Efficacy of Steroid-Impregnated Spacers After Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis
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Objectives. The aim of this study was to compare the effect of steroid-impregnated spacers to that of conventional manage-ment after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Methods. Six databases were searched from inception until November 2022. Sixteen studies were found that comparedthe improvement of chronic sinusitis-related symptoms and postoperative outcomes between a steroid-impregnatedspacer group and a control group (non-steroid-impregnated spacers). The Cochrane risk of bias tool (for randomizedcontrolled studies) and the Newcastle-Ottawa Scale (for non-randomized controlled studies) were used to assess thequality of the works included. Results. Regarding the endoscopic findings, the degree of mucosal edema, ethmoid inflammation, crust formation at 2–3 monthspostoperatively, nasal discharge, polyposis, and scarring/synechia were significantly lower in the steroid-impregnatedspacer group. The steroid-impregnated spacer group also showed significantly lower Lund–Kennedy scores and peri-operative sinus endoscopy scores than the control group at 2–3 weeks postoperatively. Furthermore, the steroid-im-pregnated spacer group had lower rates of adhesions, middle turbinate lateralization, polypoid changes, the need fororal steroid use, the need for postoperative therapeutic interventions, and lysis of adhesions than controls. However,no significant between-group differences were found in short-term (2–3 weeks postoperatively) endoscopic findingsregarding nasal discharge, postoperative crusting, polyposis, or scarring/synechia. Conclusion. Steroid-impregnated nasal packing reduced the rates of postoperative intervention and recurrent polyposisand inflammation in CRS patients undergoing ESS.
Abstract
Objectives. The aim of this study was to compare the effect of steroid-impregnated spacers to that of conventional manage-ment after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Methods. Six databases were searched from inception until November 2022. Sixteen studies were found that comparedthe improvement of chronic sinusitis-related symptoms and postoperative outcomes between a steroid-impregnatedspacer group and a control group (non-steroid-impregnated spacers). The Cochrane risk of bias tool (for randomizedcontrolled studies) and the Newcastle-Ottawa Scale (for non-randomized controlled studies) were used to assess thequality of the works included. Results. Regarding the endoscopic findings, the degree of mucosal edema, ethmoid inflammation, crust formation at 2–3 monthspostoperatively, nasal discharge, polyposis, and scarring/synechia were significantly lower in the steroid-impregnatedspacer group. The steroid-impregnated spacer group also showed significantly lower Lund–Kennedy scores and peri-operative sinus endoscopy scores than the control group at 2–3 weeks postoperatively. Furthermore, the steroid-im-pregnated spacer group had lower rates of adhesions, middle turbinate lateralization, polypoid changes, the need fororal steroid use, the need for postoperative therapeutic interventions, and lysis of adhesions than controls. However,no significant between-group differences were found in short-term (2–3 weeks postoperatively) endoscopic findingsregarding nasal discharge, postoperative crusting, polyposis, or scarring/synechia. Conclusion. Steroid-impregnated nasal packing reduced the rates of postoperative intervention and recurrent polyposisand inflammation in CRS patients undergoing ESS.
참고문헌 (32)
- Fokkens WJ, "European position paper on rhinosinusitis and nasal polyps 2020", Rhinology, 58(Suppl 29), pp.1~464 (2020)
- 박도양, "Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults", Clinical and Experimental Otorhinolaryngology, 15(1), pp.5~23 (2022), 대한이비인후과학회[DOI]
- Orlandi RR, "International consensus statement on allergy and rhinology : rhinosinusitis 2021", Int Forum Allergy Rhinol, 11(3), pp.213~739 (2021)
- Svider PF, "Geographic and temporal trends in frontal sinus surgery", Int Forum Allergy Rhinol, 5(1), pp.46~54 (2015)
- DeConde AS, "Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis", Laryngoscope, 127(3), pp.550~555 (2017)
- Stein NR, "Revision rates and time to revision following endoscopic sinus surgery : a large database analysis", Laryngoscope, 128(1), pp.31~36 (2018)
- Cote DW, "Triamcinolone-impregnated nasal dressing following endoscopic sinus surgery : a randomized, double-blind, placebo-controlled study", Laryngoscope, 120(6), pp.1269~1273 (2010)
