Systematic Review and Metaanalysis of Middle Meatal Packing after Endoscopic Sinus Surgery

Hobson, Candace E.; Choby, Garret; Wang, Eric; Morton, Sally C.; Lee, Stella

doi:10.2500/ajra.2015.29.4153

Cited by 22 publications

(20 citation statements)

References 30 publications

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“…We hypothesized that this was to prevent adhesion to the lateral wall and/or obstruction of the osteomeatal complex or perhaps was removed among a dense clutch of polyps. The former issue is important to avoid, but, rather than resecting the middle turbinate (and hence altering the anatomic appearance), we would advocate the placement of a middle meatal “spacer” at the end of the procedure 18,19 …”

Section: Discussionmentioning

confidence: 99%

Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

Bewick

Egro

Masterson

et al. 2016

Allergy�Rhinol (Providence)

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Background:It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease.Objective:To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS.Methods:A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed.Results:Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10).Conclusion:Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs.

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Section: Discussionmentioning

confidence: 99%

Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

Bewick

Egro

Masterson

et al. 2016

Allergy�Rhinol (Providence)

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“…In a meta‐analysis by Hobson et al, the pooled data revealed that 19.95% of patients with packing had synechiae compared to 36.6% in patients without packing. This difference however, did not reach statistical significance . Another meta‐analysis by Yan et al found no difference in synechiae formation rate between biodegradable nasal packing compared to no packing .…”

Section: Discussionmentioning

confidence: 95%

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

et al. 2017

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“…Whether to pack or not pack the middle meatus has been a question of interest for years. One systematic review and meta‐analysis by Hobson et al . evaluated various packing types vs control patients without packing.…”

Section: Discussionmentioning

confidence: 99%

“…Whether to pack or not pack the middle meatus has been a question of interest for years. One systematic review and meta-analysis by Hobson et al 28 evaluated various packing types vs control patients without packing. They noted that although there was a trend favoring packing, it was only marginally significant (p = 0.052), owing largely to the significant heterogeneity in study designs and data collected.…”

Section: Discussionmentioning

confidence: 99%

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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Systematic Review and Metaanalysis of Middle Meatal Packing after Endoscopic Sinus Surgery

Cited by 22 publications

References 30 publications

Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

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

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

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