Sinus Surgery For Chronic Rhinosinusitis Research Articles

Preoperative laboratory measurements as a predictor for nasal steroid irrigations after sinus surgery for chronic rhinosinusitis with nasal polyps

PurposeTo assess whether preoperative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), immunoglobulin E (IgE), and blood eosinophil percentage (EOS) can predict need for steroid irrigations after FESS. Materials and methodsAdult patients at BIDMC from inception until September 8, 2023 with chronic rhinosinusitis with nasal polyps who underwent FESS and had preoperative CRP (n = 129), ESR (n = 79), IgE (n = 107), or EOS (n = 125) were included. Labs were divided into normal (CRP: 0–5.0 mg/L; ESR: 0-15 mm/h; IgE: 150-300Ul/mL; EOS: 1–7 %) and high groups (CRP: >5.0 mg/L; ESR: >15 mm/h; IgE: >300Ul/mL; EOS: >7 %). The primary outcome was need for intranasal steroid irrigations after FESS (≤4 weeks, 4–12 weeks, 12–26 weeks, 26–52 weeks, 1–3 years, 3–5 years, and > 5 years). Receiver operating characteristic curves were created to determine thresholds for predicting postoperative steroid irrigations. ResultsElevated IgE required intranasal steroid irrigation at 1–3 years (normal 34 %, high 62 %, p = 0.02), 3–5 years (normal 24 %, high 48 %, p = 0.04), and > 5 years (normal 19 %, high 43 %, p = 0.02). Elevated EOS required intranasal steroid irrigation at 26–52 weeks (normal 7 %, high 25 %, p = 0.009) and > 5 years (normal 19 %, high 46 %, p = 0.005). The area under the curve for IgE at 1–3 years was 0.696 (95 % CI: 0.597–0.795) with cutoff at 144–148 Ul/mL. CRP and ESR were not predictive of postoperative intranasal steroid treatment. ConclusionsElevated IgE and EOS (but not CRP or ESR) may predict need for intranasal steroid treatment after FESS.

Outcomes of Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

Chronic rhinosinusitis (CRS) is a prevalent health problem that affects many people around the world and can require surgical intervention if conservative therapy fails. Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure commonly used to manage CRS. The success of FESS depends on various factors, and larger studies are necessary to determine its efficacy in managing CRS in this population. This systematic review and meta-analysis of the available literature aims to provide a comprehensive assessment of the effectiveness of FESS in the Middle East. We followed the standards outlined by PRISMA and the Cochrane Handbook for systematic reviews. The primary outcome of interest was the quality of life (QOL), and the secondary outcome was the recurrence of CRS. This systematic review and meta-analysis was conducted, and sensitivity analysis was performed to examine the robustness of the results. Six studies were included. The review found that the QOL significantly improved (p < 0.001). Two studies reported recurrence of CRS after FESS, and data showed that the recurrence of CRS after surgery was 6%. FESS is an effective intervention for CRS, but further research is needed on recurrence rates.

The safety and efficacy of spray cryotherapy after endoscopic sinus surgery in chronic rhinosinusitis: A systematic review of randomized controlled trials

Background Chronic rhinosinusitis (CRS) is a condition that affects 5–12% of the general population. Endoscopic sinus surgery (ESS) is the preferred treatment because of its few adverse effects. The most common post-operative consequences include synechia, nasal blockage, and disease recurrence. Spray cryotherapy is a novel therapeutic approach with promising outcomes for the treatment of upper airway disorders. This review aimed to investigate the effects of spray cryotherapy (SCT) following ESS in patients with chronic rhinosinusitis. Methods Six electronic databases were searched for randomized clinical trials (RCTs). The selected trials were evaluated for methodological quality, and data were extracted by two independent reviewers. The Cochrane risk-of-bias tool was used to assess the quality of evidence. Results Three RCTs with 85 patients were included in the final analysis. SCT was related to -16 and -77 reductions in Lund-McKay and SNOT-22 scores after 36 weeks of follow-up, in contrast to a placebo, which showed -10.4, -65. Regarding the side effects of SCT, no adverse effects were reported, and visual assessments showed no pain, visual field loss, or any other ocular complications. Conclusions SCT is a new treatment modality after endoscopic sinus surgery that shows an effective post-operative management strategy with better post-operative scales (Lund-McKay, SNOT-22, POSE, and Lund-Kennedy) and less edema, obstruction, crusting, and inflammation with minimal or no side effects. However, further research with longer follow-ups, a larger sample size, and subjective assessment is needed to assess any possible long-term side effects.

