Skip to main content

Comparison of triamcinolone and mitomycin C nasal pack in functional endoscopic sinus surgery: a randomized, clinical trial


Aims and Objectives

Synechia formation in a postoperative nasal cavity is a major factor for suboptimal clinical outcome in functional endoscopic sinus surgery (FESS). Nasal packs medicated with steroids like triamcinolone and topical agents like mitomycin C have been shown to reduce the formation of synechiae in postoperative patients. This study attempts to compare the efficacy of mitomycin C and triamcinoloneimpregnated nasal pack in the prevention of crusting and synechiae formation in patients undergoing FESS.


Ninety-eight consenting patients with chronic rhinosinusitis were randomized into two groups of 49 each to receive either triamcinolone-impregnated or mitomycin C-impregnated nasal pack after FESS. Blinded, postoperative endoscopic examination was done at the first and third week and at first and third month and scoring was done according to the Lund Kennedy scoring system. The primary variable for assessing the outcome was synechiae formation in the postoperative period, while reduction of crusting, discharge, mucosal edema, polypoidal mucosal changes, and maintenance of ostial patency were secondary variables.


Significant reduction in synechiae formation and crusting at 3 months duration was found in the group receiving triamcinolone nasal pack as compared with mitomycin C nasal pack. Mitomycin C was found to significantly reduce crusting in the first postoperative week. Positive trends in reduction of discharge, mucosal edema, polypoidal changes, and in maintenance of patency of ostia were observed in both the groups, but there was no significant difference between the two groups.


These results suggest that triamcinolone has a long-term effect in the reduction of synechia formation and crusting in post-FESS patients as compared with mitomycin C, though similar effects were seen in both groups in the immediate postoperative period.


  1. 1

    Wu AW, Ting JY, Platt MP, Tierney HT, Metson R. Factors affecting time to revision sinus surgery for nasal polyps: a 25-year experience. Laryngoscope 2014; 124:29–33.

    Article  Google Scholar 

  2. 2

    Franklin JH, Wright ED. Randomized, controlled, study of absorbable nasal packing on outcomes of surgical treatment of rhinosinusitis with polyposis. Am J Rhinol 2007; 21:214–217.

    Article  Google Scholar 

  3. 3

    Cho KS, Shin SK, Lee JH, Kim JY, Koo SK, Kim YW, et al. The efficacy of Cutanplast nasal packing after endoscopic sinus surgery: a prospective, randomized, controlled trial. Laryngoscope 2013; 123:564–568.

    Article  Google Scholar 

  4. 4

    Chambers DW, Davis WE, Cook PR, Nishioka GJ, Rudman DT. Long-term outcome analysis of functional endoscopic sinus surgery: correlation of symptoms with endoscopic examination findings and potential prognostic variables. Laryngoscope 1997; 107:504–510.

    CAS  Article  Google Scholar 

  5. 5

    Musy PY, Kountakis SE. Anatomic findings in patients undergoing revision endoscopic sinus surgery. Am J Otolaryngol 2004; 25:418–422.

    Article  Google Scholar 

  6. 6

    Chung JH, Cosenza MJ, Rahbar R, Metson RB. Mitomycin C for the prevention of adhesion formation after endoscopic sinus surgery: a randomized, controlled study. Otolaryngol Head Neck Surg 2002; 126:468–474.

    Article  Google Scholar 

  7. 7

    Côté DWJ, Wright ED. triamcinolone-impregnated nasal dressing following endoscopic sinus surgery: a randomized, double-blind, placebo-controlled study. Laryngoscope 2010; 120:1269–1273.

    Article  Google Scholar 

  8. 8

    Anand VK, Tabaee A, Kacker A, Newman JG, Huang C. The role of mitomycin C in preventing synechia and stenosis after endoscopic sinus surgery. Am J Rhinol 2004; 18:311–314.

    Article  Google Scholar 

  9. 9

    Soler ZM, Mace J, Smith TL. Symptom-based presentation of chronic rhinosinusitis and symptom-specific outcomes after endoscopic sinus surgery. Am J Rhinol 2008; 22:297–301.

    Article  Google Scholar 

  10. 10

    Khalid AN, Quraishi SA, Kennedy DW. Long-term quality of life measures after functional endoscopic sinus surgery. Am J Rhinol 2004; 18:131–136.

    Article  Google Scholar 

  11. 11

    Chandra RK, Conley DB, Haines GK, Kern RC. Long-term effects of FloSeal packing after endoscopic sinus surgery. Am J Rhinol 2005; 19:240–243.

    Article  Google Scholar 

  12. 12

    Rowe-Jones JM, Medcalf M, Durham SR, Richards DH, Mackay IS. Functional endoscopic sinus surgery: 5 year follow up and results of a prospective, randomised, stratified, double-blind, placebo controlled study of postoperative fluticasone propionate aqueous nasal spray. Rhinology 2005; 43:2–10.

    PubMed  Google Scholar 

  13. 13

    Jorissen M, Bachert C. Effect of corticosteroids on wound healing after endoscopic sinus surgery. Rhinology 2009; 47:280–286.

    CAS  Article  Google Scholar 

  14. 14

    Stjärne P, Olsson P, Alenius M. Use of mometasone furoate to prevent polyp relapse after endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg 2009; 135:296–302.

    Article  Google Scholar 

  15. 15

    Dijkstra MD, Ebbens FA, Poublon RML, Fokkens WJ. Fluticasone propionate aqueous nasal spray does not influence the recurrence rate of chronic rhinosinusitis and nasal polyps 1 year after functional endoscopic sinus surgery. Clin Exp Allergy 2004; 34:1395–1400.

    CAS  Article  Google Scholar 

  16. 16

    Konstantinidis I, Tsakiropoulou E, Vital I, Triaridis S, Vital V, Constantinidis J. Intra- and postoperative application of mitomycin C in the middle meatus reduces adhesions and antrostomy stenosis after FESS. Rhinology 2008; 46:107–111.

    CAS  PubMed  Google Scholar 

  17. 17

    Venkatraman V, Balasubramanian D, Gopalakrishnan S, Saxena SK, Shanmugasundaram N. Topical mitomycin C in functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol 2012; 269:1791–1794.

    Article  Google Scholar 

  18. 18

    Gupta M, Motwani G. Role of mitomycin C in reducing adhesion formation following endoscopic sinus surgery. J Laryngol Otol 2006; 120:921–923.

    CAS  Article  Google Scholar 

  19. 19

    Yamaoka WY, Gregório LC. The use of mitomycin-C to reduce synechia in middle meatus in sinus surgery: preliminary results. Braz J Otorhinolaryngol 2012; 78:44–50.

    Article  Google Scholar 

  20. 20

    Karkos PD, Leong SC, Sastry A, Assimakopoulos AD, Swift AC. Evidence-based applications of mitomycin C in the nose. Am J Otolaryngol 2011; 32:422–425.

    CAS  Article  Google Scholar 

  21. 21

    Ingrams DR, Volk MS, Biesman BS, Pankratov MM, Shapshay SM. Sinus surgery: does mitomycin C reduce stenosis? Laryngoscope 1998; 108:883–886.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Natarajan Ramalingam MBBS, MS (ENT), DNB (ENT).

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ramalingam, N., Parida, P.K., Saxena, S.K. et al. Comparison of triamcinolone and mitomycin C nasal pack in functional endoscopic sinus surgery: a randomized, clinical trial. Egypt J Otolaryngol 34, 242–247 (2018).

Download citation


  • functional endoscopic sinus surgery
  • mitomycin C
  • synechia
  • triamcinolone