Efficacy of nonmedicated middle meatal packing after endoscopic sinus surgery: A systematic review

Objectives: 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). Methods: 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. Results: 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. Conclusions: 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.