Efficacy of steroid-impregnated spacers after endoscopic sinus surgery in chronic rhinosinusitis: A systematic review and meta-analysis

Efficacy of steroid-impregnated spacers after endoscopic sinus surgery in chronic rhinosinusitis: A systematic review and meta-analysis

Sinonasal anatomical findings associated with revision functional endoscopic sinus surgery in chronic rhinosinusitis

Sinonasal anatomical findings associated with revision functional endoscopic sinus surgery in chronic rhinosinusitis

Does turbinoplasty increase emergency department visits for epistaxis following endoscopic sinus surgery?

Objectives: The purpose of this study was to investigate whether turbinoplasty increases the frequency of emergency room visits due to epistaxis following endoscopic sinus surgery. Methods: This was a retrospective cohort study. Patients who underwent primary or revision endoscopic sinus surgery for chronic rhinosinusitis between January&amp;apos; 2015 and December&amp;apos; 2021 at the tertiary Rhinology and Skull Base Surgery Center, Saudi Arabia were included. Appropriate regression models were utilized. Results: The incidence of epistaxis among the study population was 36/1,395 (2.9%). Of them, 29/36 (80.6%) underwent turbinoplasty. There was a statistically significant association between gender (p-value &amp;lt; 0.001) and the performance of turbinoplasty with the development of epistaxis post-operatively (p-value = 0.04). Conclusion: This study established a direct connection between turbinoplasty and heightened postoperative epistaxis risk after endoscopic sinus surgery. It emphasized the importance of investigating specific turbinoplasty hemostatic techniques, as these variations could impact complication rates.

Gender-Specific Differences in Preoperative Concerns in Patients Undergoing Endoscopic Sinus Surgery for Chronic Rhinosinusitis.

Among patients with chronic rhinosinusitis (CRS), gender differences in epidemiology as well as quality of life have been reported. However, whether gender differences in endoscopic sinus surgery (ESS) preoperative concerns exist is unclear. CRS patients undergoing ESS at 3 tertiary care centers in Los Angeles completed the validated Western Surgical Concern Inventory - ESS assessing ESS preoperative concerns. Of the 75 patients included, female patients expressed greater concern than male patients in regard to nasal packing, undergoing anesthesia, impact of surgery on daily activities, and pain and discomfort following surgery. This study suggests there are gender differences in ESS preoperative concerns and otolaryngologists should be aware of these possible concerns during preoperative discussions.

IL-13 and IL-13–induced periostin levels are specifically decreased in patients following endoscopic sinus surgery for chronic rhinosinusitis

BackgroundType 2 (T2) inflammation plays a pathogenic role in chronic rhinosinusitis (CRS) effects of endoscopic sinus surgery (ESS) on T2 inflammation are unknown. ObjectiveTo compare T2 inflammatory biomarkers from middle meatal (MM) mucus for distinguishing CRS from non-CRS patients, identifying major phenotypes (CRS without (CRSsNP) and with nasal polyps (CRSwNP)), assessing endotypic change and establishing cross-sectional and longitudinal outcomes in patients undergoing ESS. MethodsMM mucus samples were collected from CRSsNP and CRSwNP patients before and 6-12 months after ESS and compared to non-CRS control patients. T2 biomarkers were evaluated continuously, using threshold-based definitions of T2 endotype, and for relationships with patient-reported (SNOT-22 and CRS-PRO) and clinician-reported (radiographic and endoscopic) severity. Linear mixed models were developed to analyze clinical variables associated with T2 biomarker levels. Results154 CRS patients (89 CRSsNP, 65 CRSwNP) were enrolled with a mean 9-month interval between ESS and follow-up. Pre-ESS MM mucus analysis revealed elevated T2 mediators in CRSwNP vs. CRSsNP and non-CRS controls. Temporally stable correlations between IL-13 and IL-5; periostin and C5a; and ECP and CCL26 was observed. On this basis and pathologic significance, IL-13, periostin and ECP were further analyzed. Post-ESS, IL-13 and periostin levels decreased significantly, ECP levels remained unchanged. Across pre- and post-ESS evaluation, the T2 endotype was associated with radiographic severity but did not predict outcomes. CRSwNP status and African American race were associated with higher levels of IL-13 and periostin, whereas ECP was higher in patients undergoing extensive surgery. ConclusionESS decreased IL-13 and periostin in MM. T2 inflammation post-ESS correlated with patient- and clinician-reported severity across phenotypes. Pre-ESS T2 inflammation did not predict post-ESS outcomes.

