Middle Meatal Spacers Research Articles

Comparison between Rapid Rhino® Pack and Gloved Nasal Pack as Middle Meatal Spacers after Endoscopic Sinus Surgery

Comparison between Rapid Rhino® Pack and Gloved Nasal Pack as Middle Meatal Spacers after Endoscopic Sinus Surgery

Efficiency of a biodegradable gel containing hyaluronic acid and berberine hydrochloride in endoscopic sinus surgery (ESS): A prospective comparative study

PurposeTo evaluate the efficiency of a biodegradable gel containing hyaluronic acid and berberine hydrochloride in endoscopic sinus surgery. MethodsSixty-six chronic rhinosinusitis patients with or without nasal polyps who underwent bilateral endoscopic sinus surgery (ESS) were randomly received a biodegradable gel containing hyaluronic acid and berberine hydrochloride or merocel in both middle meatal spacers at the end procedure of ESS. Lund–Kennedy endoscopic score (LKES) was used to examine status of nasal cavity on preoperative day and postoperative day 1 to 7. The LKES ratio was calculated as the LKES on postoperative day divided into the LKES on preoperative day. Visual analogue score (VAS) was used to assess patient's status from the first postoperative day to the hospital discharge day. The average VAS during hospital stays was calculated by the sum of VAS in each examination day divided into the number of examined day. The LKES ratio, the average of VAS during hospital stays and length of hospitalized day of the patients were used as clinical outcome indices in early stage after surgery. A general linear model adjusted for confounding factors was used for data analysis. ResultsAdjusted mean of LKES ratio were lower in group used biodegrable gel of hyaruloic acid and berberin hydrochlode (study group) than those in merocele group in the postoperative day 1 to day 7. However, significant difference was found in the adjusted mean of LKES ratio on the postoperative day 2 to 6. Similarly, the adjusted mean of VAS during hospital stays and length of hospitalized day after surgery in study group were significantly decreased as compared with those in merocele group. ConclusionsBiodegradable material containing hyaluronic acid and berberine hydrochloride was more effective than merocel in length of hospital stay, post-operative symptoms, and sinus cavity's status in early stage after ESS.

Effect of Absorbable Middle Meatal Spacers in Prevention of Synechiae Following Endoscopic Sinus Surgery at Zagazig University Hospitals

Effect of Absorbable Middle Meatal Spacers in Prevention of Synechiae Following Endoscopic Sinus Surgery at Zagazig University Hospitals

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

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). 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. 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. 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.

Comparing the efficacy of Silastic and gloved-Merocel middle meatal spacers for functional endoscopic sinus surgery: a randomized controlled trial.

Spacers are inserted into the middle meatal space (MMS) following functional endoscopic sinus surgery (FESS) to prevent lateralization of the middle turbinate, scarring, and synechiae. Our objective was to determine if the incidence of postoperative synechiae, facial pain/discomfort, pain during spacer removal, scarring, and discharge differed between nasal cavities receiving Silastic or gloved-Merocel (GM) spacers following FESS. A double-blind, randomized controlled trial (RCT) was conducted in adults requiring bilateral FESS for chronic rhinosinusitis (CRS) ± nasal polyposis. Participants served as their own controls, with each subject receiving both a Silastic and GM spacer. Spacers were inserted into the MMS during FESS and left in situ for 6 days. Participants were reviewed at 6 days, 5 weeks, and 12 weeks postoperatively. The presence of synechiae and scarring were evaluated endoscopically. Inflammation, discharge, and pain during spacer removal were assessed using a visual analogue scale (VAS). Forty-eight participants (96 nasal cavities) were recruited. Preoperatively, Lund-Mackay computed tomography (CT) scores were similar between Silastic-treated and GM-treated cavities (6.38 ± 2.35 vs 6.18 ± 2.17). The incidence of synechiae and scarring did not differ significantly between spacers up to 12 weeks postoperatively. Pain during spacer removal was significantly greater for Silastic than GM spacers (2.13 ± 1.34 vs 1.51 ± 1.23, p = 0.020). Facial pain prior to removal and extent of discharge did not differ significantly between spacers. Following FESS, patients report less pain during removal of GM than Silastic spacers. However, the likelihood of synechiae and scarring did not differ between either of the spacers.

Postop Care after Endoscopic Sinus Surgery: Packing, Spacers, or Nothing

Program Description: Since the introduction of endoscopic sinus surgery, surgeons have debated the merits of middle meatus packing. Many surgeons favor a middle meatal spacer, rather than packing, since the former implies an intentional design for better wound healing. Recently, the emphasis has been upon dissolvable or fragmentable materials that may exert positive effects upon wound healing, and a dissolvable stent that provides drug delivery has also been introduced. In addition, some surgeons do not use any materials whatsoever in the middle meatus after surgery. This miniseminar will feature evidence-based reviews of the published trials, as well as practical knowledge from experienced surgeons. Educational Objectives: (1) Comprehend the principles of biomaterials selection for placement in the nose and paranasal sinuses. (2) Review principles of postoperative care with an emphasis on integration into the global surgical strategy. (3) Compare various middle meatal spacers, including chitosan, esterified hyaluronic acid, steroid-releasing implant, and synthetic fragmental foam sponge.

The Role of Postoperative Systemic Corticosteroids when Using a Steroid‐Eluting Spacer following Sinus Surgery

Objectives: 1) Describe the current evidence for middle-meatal steroid-eluting spacers in patients with chronic rhinosinusitis (CRS) following endoscopic sinus surgery (ESS) 2) Evaluate the need for postoperative systemic corticosteroids in CRS patients with nasal polyposis when using a steroid-eluting middle meatal spacer following ESS. Methods: CRS patients with nasal polyposis who failed medical therapy and elected ESS (n=36) were enrolled into this randomized, double-blind, placebo controlled trial. Patients were randomized into either a treatment arm (postoperative prednisone 30 mg once daily for 7 days; n=18) or placebo arm (placebo pill once daily for 7 days =18). Therapeutic outcomes were evaluated at 1 week, 3 weeks, and 2 months postoperatively. Primary outcome was endoscopic grading using the Lund-Kennedy scoring system. Secondary outcome included disease-specific quality of life (QoL) using the SNOT-22 survey. Results: Both study arms received significant improvement in endoscopic grading and disease-specific QoL from baseline compared to the two-month follow-up (p0.119). Conclusions: Minimizing the use of systemic corticosteroids in patients with CRS may avoid unwanted adverse events. Results from this study suggest that when using a middle meatal steroid-eluting spacer during ESS for patients with nasal polyposis, postoperative systemic corticosteroids may not significantly improve short-term endoscopic and disease-specific QoL.

A double-blind randomised controlled trial of gloved versus ungloved merocel middle meatal spacers for endoscopic sinus surgery

Middle meatal spacers are commonly used following endoscopic sinus surgery to prevent post-operative bleeding and lateralization of the middle turbinates. The effects of nasal packing on post-operative sinonasal mucosal healing remain unknown in humans. This study aims to compare the histopathalogical effects of Merocel and Merocel covered with a finger glove on mucosal healing, and patients` discomfort immediately post-operatively after endoscopic sinus surgery and at removal of the nasal packing. Thirty-seven patients with chronic rhinosinusitis undergoing bilateral endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive Merocel middle meatal spacer (MMMS) in one nostril and finger glove Merocel middle meatal spacer (FGMMS) in the contra lateral side. Patients were seen on post-operative day 6, and completed a visual analogue score reporting the post-operative discomfort from nasal packing on each side. Following the removal of nasal packing, patients indicated which side caused more discomfort on removal. Biopsies were taken from the middle turbinates and sent to a blinded pathologist who scored the level of mucosal inflammation from 0 - 4. There was no statistically significant difference between MMMS and FGMMS in regards to their effect on sinonasal mucosal inflammation and discomfort post-operatively. A statistically significant difference was noted with respect to discomfort at removal with the uncovered Merocel more likely to cause discomfort when compared to the Merocel covered in a glove finger. MMMS and FGMMS are equivalent in the amount of sinonasal mucosal inflammation and discomfort post endoscopic sinus surgery. However, the main advantage of the FGMMS was a significant reduction in pain on removal when compared with the MMMS.

A double-blind randomised controlled trial of gloved versus ungloved merocel middle meatal spacers for endoscopic sinus surgery

Background: Middle meatal spacers are commonly used following endoscopic sinus surgery to prevent post-operative bleeding and lateralization of the middle turbinates. The effects of nasal packing on post-operative sinonasal mucosal healing remain unknown in humans. Objective: This study aims to compare the histopathalogical effects of Merocel and Merocel covered with a finger glove on mucosal healing, and patients` discomfort immediately post-operatively after endoscopic sinus surgery and at removal of the nasal packing. Methods: Thirty-seven patients with chronic rhinosinusitis undergoing bilateral endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive Merocel middle meatal spacer (MMMS) in one nostril and finger glove Merocel middle meatal spacer (FGMMS) in the contra lateral side. Patients were seen on post-operative day 6, and completed a visual analogue score reporting the post-operative discomfort from nasal packing on each side. Following the removal of nasal packing, patients indicated which side caused more discomfort on removal. Biopsies were taken from the middle turbinates and sent to a blinded pathologist who scored the level of mucosal inflammation from 0 - 4. Results: There was no statistically significant difference between MMMS and FGMMS in regards to their effect on sinonasal mucosal inflammation and discomfort post-operatively. A statistically significant difference was noted with respect to discomfort at removal with the uncovered Merocel more likely to cause discomfort when compared to the Merocel covered in a glove finger. Conclusion: MMMS and FGMMS are equivalent in the amount of sinonasal mucosal inflammation and discomfort post endoscopic sinus surgery. However, the main advantage of the FGMMS was a significant reduction in pain on removal when compared with the MMMS.

Middle meatal spacers for the prevention of synechiae following endoscopic sinus surgery: a systematic review and meta‐analysis of randomized controlled trials

Middle meatal (MM) synechiae is the most common complication following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. To prevent synechiae formation, a variety of MM spacers have been employed, with varying success in the reported literature. There remains a continued debate on whether MM spacers actually reduce the risk of synechiae following ESS. The Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was used for reporting this review of randomized controlled trials evaluating the effectiveness of MM spacers compared to no spacers in patients undergoing ESS. Where appropriate, a meta-analysis on outcome data using a random effects model was performed. Eight randomized controlled trials were included in this systematic review. A pooled analysis on relevant trials found a nonsignificant trend favoring MM spacers compared to no spacers for the prevention of synechiae following ESS (relative risk [RR], 0.40; 95% confidence interval [CI], 0.14-1.12). Subgroup analysis suggested that nonabsorbable spacers (NAS) may be more effective than absorbable spacers (AS) for reducing the risk of synechiae compared to no spacers. MM spacers may be more effective than no spacers for the prevention of synechiae following ESS, especially when employing the use of an NAS. However, significant heterogeneity is observed among included trials and future studies are needed to further validate these findings.

Effect of a dexamethasone Sinu‐FoamTM middle meatal spacer on endoscopic sinus surgery outcomes: A randomized, double‐blind, placebo‐controlled trial

Off-label drug eluting middle-meatal spacers have shown promising results for improving clinical outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). This study evaluates a dexamethasone Sinu-Foam™ spacer following ESS for CRS without nasal polyposis (CRSsNP). Patients with CRSsNP (n = 36) were enrolled into a double-blind, placebo-controlled trial and randomized into either a treatment arm (dexamethasone Sinu-Foam™ mixture; n = 18) or placebo arm (Sinu-Foam™ alone; n = 18). Therapeutic outcomes were evaluated at 1 week, 4 weeks, and 3 months using sinonasal endoscopy and graded using the Lund-Kennedy scoring system. Postoperative care included nasal saline irrigations and a short course of systemic steroids. All patients completed the study follow-up period. Both study arms experienced significant improvement in endoscopic grading over the study duration (p < 0.001). There was no difference in average endoscopic scores between the treatment and placebo groups at 1 week, 4 weeks, and 3 months (all p > 0.489). This study demonstrated that an off-label drug-eluting middle-meatal spacer of dexamethasone and Sinu-Foam™ does not improve endoscopic outcomes in the early postoperative period following ESS when combined with postoperative saline irrigations and a short course of systemic steroids.

A double-blind randomised controlled trial of gloved versus ungloved merocel middle meatal spacers for endoscopic sinus surgery

A double-blind randomised controlled trial of gloved versus ungloved merocel middle meatal spacers for endoscopic sinus surgery

Transseptal Suture to Secure Middle Meatal Spacers

Middle meatal spacers are used by many sinus surgeons to aid postoperative care. Aspiration of a spacer is a concern. We demonstrate a novel method of securing spacers with a transseptal suture to prevent aspiration. We fashion each spacer from a powder-free, nonlatex glove finger that is packed with a Merocel sponge. The open end of the finger is closed with 2-0 Prolene sutures. For a bilateral procedure, the needle is left attached to one of the spacers. A spacer is placed in each ethmoid cavity, the attached needle is passed through the anterior cartilaginous septum, and the suture is tied to the suture on the opposite spacer. For unilateral procedures, the suture on the single spacer is passed to the contralateral side and tied on itself. One week later, the transseptal suture is cut and the spacers are removed. We performed this procedure on 78 patients who had undergone total ethmoidectomy. None of the spacers migrated during the 1 week they were in place. One patient complained of pain during removal of a spacer. During follow-up of 2 to 10 months, we found no evidence of injury to the septum at the site of the transseptal suture. We conclude that the transseptal suture is a safe and cosmetically superior method of securing middle meatal spacers.

Trans‐septal Suture to Secure Middle Meatal Spacers

Otolaryngology–Head and Neck SurgeryVolume 129, Issue 2 p. P263-P263 Scientific Posters Trans-septal Suture to Secure Middle Meatal Spacers Neil Hockstein presenter MD, Neil Hockstein presenter MD Philadelphia, PASearch for more papers by this authorJames N Palmer MD, James N Palmer MD Philadelphia, PASearch for more papers by this author Neil Hockstein presenter MD, Neil Hockstein presenter MD Philadelphia, PASearch for more papers by this authorJames N Palmer MD, James N Palmer MD Philadelphia, PASearch for more papers by this author First published: 17 May 2016 https://doi.org/10.1016/S0194-59980301192-6Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume129, Issue2August 2003Pages P263-P263 RelatedInformation

Middle meatal spacer and septal splint

Middle meatal spacer and septal splint

Advances In Postoperative Care Following Functional Endoscopic Sinus Surgery

The ultimate success of functional endoscopic sinus surgery often is determined during the period of postoperative care. Final surgical results are greatly influenced by preoperative surgical planning and intraoperative decision-making. One goal of postoperative care includes the prevention of scar formation, such as middle turbinate collapse. Specific techniques include mucosal preservation, middle meatal spacer corticosteroids and culture-directed antibiotics.