULTS: Local anesthesia with sedation group showed a significantly less Total operation time (33.3 ± 2.62 min), real surgical time (23.64 ± 2.70 min), intraoperative blood loss (33.9 ± 2.3 mL), hospital stay duration (7.1 ± 0.7), post-operative pain (8.6%), post-operative nasal packing (8.6%), patient satisfaction (9.3 ± 0.7), and total hospital cost (17.14 ± 1.25 $), with no significant deference regarding to nausea and vomiting (5.7%), Compared to the other control group. CONCLUSION: Septoplasty with bilateral turbinate surgery under local anesthesia with deep sedation is easy, safe, reliable, and costless that to be done under general anesthesia.

A case presentation of acquired membranous ventricular septum aneurysm as a rare delayed complication of ventricular septal defect repair surgery: 10-year follow-up

BackgroundRare as membranous ventricular septal aneurysms (MVSA) is, the possibility that occurs after ventricular septum defect (VSD) repair surgery is even more uncommon.PresentationA girl developed a MVSA 3 years after the VSD repair surgery at the age of 1 and increasing growth was noted during the follow-up. Aneurysm plication was carried done when she was 11 years old because it was observed to have a close relationship to the right coronary and obstructed the right ventricular outflow tract. Postoperative echocardiography follow-up revealed no abnormalities.ConclusionThough the prognosis of most patients with VSD repaired surgery was good, there remains varieties type of complications despite surgical advances. Accurate and rapid diagnosis of acute and delayed complications is essential to improve prognosis. In this case, the aneurysm was diagnosed by multiple imaging modalities and the girl underwent successful surgery again which provides direction for awareness and knowledge of delayed complications of VSD repair.

The use of different intranasal splints Doyle splints versus Reuter bivalve splints versus no splints in primary septal surgeries: A randomised clinical trial looking at morbidity.

The objective of this study is to compare the morbidity of different types of intranasal splints (Doyle splints and Reuter bivalve splints) with no intranasal splints in primary septal surgeries and concomitant submucosal reduction of the inferior turbinate. Randomised clinical trial SETTING: Single-Center trial at a tertiary care facility PARTICIPANTS: In this randomised clinical trial, 123 consecutive patients underwent primary septoplasty with bilateral submucosal reduction of the inferior turbinate, with no other concurrent procedure. Patients were randomised into three groups: Doyle splints, Reuter bivalve splints and patients with no splints placed. Following surgery, the patients were seen at three consecutive visits. During each visit, the Visual Analogue Scale score for headache, nasal obstruction, overall pain and bleeding and an endoscopic score for secretions, oedema and synechiae was filled. Patients were randomised into three groups, 42 received Doyle splints, 41 Reuter bivalve splints and 40 had no splints inserted. When comparing the three groups, the first two post-op visits were scheduled significantly earlier in patients with splints (p < .05). The scores from both groups with splints were statistically higher for headache, nasal obstruction and pain, for the first visit only (p < .05). There was no statistical difference between groups when looking at each subset of the endoscopic score, at each visit (p > .05). Increased post-operative pain, headaches and nasal obstruction scores were encountered in patients who had splints after surgery. However, endoscopic scores were statistically similar across the three groups with no difference in post-operative endoscopic scores at each visit. and no difference was seen in symptom scores and endoscopic scores between patients with different splints.

Preliminary Results of Ventricular Septal Defect Surgery in Festoc Center in Bamako

Interventricular septal defects are dehiscences of the interventricular septum connecting the systemic and pulmonary circulations. The aim of this study is to report the preliminary results of the first series of intraventricular septal defects managed at the Festoc centre in Bamako. This is a mono-centric, descriptive retrospective study taking place at the FESTOC Centre in the period from 10 September 2018 to 30 April 2023. Patients of any age and sex, operated for IVC were included. Patients operated abroad were not included. We recorded 74 cases of IVC, i.e. 23.19% out of 300 cases. 61% of the patients were male, with a sex ratio of 1.56. The average age was 11 years. Symptoms were dominated by dyspnoea and recurrent bronchitis in 67.21% and 49.18% respectively. Peri-membrane and admission topography were dominant, with rates of 84% and 10%

Changes in Nasal Tip Aesthetics Over Time Following Asian Tip Plasty.

