Author(s)
Noel Ayoub, BS
Wirach Chitsuthipakorn, MD
Jayakar Nayak, MD, PhD
Zara Patel, MD
Peter Hwang, MD
Affiliation(s)
Stanford University School of Medicine
Abstract:
IntroductionPatients are frequently advised to abstain from nose blowing following endoscopic sinus surgery (ESS), despite a lack of evidence for its benefit. This randomized study assessed whether postoperative nose blowing affected outcomes. Methods40 patients who underwent ESS were randomized to either an interventional arm and blew their nose at least twice-daily for the first 7 postoperative days, or a control group and refrained from nose blowing. All patients were allowed to blow their nose after 7 days. At 1 and 4 weeks postoperatively, Nasal Obstruction Symptom Evaluation (NOSE) and Sino-nasal Outcome Tests (SNOT-22) were collected, and endoscopies were recorded for blinded Lund-Kennedy scoring. Epistaxis requiring medical attention was also documented.ResultsBoth groups were similar in terms of age, gender, prior ESS, and nasal polyposis. Baseline NOSE and SNOT-22 scores were also similar (p=0.48 and p=0.23, respectively). Postoperatively, there were no differences in the median improvement in symptom scores at 1 week (NOSE: -40 in the interventional group vs. -20 in the control group, p=0.5281; SNOT-22: -17 vs. -18, p=0.8898); and at 4 weeks (NOSE: -50 vs. -35, p=0.2571; SNOT-22: -22 vs. -28.5, p=0.2751). Lund-Kennedy scores were statistically similar (p=0.2340). No bleeding events were noted in either group after 1 week; one episode of epistaxis in the interventional arm required medical attention at postoperative week 3.ConclusionsRefraining from nose blowing after routine ESS does not appear to confer significant patient benefit. Judicious nose blowing may be feasible in the absence of orbital or skull base injury.