Utilization of Transcriptomic Profiling to Identify Molecular Markers Predicting Successful Recovery Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis.

Successful recovery from chronic rhinosinusitis (CRS) following endoscopic sinus surgery (ESS) can be characterized by minimal presence of symptoms and absence of disease on endoscopy. However, molecular markers of surgical success remain to be characterized. These could allow for better tailoring of perioperative therapy. This study aims to identify novel molecular markers associated with surgery responsive patient. Prospective cohort study. Single academic hospital center. One hundred eighteen consecutive patients with CRS at high risk of recurrence after surgery were followed prospectively following ESS in an academic medical center. Symptomatic and endoscopic outcomes were assessed at 4 months, with success rigorously defined subjectively as minimal or no symptoms (no symptom greater than 1 on an ordinal scale of 0-3) and objectively by the absence of nasal polyposis on sinus cavity endoscopy and Lund-Kennedy endoscopic edema score no greater than 1. Samples were obtained at the time of surgery and at 4-month postoperatively. Changes associated with surgery were determined by gene expression profiling using Affymetrix's Clariom S Human HT arrays. Successful ESS was characterized by a mild upregulation in Type 1 inflammation, upregulation of cell cycle progression, and epithelial barrier and proliferation-associated genes and pathways. ESS failure was associated to very high levels of Type 1 inflammation along with downregulation of epithelial barrier function and regeneration genes and pathways. Successful recovery from ESS involves restoration of epithelial function and regulated activation of Type 1 inflammation. Excessively elevated Type 1 inflammation is associated with epithelial barrier dysfunction.

Bupivacaine improves surgical field and postoperative pain control in endoscopic sinus surgery: a clinical trial

IntroductionEndoscopic sinus surgery is often challenging because of bleeding and pain. A variety of techniques have been explored to reduce surgical function and pain, with the sphenopalatine ganglion block showing the most promising results. All of these researches, however, had methodological flaws since saline was used as a placebo injection, which could have irritated the ganglion and produced less-than-ideal results, in accordance with our theory.Aim and objectiveTo determine the effect of sphenopalatine ganglion block with bupivacaine on intraoperative endoscopic surgical field and postoperative pain.Patients and methodsA prospective double blind, randomized study was conducted in 50 subjects undergoing endoscopic sinus surgery for chronic rhinosinusitis with or without polyp. The case group received 1.5 ml of 0.5% bupivacaine in sphenopalatine ganglion block while control group didn’t receive any drug in ganglion. The intra-operative surgical field grade and postoperative pain score was recorded to analyze the effect of the block.ResultsWe discovered a statistically significant difference in the endoscopic surgical field between the case and control groups. In comparison to the control group, the surgical field was more visible in the sphenopalatine ganglion block group. The case group significantly outperformed the control group in terms of pain visual analogue score throughout the observation period, with the exception of the first day following surgery.ConclusionSphenopalatine ganglion block with bupivacaine 0.5% is a straightforward, efficient, and secure way to improve the endoscopic surgical field and lessen postoperative pain in patients undergoing endoscopic sinus surgery.

Clinical Characteristics of Chronic Rhinosinusitis With Nasal Polyp According to Histopathological Endotypes and Staining Method for Neutrophilic Polyp Classification and Its Clinical Implication