This study aimed to evaluate the sequential postoperative changes in tip aesthetics, by evaluating the aesthetic performance of the septal extension graft with or without tip grafting. A total of 62 patients who underwent rhinoplasty with tip plasty were included. Using a three-dimensional scanner, we measured anthropometric aesthetic features of the nasal tip, including tip height, tip width, nasolabial angle, and columellar lobular angle. Preoperative and 1-month and 12-month postoperative anthropometric parameters were compared. The patients were grouped according to surgical techniques (i.e., septal extension only and septal extension plus tip grafting groups) and subtype of tip graft. The 1-month postoperative values of all four aesthetic features were significantly increased compared with the preoperative values. The tip height, tip width, and nasolabial angle at 12 months were significantly decreased compared with 1 month post-operation values, whereas the tip height and width were still greater than the preoperative values. No difference was found between 1 and 12 month values of columellar lobular angle. There were no differences in the degree of decrease in tip height, tip width, nasolabial angle, and columellar lobular angle between the septal extension graft only and septal extension graft plus tip graft groups. There were no differences in the tip graft by subtypes, single- and multi-layer tip grafts. Increased tip height, tip width, and widened nasolabial angle gained immediately after septal extension grafting surgery gradually decreased over the year regardless of addition of tip graft or tip grafting methods. 4 Laryngoscope, 134:678-683, 2024.

Use of Echocardiography to Diagnose Obstructive Hypertrophic Cardiomyopathy

Fabian Knebel, Sana Klinikum, Berlin, Germany, and Department of Cardiology and Angiology, Charité Campus Mitte, Berlin, Germany, opened the podcast with a definition of hypertrophic cardiomyopathy (HCM), which is characterised by left ventricular hypertrophy. Knebel then described the symptoms of the condition, such as shortness of breath and syncope after physical exertion. Up to one in 400 persons carry the genetic mutations that can lead to HCM, which is a dangerous condition if left undiagnosed, potentially leading to ventricular tachyarrhythmias and sudden cardiac death, or end-stage heart failure. HCM is a genetic condition, and genetic testing should be performed in cases of unexplained death so that families can be tested if HCM is diagnosed. Echocardiography is the first imaging method of choice for patients with HCM due to its relatively low cost and wide availability, but cardiac MRI may also be performed to measure left ventricular wall thickness, fibrosis, and left ventricular outflow tract (LVOT) obstruction, and to evaluate the success of therapies such as septal myectomy. When using echocardiography, the first obvious finding to indicate HCM is a thickened left ventricular wall, usually in the interventricular septum. European and American guidelines agree that an end-diastolic left ventricular wall thickness of ≥15 mm should be considered HCM. Knebel provided advice on how to effectively perform echocardiography, including using apical cut planes, and measuring the pressure gradient in the LVOT during the Valsalva manoeuvre. A case study was presented of a patient presenting with signs and symptoms suggestive of myocardial infarction, demonstrating the potential complexity of diagnosing HCM. Knebel concluded with a summary of current therapeutic options, such as septal reduction surgery and septal branch ablation, and pointed out that in the near future there will be medications to reduce LVOT obstruction and alleviate symptoms.

Endoscopic Septoplasty: A Retrospective Analysis of Indications and Outcome.

Endoscopic septoplasty is a minimally invasive surgical procedure for the correction of nasal septal deformity. Globally, nasal septal surgeries are rarely performed, and in our country these procedures are even more scarcely undertaken, partly due to dearth of facilities and to some extent, the expertise of embarking on this specialised surgical procedure. Therefore, we aimed to document the indications and the outcome of endoscopic septoplasty in our environment. This was a retrospective study of all consecutive patients that had endoscopic septoplasty at a state tertiary hospital over three years period. Ethical approval was obtained before commencement of the study. Patients' medical records were retrieved. Biodata, clinical presentation, operative procedure and outcome were extracted and analyzed descriptively. Fourteen patients had endoscopic septoplasty over the period under review, constituting 11 (78.6%) males and 3 (21.4%) females. Predominant clinical features were nasal obstruction (100%) and nasal septal deviation (100%). The main indication for procedure was deviated nasal septum. The outcome of the surgery was good, 2(14.3%) of the patients had nasal adhesions but no major complication was recorded. The length of hospital stay ranged between 3 and 5 days with a mean of 3.7 ± 0.9 days, and all the patients were discharged successfully. Endoscopic septoplasty is a safe surgery. The main indication for the procedure was deviated nasal septum, and the procedure has a favourable outcome among the operated patients.

Funktionelle Formstörungen der Nase – Definition, Diagnostik und Therapieoptionen

The surgical spectrum of functional rhinosurgery includes nasal septum surgery, septorhinoplasty and nasal concha surgery. Based on the German guideline "Disorders of the inner and/or external nose (with functional and/or aesthetic impairment)" published in April 2022, which was prepared on behalf of the German Society of Otorhinolaryngology, Head and Neck Surgery, we discuss the indications, diagnostic approaches, the planning of the surgery and postoperative care. The most common findings of the external nose with a functional impairment include crooked nose, saddle nose, and tension nose. Combined pathologies occur. Well-documented in-depth consultation is essential for rhinosurgical procedures. In the case of revision surgery, the possible necessity of autologous ear or rib cartilage should be considered. Despite correct surgical performance, no "guarantee" can be given for the surgical (long-term) result in rhinosurgery.

