Randomized controlled trial of steroid‐soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery

Hwang, Chi Sang; Sharhan, Salma Saud Al; Kim, Bo Ra; Kim, Soo In; Kim, Jinwoong; Cho, Hyung‐Ju; Yoon, Joo Heon; Kim, Chang Hoon

doi:10.1002/lary.26871

Cited by 22 publications

(48 citation statements)

References 34 publications

(57 reference statements)

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“…Recently, several trials found that bioabsorbable implants impregnated with topical steroids have beneficial effects and can reduce the incidence of these complications. 21,24,25 However, Xu et al conducted a retrospective cohort study of 142 patients who underwent ESS for CRS. They showed steroid-impregnated absorbable spacers at the middle meatal entry did not have a statistically significant reduction in postoperative synechiae formation when compared to nonabsorbable spacers.…”

Section: Discussionmentioning

confidence: 99%

“…However, a steroid-soaked absorbable dressing has a better effect, which can deliver more steroids to the most difficult and unreachable areas, such as the frontal and sphenoid sinuses. 21 The clinical relevance of results regarding bioabsorbable steroid-impregnated implants following ESS was rare in the literature. Adriaensen et al reported patients with sinusband fluticasone propionate had significantly less nasal congestion compared with those patients with sinusband 60 days after surgery, 20 whereas Xu et al showed the triamcinolone-impregnated dressing did not improve the Sino-Nasal Outcome Test 20 scores compared to the saline-impregnated dressing.…”

Section: Discussionmentioning

confidence: 99%

“…10,14 Furthermore, the differences in the durations of the included trials (1, 2, or 3 months) were a potential source of heterogeneity, and the follow-up time is extremely short. Finally, the types of bioabsorbable implants were different, including Gelfoam dressing (Pfizer, New York, NY), 18 NasoPore dressing (Stryker, Kalamazoo, MI), 16,17 calcium alginate dressing (Algi-Pack，Seoul), 21 SinuBand dressing (MedtronicXomed Inc., Jacksonville), 20 stents, 10,14 and Sinus-Foam spacer (Athrocare, Sunnyvale), 19 which may have led to heterogeneous results. To reinforce the validity of our meta-analysis, clinical trials of the same implant soaked in steroid following ESS as well as extended followup trials should be conducted in the future.…”

Section: Discussionmentioning

confidence: 99%

“…They may be risk factors for medical and surgical interventions to enhance the postsurgical ability to heal. Recently, several trials found that bioabsorbable implants impregnated with topical steroids have beneficial effects and can reduce the incidence of these complications 21,24–25 . However, Xu et al conducted a retrospective cohort study of 142 patients who underwent ESS for CRS.…”

Section: Discussionmentioning

confidence: 99%

“…14 Six studies were ruled out because the treatment was in-office; six studies were excluded because the dates were not available; and 13 studies were ruled out because the studies were not randomized controlled trials (RCTs). Ultimately, eight published articles were eligible for analysis, 10,14,[16][17][18][19][20][21] and the study reported by Adriaensen et al 20 was a three-arm study.…”

Section: Literature Searchmentioning

confidence: 99%

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Efficacy and safety of steroid‐impregnated implants following sinus surgery: A meta‐analysis

Wang

et al. 2019

The Laryngoscope

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The purpose of this meta-analysis was to discuss the efficacy and safety of bioabsorbable steroid-impregnated implants following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) patients. Methods: PubMed, Cochrane, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were comprehensively searched for studies comparing the experimental group (bioabsorbable steroid-impregnated implants) with the control group (bioabsorbable nonsteroid-impregnated implants). Lund-Kennedy scores, Perioperative Sinus Endoscopy (POSE) scores, polyp change, significant adhesion, middle turbinate lateralization, and adverse events were extracted from the final eligible studies. RevMan 5.3 software was used to analyze the data. Results: Eight randomized controlled trials were included in our analysis. The experimental group showed no significant differences from the control group in Lund-Kennedy scores (weighted mean difference (WMD) −0.40; 95% confidence interval [confidence interval (CI)] −1.05 to −0.62; P = 0.23). The experimental group had lower POSE scores compared with the control group, and there was a significant difference (WMD −1.88; 95% CI −2.32 to −1.43, P < 0.00001). The pooled results also demonstrated significant differences in polyp change, significant adhesion, and middle turbinate lateralization between the two groups. In addition, there was no significant difference with respect to adverse events between the two groups (odds ratio (OR) 0.38; 95% CI: 0.07 to 2.03; P = 0.26). Conclusion: Bioabsorbable steroid-impregnated implants following ESS are effective in improving the endoscopic appearance of the healing process, and the safety profile appears to be favorable for the treatment of CRS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

