Middle meatal packing in endoscopic sinus surgery—to pack or not to pack?—a decision‐analysis model

Stern-Shavit, Sagit; Nachalon, Yuval; Leshno, Moshe; Soudry, Ethan

doi:10.1002/lary.26506

Cited by 16 publications

(18 citation statements)

References 28 publications

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“…Evidence exists to support the position that packing for hemostasis is not essential for the vast majority of sinus cases 2159–2167 . Five RCTs comparing packing to no‐packing reported no evidence of significant post‐operative bleeding requiring intervention in their unpacked arms 2159–2161,2165,2167 .…”

Section: Surgery For Chronic Rhinosinusitismentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

530

479

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I. Executive Summary Background The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.

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Section: Surgery For Chronic Rhinosinusitismentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

530

479

View full text Add to dashboard Cite

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“…A review article by Wietzel and Wormald evaluating resorbable and nonresorbable middle meatal stents demonstrated there were no conferred benefits of resorbable packing over nonresorbable packing for the purposes of preventing adhesions and synechia. Steroid‐eluting products were not evaluated in this particular study …”

Section: Discussionmentioning

confidence: 99%

“…There were no significant differences between SinuBand FP, SinuBand, and Merocel in regard to inflammation, adhesion, and LK scores . The use of topically delivered steroids in sufficient concentrations is theoretically ideal, but the technology is expensive and it is not clear if they could be placed alone in the middle meatus without an additional spacer . A recent Cochrane review evaluated steroid‐eluting stents for improving symptoms in CRS patients after FESS with 1 of the following types of interventions: (1) steroid‐eluting sinus stent vs non–steroid‐eluting sinus stent; (2) steroid‐eluting stent vs nasal packing; and (3) steroid‐eluting sinus stent vs no treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Steroid-eluting products were not evaluated in this particular study. 29,30 Several different kinds of stents are available ranging from absorbable drug-eluting stents to nonabsorbable purely "spacer" stents. Nonabsorbable stents may be uncomfortable for patients and cause bleeding during removal.…”

Section: Discussionmentioning

confidence: 99%

“…31 The use of topically delivered steroids in sufficient concentrations is theoretically ideal, but the technology is expensive 32 and it is not clear if they could be placed alone in the middle meatus without an additional spacer. 30 A recent Cochrane review evaluated steroid-eluting stents for improving symptoms in CRS patients after FESS with 1 of the following types of interventions: (1) steroid-eluting sinus stent vs non-steroid-eluting sinus stent; (2) steroideluting stent vs nasal packing; and (3) steroid-eluting sinus stent vs no treatment. The conclusions were that there is insufficient data to suggest steroid-eluting stents significantly improve symptom or surgical outcomes in patients undergoing FESS over other non-drug-eluting packing or no packing.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of steroid‐releasing stents vs nonabsorbable packing as middle meatal spacers

Rawl

McQuitty

Khan

et al. 2019

Int Forum Allergy Rhinol

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Background A randomized controlled trial was held to compare nonabsorbable packs to steroid‐eluting absorbable stents as middle meatal spacers after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). Methods CRS patients were randomly assigned to receive either nonabsorbable Merocel packs wrapped in non‐latex glove material (packing type A) or Propel steroid eluting stents (packing type B). Twenty‐two–item Sino‐Nasal Outcome Test (SNOT‐22) scores were collected preoperatively and postoperatively during the initial 4 debridements up to 3 months. Recording of the nasal endoscopy was also collected during all postoperative visits. In addition, Lund‐Kennedy scores and middle turbinate lateralization scores, using a new visual analogue scale, were compared between the 2 types of packing. Results Forty CRS patients were prospectively enrolled in this institutional review board (IRB)‐approved study. Patients with packing type A had significantly lower middle turbinate lateralization scores at their first (∼10 days) postoperative visit (p = 0.02 and p = 0.04, for left and right sides, respectively). This difference disappeared by later postoperative visits (from 20 days to 3 months). Overall, patients receiving packing type A had significant lower SNOT‐22 scores at 20 days postsurgery (p = 0.05). This difference also disappeared at 1 and 3 months postoperation. There were no statistically significant differences in Lund‐Kennedy scores. Conclusion In this study, nonabsorbable packing materials showed significant superior middle meatal spacing capacities as evidenced by greater middle turbinate medialization capability at the first postoperative visit. Additionally, patients with this type of packing saw improvements in their SNOT‐22 scores at the 20‐day postoperative visit. This study showed that there was no significant improvement in postoperative outcomes with drug‐eluting stents when compared to nonabsorbable packing.

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Hot saline irrigation in comparison to nasal packing after sinus surgery

Nordström

Jangard

Svedberg

et al. 2021

Laryngoscope Investig Oto

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Objectives: Previous studies have shown that hot saline solution (HSS) nasal irrigation is effective against nasal bleeding and is used to treat nasal hemorrhage. In a pilot study, we evaluated hot saline nasal irrigation in comparison to a routinely used nasal packing in terms of self-reported complications and mucosal healing after functional endoscopic sinus surgery.Methods: Patients undergoing surgery for bilateral chronic rhinosinusitis received polyvinyl acetate (PVA) nasal packing in the left nostril, and the right nostril was rinsed with 47 C sterile saline immediately after surgery. Patients' experiences of pain, bleeding, and other types of uncomfortable experiences were measured using a visual analog scale for each nostril before, during, and immediately after nasal packing removal. Two weeks post-surgery, the assessments were repeated including an endoscopic evaluation of the mucosa by the surgeon.Results: Twenty-seven patients completed the study. Prior to removal of the packing, the patients experienced significantly more pain and other uncomfortable experiences in the nostril treated with nasal packing, as compared to the nostril solely rinsed with hot saline. After removal, patients reported significantly more uncomfortable experiences from the packing treated nostril. Two weeks post-surgery, no difference in mucosal healing was observed between the two nostrils. Conclusions:The results from this study indicate that irrigation with HSS could be an alternative postoperative treatment to conventional PVA nasal packing. Hot saline irrigation may contribute to patients experiencing improved control of postoperative bleeding, pain, and less suffering of other causes as well as health-economic benefits, without affecting the mucosal healing up to 2 weeks post-surgery.

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Middle meatal packing in endoscopic sinus surgery—to pack or not to pack?—a decision‐analysis model

Abstract: 1a. Laryngoscope, 127:1506-1512, 2017.

Cited by 16 publications

References 28 publications

International consensus statement on allergy and rhinology: rhinosinusitis 2021

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Comparison of steroid‐releasing stents vs nonabsorbable packing as middle meatal spacers

Hot saline irrigation in comparison to nasal packing after sinus surgery

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