Rare Case of Pediatric Hypertrophic Obstructive Cardiomyopathy (HOCM) in A 6-year-old Boy: How to Recognize, Assess, and Manage the Risk?

Highlights: It discusses pediatric HCM which is usually caused by autosomal dominant traits caused by mutation in cardiac sarcomere protein genes. It explains how to recognize the cardiac risk Abstract: Hypertrophic Obstructive Cardiomyopathy (HOCM) is a disease characterized by increased left ventricular (LV) wall thickness and accompanied by obstructive physiology measured by increased LV outflow tract gradient. It is mainly inherited in autosomal dominant traits caused by a mutation in cardiac sarcomere protein genes. In pediatrics, HOCM is rare and comprises a different diagnosis and management approach compared to adults. The risk of sudden cardiac death (SCD) is also higher in the pediatric population. Case Summary. This report is about a case of HOCM found incidentally in a 6-year-old boy and a discussion based on the latest literature review. The patient first came for evaluation for cardiac murmur and abnormality in ECG and chest x-ray. Diagnosis of HOCM was made through echocardiography assessment. Discussion. ICD implantation for primary prevention of SCD was considered based on individualized 5-year SCD risk assessment which is around 7%. Optimal pharmacological therapy with beta-blocker, careful planning of ICD implantation with balanced benefit and risk, and septal reduction surgery when indicated should extend the life expectancy and quality of life of pediatric HOCM. It is both essential and interesting to recognize pediatric HOCM diagnostic findings and to pursue further research about therapies of this rare disease.

OWN EXPERIENCES IN THE APPLICATION OF INTRAOPERATIVE 3D SPATIAL IMAGING IN THE ENDOSCOPIC SURGERY OF THE PARANASAL SINUSES

Introduction: Intraoperative spatial imaging using a high-resolution 3D camera is a state-ofthe-art technique applied to endoscopic paranasal sinus surgery. It enables better visualization of the surgical site, improves depth perception and facilitates tissue identification. All 3D endoscopy capabilities are still under review. The purpose of this study is to compare analogous endoscopic surgeries performed with 3D technique and those performed with traditional 2D technique based on the analysis of length of surgery, blood loss, occurrence of intraoperative complications and hospital stay time. Material: The material included 346 patients who underwent endoscopic paranasal sinus surgery with unilateral or bilateral sinus opening. In case of 152 patients, corrective surgery of the nasal septum was additionally performed. The patients were divided into two groups (2D group and 3D group) comprising 173 patients each, who underwent paranasal sinus opening using 2D and 3D endoscopic visualization. Each group was divided into four subgroups: the first were patients after bilateral paranasal sinus surgery (PSS), the second were patients after bilateral endoscopic paranasal sinus surgery and nasal septal correction surgery (PSS+NS), the third were patients after unilateral paranasal sinus surgery (UPSS), and the fourth group was patients after unilateral endoscopic paranasal sinus surgery and nasal septum correction surgery (UPSS+NS). Methods: The surgery was carried out using a TipCam 3D endoscope from Storz (Germany), 18 mm in length, 4 mm in diameter, with 30° optics, with an integrated camera capable of transmitting 3D images, as well as classic 2D endoscopes, 16 mm in length, 4 mm in diameter and 30° optics, along with a video track and instrument set. Patients underwent unilateral or bilateral endoscopic surgery with opening of the maxillary sinuses, frontal sinuses, anterior and posterior ethmoid as well as corrective surgery of the nasal septum. Patients underwent unilateral or bilateral endoscopic surgery with opening of the maxillary sinuses, frontal sinuses, anterior and posterior ethmoid as well as corrective surgery of the nasal septum. Results: The length of surgery were as follows in the 2D group: 2D/PSS+NS group — 107 min. (±22); 2D/PSS group — 95 min (±24); 2D/UPSS+NS group — 68 min (±21); 2D/UPSS group — 53 min (±14); The length of surgery in the 3D group: 3D/PSS+NS group — 91 min. (±17); 3D/PSS group — 83 min (±20); 3D/UPSS+NS group — 69 min (±15); 2D/UPSS group — 49 min (±10); Among the complications were early and late postoperative bleeding, eyelid or orbital hematomas, and eyelid edema. There were 17 complications in the 2D group (9.82%), and 7 complications in the 3D group (4.05%). Conclusions: It was found that 3D endoscopic surgeries significantly reduced the length of surgery, especially in serious bilateral paranasal sinus surgeries. and influenced a decrease in perioperative complications. 3D endoscopic surgeries had no significant effect on the amount of blood loss and the length of the patient’s stay at the Clinic.