Background and Objectives There are various methods used to histologically assess the cell count of neutrophils in nasal polyps. With various classification of neutrophilic nasal polyps, determining the appropriate staining techniques and criteria is deemed important for the diagnosis of neutrophilic nasal polyps by assessing neutrophil cell counts. In this study, we tried to optimize different methods of neutrophil counting and staining by comparing clinical outcomes.Subjects and Method We studied 207 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with nasal polyp from August 2014 to September 2018. Patients’ nasal polyp were taken to make following three slide sections: hematoxylin and eosin, human neutrophil elastase (HNE), myeloperoxidase. After staining, microscope picture (×400) was taken and neutrophils were counted. Neutrophil polyp (NP) was classified either by the tissue neutrophil count (20/HPF) or by the neutrophil percentage (1%/total cell) for clinical outcome comparison.Results Two groups were made after HNE staining: the NP and the non-NP groups. The L-K scores and delta showed significant differences between each group while neutrophil was defined based on 20 counts/HPF (&lt;i&gt;p&lt;/i&gt;&lt;0.001). By Kaplan-Meier estimation, there was no statistical meaning between the two groups. But the NP group had a tendency to recur more than the non-NP group while 20 counts/HPF definition was used (&lt;i&gt;p&lt;/i&gt;&gt;0.05).Conclusion HNE staining and 20 counts/HPF were the most specific for neutrophil counting. Analyzing the nasal polyp into two groups due to histologic types showed that the NP group had worse prognosis than the non-NP group. In conclusion, neutrophils in the nasal polyp might be considered seriously for clinical outcomes.

Comparison of intranasal medication delivery devices before and after functional endoscopic sinus surgery using Phacon sinus surgery models.

Functional endoscopic sinus surgery for chronic rhinosinusitis improves sinus drainage and intranasal medication delivery. This study compares medication delivery with commonly used devices in normal and altered anatomy (post functional endoscopic sinus surgery) using sinus surgery models (Phacon). Medication delivery was simulated via nasal drops, nasal spray and an irrigation device (Neilmed Sinus Rinse). Coverage was then calculated from endoscopic pictures taken at various anatomical sites in the normal nose and post functional endoscopic sinus surgery. In the normal nose, nasal spray did not penetrate the sphenoid sinus, and drops bypassed the vestibule anteriorly. Neilmed Sinus Rinse provided superior coverage at the sphenoid site following sphenoidectomy and the frontal site following Draf III. After ethmoidectomy, nasal drops overall provided less coverage than the other methods. Neilmed Sinus Rinse generally provided the best distribution, followed by the nasal spray and then nasal drops. The type and extent of surgery also affects medication delivery.

Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia.

Introduction  Primary ciliary dyskinesia (PCD) is a rare inherited disease associated with impairment of mucociliary transport and, consequently, with a high incidence of chronic rhinosinusitis. For patients with chronic rhinosinusitis who remain symptomatic despite medical treatment, endoscopic sinus surgery is a safe and effective therapeutic option. However, to date, no studies have been found evaluating the effect of surgery on the quality of life associated with the effect on olfaction and nasal endoscopy findings of patients with primary ciliary dyskinesia and chronic rhinosinusitis. Objective  To describe the effect of endoscopic sinus surgery on the quality of life, on olfaction, and on nasal endoscopy findings of adults with PCD and chronic rhinosinusitis. Methods  Four patients who underwent endoscopic sinus surgery were included. The Sinonasal Outcome Test-22 (SNOT-22) score, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and the Lund-Kennedy score were collected preoperatively and at 3 and 6 months postoperatively. The olfaction as assessed with the University of Pennsylvania Smell Identification Test (UPSIT), which was administered preoperatively and 3 months postoperatively. Results  A total of 4 patients with a mean age of 39.3 years old (3 men and 1 woman) completed the study. All patients showed clinically significant improvement in the SNOT-22, NOSE, and Lund-Kennedy scores at 3 months postoperatively, and this improvement was sustained throughout the follow-up period. However, olfaction did not improve after surgery. Conclusion  The endoscopic sinus surgery treatment of chronic rhinosinusitis in adults with PCD was associated with improvement in quality of life and endoscopic findings. However, no improvement in olfaction was demonstrated. Studies with a larger number of patients and control groups should help confirm these findings.

Safety and Feasibility of Steroid-Eluting Stent as a Bolster in Endoscopic Anterior Skull Base Reconstruction.

