Medical Journal of the Islamic Republic Of Iran

en Investigating the Results of Using Betamethasone Ophthalmic Ointment in Polypoid Frontal Sinus in Endoscopic Sinus Surgery and Its Effect on Reducing the Recurrence of Polyposis After Surgery: A Randomized Clinical Trial Otorhinolaryngology Otorhinolaryngology Original Research Original Research     Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) often recurs after endoscopic sinus surgery (ESS), particularly in the frontal recess, which topical irrigations and sprays reach poorly. We evaluated whether intraoperative betamethasone ophthalmic ointment in the frontal sinus reduces postoperative recurrence.    Methods: In this randomized clinical trial with intra-patient control, 30 patients (≥13 years) with bilateral CRSwNP undergoing primary or revision ESS (Draf 2a) at 2 teaching hospitals in Tehran, Iran, were enrolled. One frontal sinus per patient was randomly assigned to betamethasone ophthalmic ointment at the end of surgery; the contralateral sinus served as control. Patients and outcome assessors were blinded. Polyps, inflammation, and secretion were assessed endoscopically at 1.5 and 3 months. The soft tissue density ratio (STDR) was measured on 3-dimensional CT reconstructions before and 3 months after surgery and analyzed with a generalized estimating equation model. Registration: Iranian Registry of Clinical Trials, IRCT20220510054810N1.    Results: The intervention side demonstrated significantly better endoscopic outcomes than the control side at both 1.5 months (no polyps: 93% vs 70%; no inflammation: 60% vs 20%; no secretion: 63% vs 17%) and 3 months (no polyps: 63% vs 50%; no inflammation: 67% vs 30%; no secretion: 63% vs 20%) (all P < 0.05). STDR reduction was also significantly greater on the intervention side (time × group interaction: β = −14.5, P < 0.001). Conclusion: Intraoperative betamethasone ophthalmic ointment in the frontal sinus improved endoscopic outcomes at 1.5 and 3 months and reduced postoperative STDR, including in patients with Samter's triad. Larger trials with longer follow-up are warranted.   Rhino-Sinusitis, Effects of Betamethasone Ointment, Polyp, Surgery, Endoscopic Criteria 888 895 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-8760-1&slc_lang=en&sid=1 Shahin Rajaeih rajaeih.sh@iums.ac.ir 2003194753284600100290 2003194753284600100290 No ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Zeinab Emamgholizadeh emamgholizadeh.z@iums.ac.ir 2003194753284600100291 2003194753284600100291 Yes ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Hesam Jahandideh jahandideh.h@iums.ac.ir 2003194753284600100292 2003194753284600100292 No ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Saleh Mohebbi mohebbi.sa@iums.ac.ir 2003194753284600100293 2003194753284600100293 No ENT and Head and Neck Research Center, The Five Sense Health Institute, Iran University of Medical Sciences, Tehran, Iran