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

Abstract

Objectives: 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).

Methods: 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.

Results: 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.

Conclusion: Steroid-impregnated nasal packing reduced the rates of postoperative intervention and recurrent polyposis and inflammation in CRS patients undergoing ESS.

Keywords: Nose; Operative Surgical Procedures; Sinusitis; Stents; Steroids.

Fig. 1

Diagram of the study selection process.

Fig. 2

Severity of postoperative adverse outcomes based on endoscopic examinations: comparison between the treatment and control groups. The Lund-Kennedy score at 2–3 weeks (A), and 2–3 months (B), perioperative sinus endoscopy score at 2–3 weeks (C) and 2–3 months (D). Crusting at 2–3 weeks (E), and 2–3 months (F), nasal discharge at 2–3 weeks (G) and 2–3 months (H), edema at 2–3 weeks (I). And 2–3 months (J), ethmoid inflammation at 1 month (K), polyposis at 2–3 weeks (L) and 2–3 months (M). Polypoid changes at 1 month (N) and 2–3 months (O), and the need for oral steroid use (P). SD, standard deviation; SMD, standardized mean difference; CI, confidence interval.

Fig. 3

Postoperative adverse outcomes: comparison between the treatment and control groups. Middle turbinate lateralization at 1 month (A), adhesions at 2 weeks (B), 1 month (C), and 2–3 months (D). Scarring/synechia at 2–3 weeks (E) and 2–3 months (F), non-medical or non-surgical postoperative therapeutic interventions (G), and lysis of adhesions (H). OR, odds ratio; CI, confidence interval; SD, standard deviation; SMD, standardized mean difference.