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The Egyptian Journal of Otolaryngology
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Effect of steroid-releasing sinus implants after endoscopic sinus surgery (ESS) on postoperative outcomes: A meta-analytical study

The Egyptian Journal of Otolaryngology volume 35, pages 250–255 (2019)Cite this article

Abstract

Aims

a meta-analysis to evaluate the steroid-releasing sinus implants in chronic rhinosinusitis (CRS) patients after functional endoscopic sinus surgery (FESS) in order to assess its efficacy.

Settings and Design

Meta analysis.

Methods and Material

The 4 trials enrolled a total of 539 patients utilizing an intrapatient control design. Postoperative day 30 videos were obtained for each patient, randomly ordered for grading of efficacy endpoints. The need for postoperative interventions, formation of polyposis, and adhesions were assessed. Results from the 4 studies were then pooled.

Statistical analysis used

Comprehensive Meta-Analysis© version 2 (BiostatTM, NJ, USA).

Results

Implants were successfully placed. According to the grading done by the panel, drug-releasing implants reduced significant adhesions by 2.5% (P=0.971), middle turbinate lateralization occurrence was 2.5% (P=0.954), polyp formation was 2% (P=0.830), the need for oral steroid intervention was 22% (P=0.173), significantly less need for postoperative therapeutic intervention 33% (P=0.305), or Surgical Lysis of Adhesions (LOA) intervention 14% (P=0.951), compared to controls.

Conclusions

Steroid-releasing implants improve surgical outcomes by reducing frank polyp formation, sinus adhesions, and middle turbinate lateralization. Steroid-releasing implants reduce the need for surgical intervention, and the need for oral steroid treatment.

References

  1. Wright ED, Agrawal S. 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 2007; 117:1–28.

    Article  CAS  Google Scholar 

  2. Kennedy DW. The PROPELTM steroid-releasing bioabsorbable implant to improve outcomes of sinus surgery. Expert Rev Respir Med 2012; 6:493–498.

    Article  CAS  Google Scholar 

  3. Han JK, Forwith KD, Smith TL, Kern RC, Brown WJ, Miller SK, et al. RESOLVE: a randomized, controlled, blinded study of bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis. Int Forum Allergy Rhinol 2014; 4:861–870.

    Article  Google Scholar 

  4. Marple BF, Smith TL, Han JK, Gould AR, Jampel HD, Stambaugh JW, et al. Advance II: a prospective, randomized study assessing safety and efficacy of bioabsorbable steroid releasing sinus implants. Otolaryngol Head Neck Surg 2012; 146:1004–1011.

    Article  Google Scholar 

  5. Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clin Proc 2011; 86:427–443.

    Article  Google Scholar 

  6. Murr AH, Smith TL, Hwang PH, Bhattacharyya N, Lanier BJ, Stambaugh JW, et al. Safety and efficacy of a novel bioabsorbable, steroid-eluting sinus stent. Int Forum Allergy Rhinol 2011; 1:23–32.

    Article  Google Scholar 

  7. Xu JJ, Busato GM, Mc Knight C, Lee JM. Absorbable steroid –impregnated spacer after endoscopic sinus surgery to reduce synechiae formation. Ann Otol Rhinol Laryngol 2016; 125:195–198.

    Article  Google Scholar 

  8. Rudmik L, Mace J, Mechor B. 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 2012; 2:248–251.

    Article  Google Scholar 

  9. Cote DW, Wright ED. Triamcinolone-impregnated nasal dressing following endoscopic sinus surgery: a randomized, double-blind, placebo-controlled study. Laryngoscope 2010; 120:1269–1273.

    Article  CAS  Google Scholar 

  10. More Y, Willen S, Catalano P. Management of early nasal polyposis using a steroid-impregnated nasal dressing. Int Forum Allergy Rhinol 2011; 1:401–404.

    Article  Google Scholar 

  11. Lavigne F, Miller SK, Gould AR, Lanier BJ, Romett JL. Steroid-eluting sinus implant for in-office treatment of recurrent nasal polyposis: a prospective, multi-center study. Int Forum Allergy Rhinol 2014; 4:381–389.

    Article  Google Scholar 

  12. Waksman R. Biodegradable stents: they do their job and disappear. J Invasive Cardiol 2006; 18:70–74.

    PubMed  Google Scholar 

  13. Dautremont JF, Mechor B, Rudmik L. The role of immediate post-operative systemic corticosteroids when utilizing a steroid-eluting spacer following sinus surgery. Otolaryngol Head Neck Surg 2014; 150:689–695.

    Article  Google Scholar 

  14. Hosemann W, Wigand ME, Göde U, Länger F, Dunker I. Normal wound healing of the paranasal sinuses: clinical and experimental investigations. Eur Arch Otorhinolaryngol 1991; 248:390–394.

    Article  CAS  Google Scholar 

  15. Forwith KD, Chandra RK, Yun PT, Miller SK, Jampel HD. ADVANCE: a multi-site trial of bioabsorbable steroid-eluting sinus implants. Laryngoscope 2011; 121:2473–2480.

    Article  CAS  Google Scholar 

  16. Fokkens W, Lund V, Mullol J, Bachert C, Alobid I, Baroody F, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps2012. A summary for otorhinolaryngologists. Rhinology 2012; 50:1–12.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, 00202, Cairo, Egypt

    Michael M. Stefan, Nabil A. Rabie, Tamer S. Sobhy MD (Associate professor of ORL) & Ahmed M. Maarouf

Authors
  1. Michael M. Stefan
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  2. Nabil A. Rabie
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  3. Tamer S. Sobhy MD
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  4. Ahmed M. Maarouf
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Corresponding author

Correspondence to Tamer S. Sobhy MD.

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Stefan, M.M., Rabie, N.A., Sobhy, T.S. et al. Effect of steroid-releasing sinus implants after endoscopic sinus surgery (ESS) on postoperative outcomes: A meta-analytical study. Egypt J Otolaryngol 35, 250–255 (2019). https://doi.org/10.4103/ejo.ejo_92_18

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  • DOI: https://doi.org/10.4103/ejo.ejo_92_18

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