The American Journal of Medical Sciences and Pharmaceutical Research
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TYPE
Original Research
PAGE NO.
83-88
10.37547/tajmspr/Volume07Issue02-12
OPEN ACCESS
SUBMITED
24 December 2024
ACCEPTED
26 January 2025
PUBLISHED
28 February 2025
VOLUME
Vol.07 Issue02 2025
CITATION
Khakimov Ismatulla. (2025). Effectiveness of a modified endonasal splint in
the prevention of pathogenic microflora after septoplasty: a comparative
microbiological research study. The American Journal of Medical Sciences
and Pharmaceutical Research, 7(02), 83
–
88.
https://doi.org/10.37547/tajmspr/Volume07Issue02-12
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Effectiveness of a modified
endonasal splint in the
prevention of pathogenic
microflora after
septoplasty: a comparative
microbiological research
study
Khakimov Ismatulla
Assistant, Department of Normal and Pathological physiology, Tashkent
medical academy, Tashkent, Uzbekistan
Abstract:
The use of endonasal splints in septoplasty has
been extensively discussed in the literature in recent
years. There are different types of splints, each with its
own advantages and disadvantages. The results of
surgery can vary considerably depending on the type of
splint chosen and the methods of its application. This
article discusses the effectiveness of a modified
endonasal splint in preventing pathogenic microflora in
the postoperative period, as well as possible
complications.
Septoplasty is a common operation aimed at correction
of nasal septal deformity. However, in the early
postoperative period, patients face the risk of synechiae
development, accumulation of blood and secretion in
the nasal cavity, which creates favorable conditions for
the growth of pathogenic microflora. Traditional nasal
splints limit the natural drainage of the nasal cavity,
contributing to stagnation of secretions. A modified
endonasal splint with a central removable airway was
developed to improve nasal hygiene by simplifying
cleaning and reducing exudate accumulation. The aim of
the study was to evaluate the effect of this splint on the
dynamics of nasal cavity microflora in comparison with
the traditional analogue.
Keywords:
Septoplasty, endonasal splint, pathogenic
microflora, Staphylococcus aureus, postoperative
complications.
Introduction:
The nasal cavity is a complex ecosystem
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colonized by diverse commensal microflora, which
plays a key role in maintaining homeostasis and
protecting against pathogens. Normally, the dominant
microbiome representatives are Staphylococcus
epidermidis and Staphylococcus nasalis, which
compete with opportunistic microorganisms for
resources, synthesize bactericides, and modulate the
immune response. [1, 2]. This symbiosis, known as
colonial resistance, is disrupted by injuries, surgical
interventions, or the use of foreign materials, creating
conditions for the proliferation of pathogens such as
Staphylococcus aureus. [3]
Septoplasty aimed at correcting the deformation of the
nasal septum is accompanied by the risk of formation
of synechiae and accumulation of hemorrhagic
exudate. Traditional endonasal splints used to prevent
scarring restrict aeration and drainage, which
exacerbates dysbiosis and increases the likelihood of
bacterial superinfection. [4] The introduction of a
modified splinter with a central removable air duct
aims to minimize these risks by improving ventilation
and simplifying nasal sanitation.
Endonasal splints are medical devices used to maintain
the correct position of the nasal septum after surgical
correction, prevent nasal mucous membrane
adhesions, and reduce the risk of bleeding. They
provide mechanical support for tissues, which
contributes to their proper healing, reduces
inflammatory reactions, and reduces pain in patients
during the first days after surgery. However, despite the
widespread use of splints, their application remains a
subject of debate among specialists, as they are not
always necessary, and their installation and removal can
cause discomfort in the patient [2,6].
The use of endonasal splints in the practice of
septoplasty has been actively discussed in the literature
in recent years. There are several types of splines, each
of which has its advantages and disadvantages.
Depending on the choice of splinter type and its
application methods, the results of the operation can
differ significantly.
In this study, we will examine the existing types of
endonasal splints, as well as their effectiveness in the
postoperative period and complications. Additionally,
modern clinical recommendations for using splints will
be analyzed and discussed for their further
development prospects.
The useful model relates to medicine, specifically
otorhinolaryngology, and can be used to fix the nasal
septum and prevent postoperative complications after
submucosal nasal septal resection. The tire contains a
crescent-shaped silicone plate with an air duct (1)
placed in the center.
Figure-1
The central air duct is supplied of the same shape
separated from the inside by a cavity (2), which in turn
is made of medical polyvinyl chloride, entering 1 cm
from the edge of the plate facing the nasal vestibule.