With a rising incidence of cerebrospinal fluid (CSF) leaks, endoscopic endonasal CSF leak repair is increasingly performed. Current approaches utilize a variety of materials including free mucosal grafts and vascularized flaps, but post-op leaks continue to be reported. Steroid-eluting bioabsorbable stents (SES) are used during functional endoscopic sinus surgery for chronic rhinosinusitis to reduce inflammation and scarring while maintaining patency of sinus ostia. The aim of this study is to assess the feasibility of SES as a graft/flap bolster for endoscopic endonasal CSF leak repair. This is a retrospective review of patients undergoing endoscopic endonasal CSF leak repair with SES placed as part of the bolster technique at a tertiary care center between January 2019 and May 2022. Age, sex, BMI, comorbid idiopathic intracranial hypertension, pathology, location of CSF leak, intraoperative CSF leak flow, reconstruction type, and presence of post-op CSF leak were recorded. Twelve patients (mean age 52, median BMI 30.9, 58% female) had SES placement as part of the bolster technique. The most common pathology was meningoencephalocele (75%). Reconstruction was performed with either a free mucosal graft (6), or a flap (6). No post-op CSF leaks occurred at a reconstruction site with a stent, and no known complications were reported. All sinusotomies were patent at the last follow-up visit. SES placement as an adjunct to graft and/or flap bolster appears to be safe and feasible during anterior skull base reconstruction and CSF leak repair providing longer term structural support and preserving sinus drainage patency.

Complications of endoscopic sinus surgery for chronic rhinosinusitis in a tertiary care teaching hospital in Saudi Arabia

To aimed to determine the incidence of complications of endoscopic sinus surgery (ESS) and to investigate the factors associated with the occurrence of complications.In this retrospective study, we reviewed the medical records of all patients who had undergone ESS at King Saud University Medical City (KSUMC) between January 2015 and March 2022. Patients who underwent ESS for complicated acute sinusitis, sinonasal malignancy, and cerebrospinal fluid leak repair, and those who underwent extended ESS for indications other than chronic rhinosinusitis were excluded. This study was approved by the KSUMC Institutional Review Board.We included 1395 patients, 3 of whom had major complications and 28 had minor complications, resulting in an overall major complication rate of 0.2% and a minor complication rate of 2%. The most common major complication was orbital hematoma, and the most common minor complication was synechia. Moreover, the duration of surgery and laterality increased the risk of complications, whereas the use of image guidance had no effect.The ESS is a safe procedure. The operative start time and laterality were associated with an increased risk of complications and warrant further investigation.

Phenotypic associations of medical polypectomy and revision surgery following endoscopic sinus surgery: a retrospective study of a single centre experience in Scotland.

Some chronic rhinosinusitis with nasal polyps patients undergo revision surgery at some point following initial functional endoscopic sinus surgery. This review aimed to identify the predictive factors for recurrence of nasal polyps requiring oral corticosteroids or revision surgery in chronic rhinosinusitis with nasal polyps following functional endoscopic sinus surgery. A retrospective analysis of 221 patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps in a tertiary rhinology centre, between January 2015 and December 2018, was undertaken. Forty-four (21.6 per cent) patients underwent medical polypectomy, 19 (9 per cent) underwent revision surgery and 51 (24.3 per cent) underwent combined polypectomy during the mean follow-up time of 5.3 years. Patients aged less than 55 years of age, with a history of previous functional endoscopic sinus surgery, peripheral blood eosinophil counts of 300 cells/μl or higher, a Lund-Mackay score of more than 17 and concomitant aspirin-exacerbated respiratory disease had significantly increased odds for medical polypectomy, revision surgery and combined polypectomy. Knowing these predictive factors, clinicians can better identify patients with an increased likelihood of severe polyp recurrence and therefore arrange closer follow-up to optimise therapy.

Quality of life: pre-and post-functional endoscopic sinus surgery in chronic rhinosinusitis

Background: Chronic sinusitis (CRS) includes all inflammatory diseases of the nose and paranasal sinuses with a minimum duration of 12 weeks. Physical examination (anterior rhinoscopy, endoscopy) and/or radiography, ideally from sinus computed tomography, can provide objective proof of the same. After failure of conservative treatment, functional endoscopic sinus surgery (FESS) is the preferred modality for chronic rhinosinusitis that has been frequently used over the past years. Methods: The present prospective study aimed to assess the quality of life (QOL), the nasal endoscopy scores- before and after FESS in 60 patients aged more than 18 years suffering from chronic rhinosinusitis. QOL was assessed using SNOT-20 questionnaire and endoscopy was quantified using Lund-Kennedy sinonasal endoscopy scoring system. Results: QOL scores were significantly higher (p&lt;0.001) before surgery (41.28±15.30) than after FESS (6.83±5.96) indicating improvement in QOL. Lund-Kennedy endoscopy scores of patients suffering from chronic rhinosinusitis before and after surgery was also significantly reduced (p&lt;0.001). Conclusions: This study concludes that there is significant improvement in the QOL and reduction in the severity of symptoms in patients suffering from chronic rhinosinusitis after FESS.