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Efficacy and safety of steroid‐impregnated implants following sinus surgery: A meta‐analysis

Wang

et al. 2019

The Laryngoscope

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Effects of implants with steroids after endoscopic sinus surgery: A systematic review with meta‐analysis of randomized controlled trials

Kao

Huang

Tsai

et al. 2021

Int Forum Allergy Rhinol

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Background Chronic rhinosinusitis affects approximately 5%−2% of the general population worldwide. Steroid implants after endoscopic sinus surgery (ESS) have drawn considerable interest for their cost savings, but relevant guidelines indicate that evidence on this topic is of low quality with high heterogeneity. The purpose of this study was to examine the efficacy of steroid implants after ESS by synthesizing relevant randomized controlled trials (RCTs). Methods Two authors independently assessed the eligibility of potential references from five biomedical databases. They further extracted relevant data from the included studies, including (a) mean, standard deviation, or standard error for Lund–Kennedy endoscopic (LKE) score and Perioperative Sinus Endoscopy (POSE) score and (b) events and sample sizes of each group for further intervention. Data were pooled in a random‐effects model, and results were presented as the weighted mean difference (WMD) or risk ratio (RR) with 95% confidence interval (CI) and I2. Results Eleven RCTs (n = 853) were included and showed that the steroid implant group had lower LKE scores (WMD, ‐1.19; 95% CI, ‐1.75 to ‐0.62; I2 = 0%) and POSE scores (WMD, ‐1.62; 95% CI, ‐2.47 to ‐0.76; I2 = 48%) than the placebo implant group at postoperative week 2. Moreover, the reoperation rate in the steroid implant group was also lower than in the placebo implant group (RR, 0.49; 95% CI, 0.30 to 0.80; I2 = 0%). However, no significant difference was observed in the postoperative oral steroid requirement between both groups. Conclusions Collectively, steroid implant decreases LKE and POSE among patients receiving ESS in the short term, but long‐term effects remain unclear. Patient‐based outcomes are worth further discussion in the future.

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Efficacy of Absorbable Steroid‐Impregnated Nasal Packing in Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review

2021

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Objective: To evaluate the efficacy of absorbable steroid-impregnated nasal packing on postoperative outcomes following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS).Methods: A systematic review of the literature was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twelve databases (including Journals@Ovid, Embase ® , Medline ® , EBM Reviews and Joanna Briggs Institute EBP Database) were searched using relevant keywords and expanded with corresponding MeSH/Emtree terms. Results were narrowed to English articles assessing the efficacy of absorbable packing impregnated with steroids post-production placed at time of surgery under general anesthetic, with hollow-lumen devices and devices inserted in-office excluded.Results: Eight studies met criteria and were included in this review. Five evaluated the efficacy of the intervention in only CRS with nasal polyposis (CRSwNP) patients, two included all subtypes of CRS, and one included only CRS without nasal polyposis (CRSsNP). Of the eight studies, four studied the efficacy of Nasopore ® , three studied bioabsorbable gels, and one studied bioabsorbable calcium alginate. Four studies applied triamcinolone as the operative steroid, with the other studies utilizing betamethasone, budesonide, mometasone, and dexamethasone. Seven studies demonstrated statistically significant improvements in endoscopic outcomes using validated scoring scales, albeit at differing timepoints. The one study which included only CRSsNP patients failed to find a significant difference.Conclusion: Steroid-impregnated nasal packing appears to have positive effects on postoperative endoscopic outcomes in CRSwNP patients undergoing FESS. Additional research is needed to evaluate the efficacy of these interventions in more recently defined subtypes of CRS, and whether these interventions differ in their efficacy in eosinophilic and noneosinophilic CRS.

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Randomized controlled trial of steroid‐soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery

Abstract: 1b. Laryngoscope, 128:311-316, 2018.

Cited by 22 publications

References 34 publications

Efficacy and safety of steroid‐impregnated implants following sinus surgery: A meta‐analysis

Efficacy and safety of steroid‐impregnated implants following sinus surgery: A meta‐analysis

Effects of implants with steroids after endoscopic sinus surgery: A systematic review with meta‐analysis of randomized controlled trials

Efficacy of Absorbable Steroid‐Impregnated Nasal Packing in Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review

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