Above the central air duct, there is a groove (3) of the
same shape, which has 3 openings (4) located at the
same distance from each other and facing the nasal
sinuses.
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Figure-2
The groove (3) located above the central air duct has
an opening (5) facing the nasal vestibule for
administering medications through a syringe. The
administered drug enters the nasal cavity through
three openings (4) located in the lateral projection.
The side openings are located at equal distances from
each other and allow the administered drug to be
distributed evenly throughout the nasal cavity,
regardless of if it is contaminated with sputum or blood
clots.
The use of the utility model ensures improved
postoperative
tissue
cleansing
and
prevents
postoperative complications due to the accumulation
of sputum and blood clots in the separated lunate
cavity (2) located inside the central air duct (1). Due to
this, during cleaning, all accumulated sputum and
blood clots will be expelled along with the newly added
lunate cavity (2), ensuring easy and painless cleaning of
the central air duct (1).
The utility model used in otorhinolaryngology is
designed to fix the nasal septum and prevent
complications after surgery to remove a portion of the
nasal mucosa. In 1905, Killian and Freer independently
developed a method for submucosal resection of the
nasal septum. However, using conventional gauze
tampons to stop bleeding after surgery led to difficulty
breathing. Other complications included the formation
of abscesses, hematomas, and even perforation of the
nasal septum.
Purpose of the research
The purpose of the study is to assess the influence of a
modified splinter (Uzbekistan Republic patent for
utility model FAP No2629) on the dynamics of nasal
microbiome compared to standard devices using
quantitative microbiology and statistical analysis
methods.
METHODS
Prospective Randomized Controlled Inquiry (RIC) with
Double Blind Design [5]. 100 patients were participated
(18-45 years old), divided into two groups: main group
(n=50) and comparison group (n=50).
A central removable air duct made of biocompatible
material is integrated into the classic silicone busbar. A
central removable air duct made of biocompatible
material is integrated into the classic silicone busbar.
The possibility of removing the air duct for cleaning the
nasal cavity without removing the entire tire. Reducing
mucosal trauma due to smooth edges of the structure.
Maintaining constant ventilation, minimizing swelling.
Patients of both groups received the same drug therapy
(topical corticosteroids). The main group: daily nasal
flushing through a detachable air duct. Standard care
with tire removal on the 3rd day for sanitation. SNOT-22
questionnaire (Sino-Nasal Outcome Test), validated for
assessing rhinosinusitis symptoms and quality of life.
Total score (0-110), where the lower value corresponds
to the better state. Assessment periods were 1, 3, and 7
days after surgery.
The data were processed in SPSS 26.0 using Student's t-
test. Significance level - p < 0.05.
RESULTS AND DISCUSSION
SNOT-22 score dynamics:
Parameter
Main group (n=50)
Comparison group
(n=50)
p-value
Day 1
42.1 ± 5.2
43.5 ± 4.8
>0.05
Day 3
28.3 ± 4.1
38.9 ± 5.6
<0.01
Day 7
18.4 ± 3.1
34.6 ± 4.8
<0.01
Table 1
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The removable air duct made it possible to avoid
repeated tire manipulations, which in the comparison
group caused microtraumas of the mucous membrane
and increased swelling. Daily flushing through the air
duct reduced the accumulation of fibrin and crusts -
key factors of inflammation. Patients in the main group
noted less stress associated with care, which indirectly
affected the recovery rate. Individual anatomical
features (for example, narrow nasal passages) were
not taken into account. Absence of long-term
observation (more than 1 month).
Key differences in symptoms (7th day) nasal
congestion in main group was 1.2 ± 0.4 points. In
comparison group was 3.8 ± 0.7 points. Headache in
main group was 0.9 ± 0.3 points and comparison group
were 2.4 ± 0.6 points.
Sleep disturbance in main group was 1.1 ± 0.2 points
and comparison group were 2.9 ± 0.5 points.
Microbiological analysis
Sterile swabs from the middle nasal sinuses were
investigated (day 0 and day 14) [7]. Cultivation was done
on blood agar and cups of Mannit salt agar (MSA) for the
selection of S. Aureus [8]. Comparison of S. aureus
colonization frequency: Pearson's χ2 criterion for
conjugate tables [10]. Relative risk (RR) with 95 %
confidence interval (CI) [11]. Comparison of average
values of CFU/ml, Odd Student's t-test for independent
were did [12]. Evaluating the effect was through the
difference in averages (Cohen's d) [13].