Efficacy of Steroid-Impregnated Spacers After Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

The aim of this study was to compare the effect of steroid-impregnated spacers to that of conventional management after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Six databases were searched from inception until November 2022. Sixteen studies were found that compared the improvement of chronic sinusitis-related symptoms and postoperative outcomes between a steroid-impregnated spacer group and a control group (non-steroid-impregnated spacers). The Cochrane risk of bias tool (for randomized controlled studies) and the Newcastle-Ottawa Scale (for non-randomized controlled studies) were used to assess the quality of the works included. Regarding the endoscopic findings, the degree of mucosal edema, ethmoid inflammation, crust formation at 2-3 months postoperatively, nasal discharge, polyposis, and scarring/synechia were significantly lower in the steroid-impregnated spacer group. The steroid-impregnated spacer group also showed significantly lower Lund-Kennedy scores and perioperative sinus endoscopy scores than the control group at 2-3 weeks postoperatively. Furthermore, the steroid-impregnated spacer group had lower rates of adhesions, middle turbinate lateralization, polypoid changes, the need for oral 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 findings regarding nasal discharge, postoperative crusting, polyposis, or scarring/synechia. Steroid-impregnated nasal packing reduced the rates of postoperative intervention and recurrent polyposis and inflammation in CRS patients undergoing ESS.

Efficacy of Submucosal Diathermy of Inferior Turbinate in Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery.

To assess the efficacy of submucosal diathermy (SMD) in Chronic rhinosinusitis and inferior turbinate hypertrophy undergoing Functional Endoscopic Sinus Surgery. We conducted a Randomized Prospective study in patients undergoing Functional Endoscopic Sinus surgery for Chronic Rhinosinusitis in a tertiary care centre in South India for a period of 2 years. Patients were divided into two groups, Group A underwent FESS and Group B underwent FESS with SMD. The outcome was evaluated using nasal endoscopy score (NES), modified SNOT score and Modified Lund Kennedy scores. A total of 80 patients were included in this study.40 patients were allotted in each group. Male: Female ratio was 48:32. The age distribution ranged from 19 to 44 years with a mean of 29.55 ± 6.90 yrs. Mean NES scores, Modified SNOT and Modified Lund -kennedy scores were estimated pre-operatively and during 1st, 2nd and 3rd month of post-operative periods. The mean pre-operative sores were comparable in both the groups except NES score, which was higher in group B. Both the groups showed significant improvement in post-operative period. Inter group comparison showed significant difference in all scores with group B having better results when compared to group A. This study proves that FESS combined with SMD improves the postoperative clinical outcomes when compared with FESS without turbinate reduction. We conclude that SMD is a simple, mucosal preserving technique with almost no complications and can be safely done along with FESS to improve the outcomes .

Efficacy of prophylactic pre-operative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: A systematic review and meta-analysis of randomised placebo-controlled trials.

To examine the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). Systematic review and meta-analysis of randomised controlled trials (RCTs). The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18 March 2022. Patients undergoing FESS. Primary efficacy endpoints comprised intraoperative blood loss, visual clarity, and operation time. Secondary endpoints comprised side effects. The efficacy endpoints were summarised as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Five RCTs comprising 380 patients (desmopressin=191 patients and placebo=189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n= 5 RCTs, MD=-37.97 ml, 95% CI [-56.97, -18.96], p < .001), 5-point Boezaart scores (n= 2 RCTs, MD=-.97, 95% CI [-1.21, -.74], p < .001), and 10-point Boezaart scores (n= 2 RCTs, MD=-3.00, 95% CI [-3.61, -2.40], p < .001) were significantly reduced in favour of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n= 5 RCTs, MD=-3.73 min, 95% CI [-14.65, 7.18], p= .50). No patient in both groups developed symptomatic hyponatremia (n= 3 RCTs, 194 patients) or thromboembolic events (n= 2 RCTs, 150 patients). Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihaemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS.