Iftikhar Haissan, Abbasi Ammaar M A, Mustafa Khawaja, Das Jai K, Javer Amin R
Department of Surgery University Hospitals Birmingham Birmingham UK.
Aga Khan University Medical College Karachi Pakistan.
World J Otorhinolaryngol Head Neck Surg. 2024 Mar 21;10(4):315-323. doi: 10.1002/wjo2.148. eCollection 2024 Dec.
This review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).
We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was performed on Medline (PubMed), EBSCO CINAHL plus, CENTRAL, and Clinicaltrials.org and included randomized controlled trials in the English language only. We extracted all relevant data and conducted quality assessment using the Cochrane risk of Bias tool (version 2). We also performed the quality assessment of the outcomes using Grading of Recommendations Assessment, Development and Evaluation.
Our search identified 390 articles of which four met our eligibility criteria. A total of 139 patients were randomized to receive middle meatal pack in either of the nostrils. At 4 weeks of follow-up, there was no difference in the risk of synechia formation on either the packed side or the unpacked side, with a relative risk (RR) of 0.77 (95% confidence interval [CI]: 0.48-1.25). Similarly, no difference was seen at either 8-12 weeks of follow-up, with an RR of 0.68 (95% CI: 0.42-1.20). Nasal congestion was reported to be less on the packed side on the follow-up in one of the trials.
Our systematic review, with limited evidence, indicates no difference in synechia formation between the nonmedicated packed and unpacked middle meatus at four and eight or 12 weeks after ESS for CRS. Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long-term sequelae.
本综述旨在评估在内镜鼻窦手术（ESS）治疗慢性鼻-鼻窦炎（CRS）后长达12周的时间里，与不进行填塞相比，非药物性中鼻道填塞对粘连形成的作用。
我们根据系统评价和Meta分析的首选报告项目指南进行了一项系统评价。在Medline（PubMed）、EBSCO CINAHL plus、CENTRAL和Clinicaltrials.org上进行了文献检索，纳入的仅为英文随机对照试验。我们提取了所有相关数据，并使用Cochrane偏倚风险工具（第2版）进行质量评估。我们还使用推荐分级评估、制定和评价方法对结果进行了质量评估。
我们的检索共识别出390篇文章，其中4篇符合我们的纳入标准。共有139例患者被随机分配至双侧鼻孔之一接受中鼻道填塞。在随访4周时，填塞侧和未填塞侧粘连形成的风险没有差异，相对风险（RR）为0.77（95%置信区间[CI]：0.48-1.25）。同样，在随访8-12周时也未观察到差异，RR为0.68（95%CI：0.42-1.20）。在其中一项试验的随访中，据报告填塞侧的鼻充血较轻。
我们的系统评价证据有限，表明在CRS的ESS术后4周、8周或12周时，非药物性填塞和未填塞的中鼻道在粘连形成方面没有差异。需要进一步的研究来确定用不同材料填塞中鼻道的真实效果及其长期后遗症。