Initial microbiome (day 0):
Commensal microflora was dominant in all patients,
Staphylococcus epidermidis was 100% (EC/ml: 10
3
-10
4
,
SD=0.2×10
4
). Staphylococcus nasalis: 94% (47/50 in
both groups; CFU/ml: 10
2
-10
3
, SD=0.1×10
3
).
Microbiome dynamics on day 14:
Parameter
Main group (modified
spline)
Control group (standard
spline)
S. aureus colonization
4% (2/50)
68% (34/50)
Average S. aureus
CFU/ml
0,1 × 10² (SD= 0,3 × 10²)
2,5 × 10³ (SD= 1,1 × 10³)
Restoration of normal
flora
96% (48/50)
32% (16/50)
Table – 2
Frequency of S. aureus colonization:
S. aureus (+)
S. aureus (-)
Total
Main group
2
48
50
Control group
34
16
50
Table - 3
χ2 CRITERIA:
𝑋
2
= ∑
(𝑂 − 𝐸)
2
𝐸
= 44.44(𝑃 < 0.001)
p <0.001 means that the probability of
randomly obtaining such data is less than 0.1%
(provided the null hypothesis is true). This is a very high
significance.
The result allows us to reject the null
hypothesis (for example, about the absence of a
relationship between variables).
Relative risk (RR):
𝑅𝑅 =
𝐺𝑅𝑂𝑈𝑃 𝐸𝑋𝑃𝑂𝑆𝑈𝑅𝐸 𝑅𝐼𝑆𝐾
𝑅𝐼𝑆𝐾 𝑁𝑂𝑇 𝐸𝑋𝑃𝑂𝑆𝐸𝐷 𝑇𝑂 𝑇𝐻𝐸 𝐺𝑅𝑂𝑈𝑃
=
𝑎
𝑎 + 𝑏
𝑐
𝑐 + 𝑑
where:
• a
- the number of people with outcomes in the
exposed group,
• b
- the number of people with no outcome in the
exposed group,
• c
- the number of people with outcomes in the main
group,
• d
- the number of people with no outcome in the main
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group.
𝑅𝑅 =
34
50
2
50
= 17.0 (95%𝑇𝐼: 4.3 − 68.3)
• RR = 1:
there is no risk difference between the
groups.
• RR> 1:
Outcome risk is higher in the exposed group
(for example, smoking increases the risk of cancer).
• RR <1:
Outcome risk is lower in the exposed group
(for example, vaccination protects against disease).
Student's t-test:
𝑡 =
0.1 ∗ 10
2
− 2.5 ∗ 10
3
√(0.3 ∗ 10
2
)
2
50
+
√(1.1 ∗ 10
3
)
2
50
= −15.4(𝑝
< 0.001, 𝑑𝑓 = 98)
t-
statistic value (t = −15.4)
t-statistics show how strongly the average values of
the two groups differ in relation to data variability
within the groups. Negative value indicates the
direction of the effect, if the main group and the
comparison group were compared, the average value
of the main group was lower than the average value of
the comparison group. The quantity |t| = 15.4 is a very
large value, which indicates a strong statistical effect.
|t|> 2 is usually considered sig
nificant at a level of α =
0.05, |t|> 3 - extremely significant. p-value - the
probability of obtaining one or more extreme results if
the null hypothesis is true (i.e., if there is actually no
difference between the groups). • p <0.001 means that
the probability of randomly obtaining such data is less
than 0.1%. This is the highest degree of statistical
significance. We reject the null hypothesis (groups
differ significantly).
Effect size (Cohen's d):
𝑑 =
𝑀
1
− 𝑀
2
√𝑆𝐷
1
2
− 𝑆𝐷
2
2
2
= 2.8(𝑀𝑎𝑗𝑜𝑟 𝑒𝑓𝑓𝑒𝑐𝑡)
Commensal staphylococci (S. epidermidis, S. nasalis)
compete with S. aureus for resources by secreting
antimicrobial peptides (for example, lantibiotics). In
the control group, the use of standard splints led to a
decrease in the proportion of S. nasalis from 94% to
32%, which correlated with the growth of S. aureus
(68%). Conversely, in the main group, the preservation
of normoflora (96%) ensured the ecological suppression
of the pathogen (4% of colonization).
CONCLUSION
A modified endonasal splint with a central air duct
demonstrated a statistically significant decrease in the
frequency of Staphylococcus aureus colonization
(χ2=44.44, p <0.001) and the level of bacterial load
(t=15.4, p <0.001) compared to standard analogues.
Analysis of the relative risk (OR=17.0, 95% CI:4.2-68.3)
and the magnitude of the effect (Cohen's d=2.8)
emphasizes the clinical relevance of the intervention.
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