- Adriaensen GF, "Safety and efficacy of a bioabsorbable fluticasone propionate-eluting sinus dressing in postoperative management of endoscopic sinus surgery : a randomized clinical trial", Int Forum Allergy Rhinol, 7(8), pp.813~820 (2017)
- Grzeskowiak B, "Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery : a randomized, double blind, placebo-controlled study", Braz J Otorhinolaryngol, 85(4), pp.473~480 (2019)
- Gyawali BR, "Comparison of outcomes of triamcinolone versus normal saline soaked polyvinyl alcohol pack following bilateral endoscopic sinus surgery", Rhinology, 57(4), pp.287~292 (2019)
- Ha T, "The efficacy of a novel budesonide chitosan gel on wound healing following endoscopic sinus surgery", Int Forum Allergy Rhinol, 8(3), pp.435~443 (2018)
- Huang Z, "Comparison of bioabsorbable steroid-eluting sinus stents versus nasopore after endoscopic sinus surgery : a multicenter, randomized, controlled, single-blinded clinical trial", Ear Nose Throat J, 101(4), pp.260~267 (2022)
- Hwang CS, "Randomized controlled trial of steroid-soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery", Laryngoscope, 128(2), pp.311~316 (2018)
- Luong A, "Safety and effectiveness of a bioabsorbable steroid-releasing implant for the paranasal sinus ostia : a randomized clinical trial", JAMA Otolaryngol Head Neck Surg, 144(1), pp.28~35 (2018)
- Marple BF, "Advance II : a prospective, randomized study assessing safety and efficacy of bioabsorbable steroid-releasing sinus implants", Otolaryngol Head Neck Surg, 146(6), pp.1004~1011 (2012)
- More Y, "Management of early nasal polyposis using a steroid-impregnated nasal dressing", Int Forum Allergy Rhinol, 1(5), pp.401~404 (2011)
- Murr AH, "Safety and efficacy of a novel bioabsorbable, steroid-eluting sinus stent", Int Forum Allergy Rhinol, 1(1), pp.23~32 (2011)
- Rudmik L, "Effect of a dexamethasone Sinu-FoamTM middle meatal spacer on endoscopic sinus surgery outcomes : a randomized, double-blind, placebo-controlled trial", Int Forum Allergy Rhinol, 2(3), pp.248~251 (2012)
- Sabarinath V, "Triamcinolone impregnated nasal pack in endoscopic sinus surgery : our experience", Indian J Otolaryngol Head Neck Surg, 69(1), pp.88~92 (2017)
- Samarei R, "Efficacy of triamcinolone acetonide-impregnated Gelfoam nasal pack in management of chronic sinusitis with nasal polyps following endoscopic sinus surgery : a perfectly matched, placebo-controlled trial study", Eur Arch Otorhinolaryngol, 279(6), pp.2915~2924 (2022)
- Smith TL, "Randomized controlled trial of a bioabsorbable steroid-releasing implant in the frontal sinus opening", Laryngoscope, 126(12), pp.2659~2664 (2016)
- Xu J, "Effects of triamcinolone-impregnated nasal dressing on subjective and objective outcomes following endoscopic sinus surgery", Eur Arch Otorhinolaryngol, 273(12), pp.4351~4357 (2016)
- Zhao KQ, "Effects of mometasone furoate-impregnated biodegradable nasal dressing on endoscopic appearance in healing process following endoscopic sinus surgery : a randomized, double-blind, placebo-controlled study", Int Forum Allergy Rhinol, 8(11), pp.1233~1241 (2018)
- 김도현, "Clinical and Laboratory Features of Various Criteria of Eosinophilic Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis", Clinical and Experimental Otorhinolaryngology, 15(3), pp.230~246 (2022), 대한이비인후과학회[DOI]
- 황세환, "Practical Review of Olfactory Training and COVID-19", Journal of Rhinology, 29(3), pp.127~133 (2022), 대한비과학회[DOI]
- Wright ED, "Impact of perioperative systemic steroids on surgical outcomes in patients with chronic rhinosinusitis with polyposis : evaluation with the novel Perioperative Sinus Endoscopy(POSE)scoring system", Laryngoscope, 117(11 Pt 2 Suppl 115), pp.1~28 (2007)
- Li W, "Efficacy and safety of steroid-impregnated implants following sinus surgery : a meta-analysis", Laryngoscope, 130(12), pp.2754~2759 (2020)
- Stefan MM, "Effect of steroid-releasing sinus implants after endoscopic sinus surgery(ESS)on postoperative outcomes : a meta-analytical study", Egypt J Otolaryngol, 35, pp.250~255 (2019)
- Zhao X, "A systematic review of nonabsorbable, absorbable, and steroid-impregnated spacers following endoscopic sinus surgery", Int Forum Allergy Rhinol, 3(11), pp.896~904 (2013)
- Goshtasbi K, "Efficacy of steroid-eluting stents in management of chronic rhinosinusitis after endoscopic sinus surgery : updated meta-analysis", Int Forum Allergy Rhinol, 9(12), pp.1443~1450 (2019)
- Zhang M, "Efficacy of absorbable steroid-impregnated nasal packing in functional endoscopic sinus surgery for chronic rhinosinusitis : a systematic review", Laryngoscope, 131(8), pp.1704~1714 (2021)
- Hosemann W, "Normal wound healing of the paranasal sinuses : clinical and experimental investigations", Eur Arch Otorhinolaryngol, 248(7), pp.390~394 (1991)