Nasal Packing in Septal Surgery: A Narrative Review.

Recently, alternatives to intranasal packing following septoplasty and rhinoseptoplasty have been widely used and promoted. Here, we aimed to systemically review and compare the different types of nasal packing used in these two surgeries. To assess patient comfortand surgical outcomes, we conducted a comprehensive search of multiple databases such as PubMed, MEDLINE, Web of Science, and Google Scholar to identify and evaluate relevant articles.A detailed and extensive search was performed with the help of the keywords "nasal packing,""septoplasty,""rhinoseptoplasty,""nasal splints," and "intranasal packing."Overall, our review findings indicate that alternative methods (e.g., trans-septal suturing and insertion of intranasal splints) are better options than intranasal packing.

Post-infarction ventricular septal defect surgery in Portugal

Introduction and ObjectiveWe performed a collective analysis of a dedicated national post-myocardial infarction ventricular septal defect (VSD) registry to further elucidate controversial areas of this clinical entity's surgical treatment. MethodsA descriptive statistical analysis was carried out and cumulative survival using the Kaplan-Meier method and multivariate logistic regression of risk factors for 30-day mortality are presented. ResultsMedian survival of the cohort (n=76) was 72 months (95% CI 4–144 months). Better cumulative survival was observed in patients who underwent VSD closure more than 10 days after myocardial infarction (log-rank p=0.036). Concomitant coronary artery bypass grafting (CABG), different closure techniques, location of the VSD, extracorporeal membrane oxygenation as bridge to closure, or intra-aortic balloon pump as bridge to closure showed no statistically significant differences at Kaplan-Meier analysis. Multivariate binary logistic regression for independent factors affecting status at 30 days showed a statistically significant effect of age (OR 1.08; 95% CI 1.01–1.15) and concomitant CABG (OR 0.23; 95% CI 0.06–0.90). ConclusionsOur results are comparable with previous reports regarding mortality, risk factors and concomitant procedures. Timing of surgery remains a controversial issue. Later closure seems to be advantageous, however, there is significant observational bias.

A PROSPECTIVE STUDY COMPARING THE OUTCOMES OF NASAL SEPTAL CLIP VERSUS MEROCEL APPLICATION AFTER NASAL SEPTAL CORRECTIVE SURGERY

Nasal splint application is an important step of septal corrective surgeries to keep the septum in midline after the surgery. Septal clip is most commonly used. In our study we have compared the use of nasal septal clip and Merocel application post surgery and the morbidities associated with it

Effect of Anterior Nasal Packing on Middle Ear Pressure

Background: Bilateral anterior nasal packing is often done after septal surgery for hemostatic reasons and mechanical splinting. It has been suggested that nasal packing following septal surgery is a frequent cause of short term eustachian tube dysfunction such as ear fullness and mild pain.&#x0D; Objectives: To evaluate the effect of anterior nasal packing on middle ear pressure.&#x0D; Methods: For this prospective, longitudinal study, ninety-two (92) patients admitted for routine septal surgeries were selected according to inclusion and exclusion criteria from the in-patient Department of ENT and Head &amp;Neck Surgery, Dhaka Medical College and Hospital, Dhaka during 1st January 2020 to 31st July 2021. Following informed written consent, the patients were interviewed three times: preoperative, after 24 hours of ANS pack and 6 days after pack removal. During each time, middle ear pressure was measured by an impedance audiometer. Any otological symptoms produced when ANS pack was in place for 24 hours and 6 days after pack removal were also observed and recorded.&#x0D; Results: Among 92 patients in this study, mean preoperative middle ear pressure was -5.5 (± 30.14) daPa. After 24 hours of anterior nasal packing, 70 ears (38%) showed abnormal middle ear pressure among 184 ears. Mean middle ear pressure after 24 hours of ANS pack was -76.5 (± 58.8) daPa. Middle ear pressure again measured after 6 days of removal of ANS pack and showed that the middle ear pressure of all the patients were within normal range. Mean middle ear pressure was -12.4(± 36.5) daPa after 6 days of pack removal. Some otological symptoms developed due to change in middle ear pressure following ANS pack like ear fullness, earache and tinnitus. All these symptoms subsided after 6 days of pack removal.&#x0D; Conclusion: Anterior nasal packing decreases middle ear pressure which is reversible and returns to normal 6 days after pack removal. Some otological symptoms developed due to change in middle ear pressure which were transient and all came to normal after 6 days of pack removal.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(2): 135-140